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The Experienced Midwife, a non-fiction book by Aristotle |
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Chapter 5. Of Natural Labour--What The Midwife Is To Do... |
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_ CHAPTER V Of Natural Labour; What it is and what the Midwife is to do in such Labour.
There are four things which denominate a woman's natural labour; the first is, that it be at the full time, for if a woman comes before her time, it cannot be termed natural labour, neither will it be so easy as though she had completed her nine months. The second thing is, that it be speedy, and without any ill accident; for when the time of her birth come, nature is not dilatory in the bringing it forth, without some ill accident intervene, which renders it unnatural. The third is, that the child be alive; for all will grant, that the being delivered of a dead child is very unnatural. The fourth is, that the child come right, for if the position of the child in the womb be contrary to that which is natural, the event will prove it so, by making that which should be a time of life, the death both of the mother and the child. Having thus told you what I mean by natural labour, I shall next show how the midwife is to proceed therein, in order to the woman's delivery. When all the foregoing requisites concur, and after the waters be broken of themselves, let there rather a quilt be laid upon the pallet bedstead than a feather bed, having there-on linen and cloths in many folds, with such other things as are necessary, and that may be changed according to the exigency requiring it, so that the woman may not be incommoded with the blood, waters and other filth which are voided in labour. The bed ought to be ordered, that the woman being ready to be delivered, should lie on her back upon it, having her body in a convenient posture; this is, her head and breast a little raised, so that she may be between lying and sitting, for being so placed, she is best capable of breathing, and, likewise, will have more strength to bear her pains than if she lay otherwise, or sunk down in her bed. Being so placed, she must spread her thighs abroad, folding her legs a little towards her buttocks, somewhat raised by a little pillow underneath, to the end that her rumps should have more liberty to retire back; and let her feet be stayed against some firm thing; besides this, let her take firm hold of some of the good women attending her, with her hands, that she may the better stay herself during her pains. She being thus placed at her bed, having her midwife at hand, the better to assist as nature may require, let her take courage, and help her pains as best she can, bearing them down when they take her, which she must do by holding her breath, and forcing them as much as possible, in like manner as when she goes to stool, for by such straining, the diaphragm, or midriff, being strongly thrust downward, necessarily forces down the womb and the child in it. In the meantime, let the midwife endeavour to comfort her all she can, exhorting her to bear her labour courageously, telling her it will be quickly over, and that there is no fear but that she will have a speedy delivery. Let the midwife also, having no rings on her fingers, anoint them with oil of fresh butter, and therewith dilate gently the inward orifice of the womb putting her finger ends into the entry thereof, and then stretch them one from the other, when her pains take her; by this means endeavouring to help forward the child, and thrusting by little and little, the sides of the orifice towards the hinder part of the child's head, anointing it with fresh butter if it be necessary. When the head of the infant is a little advanced into the inward orifice, the midwife's phrase is:--"It is crowned"; because it girds and surrounds it just as a crown; but when it is so far that the extremities begin to appear without the privy parts, then they say, "The infant is in the passage"; and at this time the woman feels herself as if it were scratched, or pricked with pins, and is ready to imagine that the midwife hurts her, when it is occasioned by the violent distension of those parts and the laceration which sometimes the bigness of the child's head causeth there. When things are in this posture, let the midwife seat herself conveniently to receive the child, which will come quickly, and with her finger ends (which she must be sure to keep close pared) let her endeavour to thrust the crowning of the womb (of which I have spoken before), back over the head of the child, and as soon as it is advanced as far as the ears, or thereabouts, let her take hold of the two sides with her two hands, that when a good pain comes she may quickly draw forth the child, taking care that the navel-string be not entangled about the neck or any part, as sometimes it is, lest thereby the after-burden be pulled with violence, and perhaps the womb also, to which it is fastened, and so either cause her to flood or else break the strings, both which are of bad consequence to the woman, whose delivery may thereby be rendered the more difficult. It must also be carefully observed that the head be not drawn forth straight, but shaking it a little from one side to the other, that the shoulders may sooner and easier take their places immediately after it is past, without losing time, lest the head being past, the child be stopped there by the largeness of the shoulders, and so come in danger of being suffocated and strangled in the passage, as it sometimes happens, for the want of care therein. But as soon as the head is born, if there be need, she may slide her fingers under the armpits, and the rest of the body will follow without any difficulty. As soon as the midwife hath in this manner drawn forth the child, let her put it on one side, lest the blood and water which follows immediately, should do it any injury by running into its mouth and nose, as they would do, if it lay on its back; and so endanger the choking of it. The child being thus born, the next thing requisite is, to bring away the after-burden, but before that let the midwife be very careful to examine whether there be more children in the womb; for sometimes a woman may have twins that expected it not; which the midwife may easily know by the continuance of the pains after the child is born, and the bigness of the mother's belly. But the midwife may be sure of it, if she puts her hand up to the entry of the womb, and finds there another watery gathering, and the child in it presenting to the passage, and if she find it so, she must have a care of going to fetch the after-birth, till the woman be delivered of all the children she is pregnant with. Wherefore the first string must be cut, being first tied with a thread three or four times double, and fasten the other end with string to the woman's thighs, to prevent the inconvenience it may cause by hanging between the thighs; and then removing the child already born, she must take care to deliver her of the rest, observing all the circumstances as with the first; after which, it will be necessary to fetch away the after-birth, or births. But of that I shall treat in another section, and first show what is to be done to the new-born infant.
SECT. II.--Of the Cutting of the Child's Navel String. Though this is accounted by many but as a trifle, yet great care is to be taken about it, and it shows none of the least art and skill of a midwife to do it as it should be; and that it may be so done, the midwife should observe: (1) The time. (2) The place. (3) The manner. (4) The event. (1) The time is, as soon as ever the infant comes out of the womb, whether it brings part of the after-burden with it or not; for sometimes the child brings into the world a piece of the amnios upon its head, and is what mid wives call the _caul_, and ignorantly attribute some extraordinary virtue to the child so born; but this opinion is only the effect of their ignorance; for when a child is born with such a crown (as some call it) upon its brows, it generally betokens weakness and denotes a short life. But to proceed to the matter in hand. As soon as the child comes into the world, it should be considered whether it is weak or strong; and if it be weak, let the midwife gently put back part of the natural and vital blood into the body of the child by its navel; for that recruits a weak child (the vital and natural spirits being communicated by the mother to the child by its navel-string), but if the child be strong, the operation is needless. Only let me advise you, that many children that are born seemingly dead, may soon be brought to life again, if you squeeze six or seven drops of blood out of that part of the navel-string which is cut off, and give it to the child inwardly. (2) As to the place in which it should be cut, that is, whether it should be cut long or short, it is that which authors can scarcely agree in, and which many midwives quarrel about; some prescribing it to be cut at four fingers' breadth, which is, at best, but an uncertain rule, unless all fingers were of one size. It is a received opinion, that the parts adapted to the generation are contracted and dilated according to the cutting of the navel-string, and this is the reason why midwives are generally so kind to their own sex, that they leave a longer part of the navel-string of a male than female, because they would have the males well provided for the encounters of Venus; and the reason they give, why they cut that of the female shorter is, because they believe it makes them more acceptable to their husbands. Mizaldus was not altogether of the opinion of these midwives, and he, therefore, ordered the navel string to be cut long both in male and female children; for which he gives the following reason, that the instrument of generation follows the proportion of it; and therefore, if it be cut too short in a female, it will be a hindrance to her having children. I will not go about to contradict the opinions of Mizaldus; these, experience has made good:--That one is, that if the navel-string of a child, after it be cut, be suffered to touch the ground, the child will never hold its water, either sleeping or waking, but will be subjected to an involuntary making of water all its lifetime. The other is, that a piece of a child's navel-string carried about one, so that it touch his skin, defends him that wears it from the falling sickness and convulsions. (3) As to the manner it must be cut, let the midwife take a brown thread, four or five times double, of an ell long, or thereabouts, tied with a single knot at each of the ends, to prevent their entangling; and with this thread so accommodated (which the woman must have in readiness before the woman's labour, as also a good pair of scissors, that no time may be lost) let her tie the string within an inch of the belly with a double knot, and turning about the end of the thread, let her tie two more on the other side of the string, reiterating it again, if it be necessary; then let her cut off the navel-string another inch below the ligatures, towards the after-birth, so that there only remains but two inches of the string, in the midst of which will be the knot we speak of, which must be so close knit, as not to suffer a drop of blood to squeeze out of the vessels, but care must be taken, not to knit it so strait, as to out it in two, and therefore the thread must be pretty thick and pretty strait cut, it being better too strait than too loose; for some children have miserably lost their lives, with all their blood, before it was discovered, because the navel-string was not well tied, therefore great care must be taken that no blood squeeze through; for if there do, a new knot must be made with the rest of the string. You need not fear to bind the navel-string very hard because it is void of sense, and that part which you leave, falls off in a very few days, sometimes in six or seven, or sooner, but never tarries longer than eight or nine. When you have thus cut the navel-string, then take care the piece that falls off touch not the ground, for the reason I told you Mizaldus gave, which experience has justified. (4) The last thing I mentioned, was the event or consequence, or what follows cutting the navel-string. As soon as it is cut, apply a little cotton or lint to the place to keep it warm, lest the cold enter into the body of the child, which it most certainly will do, if you have not bound it hard enough. If the lint or cotton you apply to it, be dipped in oil of roses, it will be the better, and then put another small rag three or four times double upon the belly; upon the top of all, put another small bolster, and then swathe it with a linen swathe, four fingers broad, to keep it steady, lest by moving too much, or from being continually stirred from side to side, it comes to fall off before the navel-string, which you left remaining, is fallen off. It is the usual custom of midwives to put a piece of burnt rag to it, which we commonly call tinder; but I would rather advise them to put a little ammoniac to it, because of its drying qualities.
SECT. III.--How to bring away the After-burden. A woman cannot be said to be fairly delivered, though the child be born, till the after-burden be also taken from her; herein differing from most animals, who, when they have brought forth their young, cast forth nothing else but some water, and the membranes which contained them. But women have an after-labour, which sometimes proves more dangerous than the first; and how to bring it safely away without prejudice to her, shall be my business to show in this section. As soon as the child is born, before the midwife either ties or cuts the navel-string, lest the womb should close, let her take the string and wind it once or twice about one or two fingers on her left hand joined together, the better to hold it, with which she may draw it moderately, and with the right hand, she may only take a single hold of it, above the left, near the privities, drawing likewise with that very gently, resting the while the forefinger of the same hand, extended and stretched forth along the string towards the entrance of the vagina, always observing, for the greater facility, to draw it from the side where the burden cleaves least; for in so doing, the rest will separate the better; and special care must be taken that it be not drawn forth with too much violence, lest by breaking the string near the burden, the midwife be obliged to put the whole hand into the womb to deliver the woman; and she need to be a very skilful person that undertakes it, lest the womb, to which the burden is sometimes very strongly fastened, be drawn away with it, as has sometimes happened. It is, therefore, best to use such remedies as may assist nature. And here take notice, that what brings away the birth, will also bring away the after-birth. And therefore, for effecting this work, I will lay down the following rules. (1) Use the same means of bringing away the after-birth, that you made use of to bring away the birth; for the same care and circumspection are needful now that there were then. (2) Considering that the labouring woman cannot but be much spent by what she has already undergone in bringing forth the infant, be therefore sure to give her something to comfort her. And in this case good jelly broths, also a little wine and toast in it, and other comforting things, will be necessary. (3) A little hellebore in powder, to make her sneeze, is in this case very proper. (4) Tansey, and the stone aetites, applied as before directed, are also of good use in this case. (5) If you take the herb vervain, and either boil it in wine, or a syrup with the juice of it, which you may do by adding to it double its weight of sugar (having clarified the juice before you boil it), a spoonful of that given to the woman is very efficacious to bring away the secundine; and feverfew and mugwort have the same operation taken as the former. (6) Alexanders[10] boiled in wine, and the wine drank, also sweet servile, sweet cicily, angelica roots, and musterwort, are excellent remedies in this case. (7) Or, if this fail, the smoke of marigolds, received up a woman's privities by a funnel, have been known to bring away the after-birth, even when the midwife let go her hold. (8) Boil mugwort in water till it be very soft, then take it out, and apply it in the manner of a poultice to the navel of the labouring woman, and it instantly brings away the birth. But special care must be taken to remove it as soon as they come away, lest by its long tarrying it should draw away the womb also.
SECT. IV.--Of Laborious and Difficult Labours and how the Midwife is to proceed therein. There are three sorts of bad labours, all painful and difficult, but not all properly unnatural. It will be necessary, therefore, to distinguish these. The _first_ of these labours is that when the mother and child suffer very much extreme pain and difficulty, even though the child come right; and this is distinguishably called the laborious labour. The _second_ is that which is difficult and differs not much from the former, except that, besides those extraordinary pains, it is generally attended with some unhappy accident, which, by retarding the birth, causes the difficulty; but these difficulties being removed, it accelerates the birth, and hastens the delivery. Some have asked, what is the reason that women bring forth their children with so much pain? I answer, the sense of feeling is distributed to the whole body by the nerves, and the mouth of the womb being so narrow, that it must of necessity be dilated at the time of the woman's delivery, the dilating thereof stretches the nerves, and from thence comes the pain. And therefore the reason why some women have more pain in their labour than others, proceeds from their having the mouth of the matrix more full of nerves than others. The best way to remove those difficulties that occasion hard pains and labour, is to show first from whence they proceed. Now the difficulty of labour proceeds either from the mother, or child, or both. From the mother, by reason of the indisposition of the body, or from some particular part only, and chiefly the womb, as when the woman is weak, and the mother is not active to expel the burden, or from weakness, or disease, or want of spirits; or it may be from strong passion of the mind with which she was once possessed; she may also be too young, and so may have the passage too narrow; or too old, and then, if it be her first child, because her pains are too dry and hard, and cannot be easily dilated, as happens also to them which are too lean; likewise those who are small, short or deformed, as crooked women who have not breath enough to help their pains, and to bear them down, persons that are crooked having sometimes the bones of the passage not well shaped. The colic also hinders labour, by preventing the true pains; and all great and active pains, as when the woman is taken with a great and violent fever, a great flooding, frequent convulsions, bloody flux, or any other great distemper. Also, excrements retained cause great difficulty, and so does a stone in the bladder: or when the bladder is full of urine, without being able to void it, or when the woman is troubled with great and painful piles. It may also be from the passages, when the membranes are thick, the orifice too narrow, and the neck of the womb not sufficiently open, the passages strained and pressed by tumours in the adjacent parts, or when the bones are too firm, and will not open, which very much endangers the mother and the child; or when the passages are not slippery, by reason of the waters having broken too soon, or membranes being too thin. The womb may also be out of order with regard to its bad situation or conformation, having its neck too narrow, hard and callous, which may easily be so naturally, or may come by accident, being many times caused by a tumour, an imposthume, ulcer or superfluous flesh. As to hard labour occasioned by the child, it is when the child happens to stick to a mole, or when it is so weak it cannot break the membranes; or if it be too big all over, or in the head only; or if the natural vessels are twisted about its neck; when the belly is hydropsical; or when it is monstrous, having two heads, or joined to another child, also, when the child is dead or so weak that it can contribute nothing to its birth; likewise when it comes wrong, or there are two or more. And to all these various difficulties there is oftentimes one more, and that is, the ignorance of the midwife, who for want of understanding in her business, hinders nature in her work instead of helping her. Having thus looked into the cause of hard labour, I will now show the industrious midwife how she may minister some relief to the labouring woman under these difficult circumstances. But it will require judgment and understanding in the midwife, when she finds a woman in difficult labour, to know the particular obstruction, or cause thereof, that so a suitable remedy may be applied; as for instance, when it happens by the mother's being too young and too narrow, she must be gently treated, and the passages anointed with oil, hog's lard, or fresh butter, to relax and dilate them the easier, lest there should happen a rupture of any part when the child is born; for sometimes the peritoneum breaks, with the skin from the privities to the fundament. But if the woman be in years with her first child, let her lower parts be anointed to mollify the inward orifice, which in such a case being more hard and callous, does not easily yield to the distention of labour, which is the true cause why such women are longer in labour, and also why their children, being forced against the inward orifice of the womb (which, as I have said, is a little callous) are born with great bumps and bruises on their heads. Those women who are very small and mis-shaped, should not be put to bed, at least until the waters are broken, but rather kept upright and assisted to walk about the chamber, by being supported under the arms; for by that means, they will breathe more freely, and mend their pains better than on the bed, because there they lie all of a heap. As for those that are very lean, and have hard labour from that cause, let them moisten the parts with oil and ointments, to make them more smooth and slippery, that the head of the infant, and the womb be not so compressed and bruised by the hardness of the mother's bones which form the passage. If the cause be weakness, she ought to be strengthened, the better to support her pains, to which end give her good jelly broths, and a little wine with a toast in it. If she fears her pains, let her be comforted, assuring her that she will not endure any more, but be delivered in a little time. But if her pains be slow and small, or none at all, they must be provoked by frequent and pretty strong clysters; let her walk about her chamber, so that the weight of the child may help them forward. If she flood or have strong convulsions she must then be helped by a speedy delivery; the operation I shall relate in this section of unnatural labours. If she be costive, let her use clysters, which may also help to dispel colic, at those times very injurious because attended with useless pains, and because such bear not downward, and so help not to forward the birth. If she find an obstruction or stoppage of the urine, by reason of the womb's bearing too much on the bladder, let her lift up her belly a little with her hands, and try if by that she receives any benefit; if she finds she does not, it will be necessary to introduce a catheter into her bladder, and thereby draw forth her urine. If the difficulty be from the ill posture of the woman, let her be placed otherwise, in a posture more suitable and convenient for her; also if it proceeds from indispositions of the womb, as from its oblique situation, etc., it must be remedied, as well as it can be, by the placing her body accordingly; or, if it be a vicious conformation, having the neck too hard, too callous, too straight, it must be anointed with oil and ointments, as before directed. If the membranes be so strong that the waters do not break in due time, they may be broken with the fingers, if the midwife be first well assured that the child is come forward into the passage, and ready to follow presently after; or else, by the breaking of the waters too soon, the child may be in danger of remaining dry a long time; to supply which defect, you may moisten the parts with fomentations, decoctions, and emollient oils; which yet is not half so well as when nature does her work in her own time, with the ordinary slime and waters. The membranes sometimes do press forth with the waters, three or four fingers' breadth out of the body before the child resembling a bladder full of water; but there is no great danger in breaking them, if they be not already broken; for when the case is so, the child is always in readiness to follow, being in the passage, but let the midwife be very careful not to pull it with her hand, lest the after-burden be thereby loosened before its time, for it adheres thereto very strongly. If the navel-string happen to come first, it must presently be put up again, and kept so, if possible, or otherwise, the woman must be immediately delivered. But if the after-burden should come first, it must not be put up again by any means; for the infant having no further occasion for it, it would be but an obstacle if it were put up; in this case, it must be cut off, having tied the navel-string, and afterwards draw forth the child with all speed that may be, lest it be suffocated.
SECT. V.--Of Women labouring of a dead Child. When the difficulty of labour arises from a dead child, it is a great danger to a mother and great care ought to be taken therein; but before anything be done, the midwife ought to be well assured that the child is dead indeed, which may be known by these signs. (1) The breast suddenly slacks, or falls flat, or bags down. (2) A great coldness possesses the belly of the mother, especially about the navel. (3) Her urine is thick, with a filthy stinking settling at the bottom. (4) No motion of the child can be perceived; for the trial whereof, let the midwife put her hand into warm water, and lay it upon the belly, for that, if it is alive, will make it stir. (5) She is very subject to dreams of dead men, and affrighted therewith. (6) She has extraordinary longings to eat such things as are contrary to nature. (7) Her breath stinks, though not used so to do. (8) When she turns herself in her bed, the child sways that way like a lump of lead. These things being carefully observed, the midwife may make a judgment whether the child be alive or dead, especially if the woman take the following prescription:--"Take half a pint of white wine and burn it, and add thereto half an ounce of cinnamon, but no other spices whatever, and when she has drunk it, if her travailing pains come upon her, the child is certainly dead; but if not, the child may possibly be either weak or sick, but not dead. This will bring her pains upon her if it be dead, and will refresh the child and give her ease if it be living; for cinnamon refresheth and strengtheneth the child. Now, if upon trial it be found the child is dead, let the mother do all she can to forward the delivery, because a dead child can in no wise be helpful therein. It will be necessary, therefore, that she take some comfortable things to prevent her fainting, by reason of the putrid vapours arising from the dead child. And in order to her delivery let her take the following herbs boiled in white wine (or at least as many of them as you can get), viz., dittany, betony, pennyroyal, sage, feverfew, centaury, ivy leaves and berries. Let her also take sweet basil in powder, and half a drachm at a time in white wine; let her privities also be anointed with the juice of the garden tansey. Or take the tansey in the summer when it can most plentifully be had, and before it runs up to flower, and having bruised it well, boil it in oil until the juice of it be consumed. If you set it in the sun, after you have mixed it with oil, it will be more effectual. This, an industrious midwife, who would be prepared against all events, ought to have always by her. As to the manner of her delivery, the same methods must be used as are mentioned in the section of natural labour. And here again, I cannot but commend the stone aetites, held near the privities, whose magnetic virtue renders it exceedingly necessary on this occasion, for it draws the child any way with the same facility that the load-stone draws iron. Let the midwife also make a strong decoction of hyssop with water, and let the woman drink it very hot, and it will in a little time bring away the dead child. If, as soon as she is delivered of the dead child, you are in doubt that part of the afterbirth is left behind in the body (for in such cases as these many times it rots, and comes away piece-meal), let her continue drinking the same decoction until her body be cleansed. A decoction made of herbs, muster-wort, used as you did the decoction of hyssop, works the effect. Let the midwife also take the roots of pollodum and stamp them well; warm them a little and bind them on the sides of her feet, and it will soon bring away the child either dead or alive. The following medicines also are such as stir up the expulsive faculty, but in this case they must be stronger, because the motion of the child ceases. Take savine, round birthwort, trochisks of myrrh, castor, cinnamon and saffron, each half a drachm; make a powder, give a drachm. Or she may purge first, and then apply an emollient, anointing her about the womb with oil of lilies, sweet almonds, camomiles, hen and goose-grease. Also foment to get out the child, with a decoction of mercury, orris, wild cucumbers, saecus, broom flowers. Then anoint the privities and loins with ointment of sow-bread. Or, take coloquintida, agaric, birthwort, of each a drachm; make a powder, add ammoniacum dissolved in wine, ox-gall, each two drachms. Or make a fume with an ass's hoof burnt, or gallianum, or castor, and let it be taken in with a funnel. To take away pains and strengthen the parts, foment with the decoction of mugwort, mallows, rosemary, with wood myrtle, St. John's wort, each half an ounce, spermaceti two drachms, deer's suet, an ounce; with wax make an ointment. Or take wax six ounces, spermaceti an ounce; melt them, dip flux therein, and lay it all over her belly. If none of these things will do, the last remedy is to try surgery, and then the midwife ought without delay to send for an expert and able man-midwife, to deliver her by manual operation, of which I shall treat more at large in the next chapter.
FOOTNOTES: [10] Horse-parsley. _ |
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