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 The Province of Midwives in the Practice of their Art,
 by William Clark, M. D. 1698–ca. 1780.




 THE PROVINCE OF MIDWIVES

 IN THE

 Practice of their ART:

 Instructing them in the timely Knowledge of such
 _Difficulties_ as require the Assistance of MEN,

 For the Preservation of

 MOTHER and CHILD.

 Very necessary for the Perusal of ALL the SEX
 interested in the Subject,

 And interspersed with some

 _New_ and _Useful_ OBSERVATIONS.

 _By_ WILLIAM CLARK, _M. D._

 _And of the_ College _of_ PHYSICIANS.

 _Molliter Aufer Onus._      OVID. FASTI.

 Printed for _William Frederick_, in BATH; and sold by
 _M. Cooper_, in _Pater-Noster-Row_, LONDON.

 MDCCLI.




ADVERTISEMENT TO THE READER.


_The following small Tract will appear contemptible to those who
judge of the Worth of Books by their Bulk; but the Author believes
such as are practis’d in Midwifry will acknowledge both the Want
and Usefulness of an Essay of this Kind._

_The Division of the Chapters, naturally arising from the various
Circumstances which are treated of, will rather assist than
burden the Memory, and admit of a ready Recourse to the short
Instructions, in the Knowledge and Practice_ absolutely necessary,
_given under each Head._

_The Reader will the more readily excuse any Defect in the Stile,
when he considers_ _the Necessity of a strict Expression on the
Subject and the Difficulty a Man lies under, who writes not to
the learned and experienced, but chiefly for the Sake of Persons
ignorant in Anatomy and Philosophy, on a Subject which for the most
Part excludes Information by Sight._

_On such a Subject it will not be imagined Vanity or Applause can
incline a Man to write a Pamphlet, rather than a Volume; when the
Author is not conscious of having omitted the Instruction to be
found in any Book extant, within the Limits of his Design; and
hopes Experience will teach its Value both to Midwives and Matrons;
and that the Perusal will not at all injure, if it does not
improve, the most knowing and experienced._

       *       *       *       *       *

The READER is desir’d to correct the following ERRORS with the Pen.

 Page 9, Line 16, _read_ Pains about the Back, Navel, _&c._—P. 33,
 l. 12. omit the Period after the Word Pain; and make a Semicolon,
 instead of the Comma, after touch’d it.




CHAPTER I.

_The_ DESIGN.


The Case of _Child-bearing_ Women is very lamentable, in the
Country especially, by Reason of the Ignorance and Unskilfulness
of _Midwives_; for by their Negligence and perverse Management,
many Mothers and Children are destroyed, to the great Misfortune of
particular Families, as well as of the _Publick_, at a Time when it
suffers by the Loss of useful Hands, from too many other Causes. It
were therefore to be wished, that all Midwives were so far appris’d
of their Duty, as to be able to distinguish between Cases within
their Abilities, and such Difficulties as may occasion the Loss of
the Mother, or Child, or both, for Want of necessary Assistance.

They who intend to practice Midwifry in PARIS, are oblig’d to
attend _anatomical_ Lectures and _Dissections_, that their
Judgments may be inform’d, by the Knowledge of the Structure of the
Body, for an Undertaking so hazardous in ignorant Hands.

London, at present, affords equal Advantages of Information; for
the _anatomical_ Wax-work, with suitable Lectures, might furnish as
good a Qualification, with less Offence than real Dissections; and
there are not wanting those who professedly instruct both Sexes by
_mechanical Demonstrations_.

And for the future, it is to be hoped, there will be no Necessity
for Men to have Recourse to PARIS for _Observation_, since we have
_Infirmaries_ at Home for the Accommodation of Women in Child-bed;
and tho’ they are expos’d naked to the Eye in the _Hotel de Dieu_,
it must be confess’d, that the fundamental Rules of the _Art_ are
not built on what the Eye of the Observer can possibly discover in
the most expert _Operators_; but depend on Circumstances conceal’d
from Sight, within the Body of the Patient.

But whatever Advantages LONDON and WESTMINSTER afford for the
Instruction of Midwives, the Country is entirely destitute of them;
and the best Books on the Subject, adorn’d with elegant Figures,
can give but a very imperfect Notion of the Parts they represent,
to any who have not attended _Dissections_, or seen more natural
_Resemblances_ than Cuts.

The Figures in Books, exhibit the _Bones_ of the _Pelvis_, a
Variety of _Situations_ of the Infant, and _Uterus_, the Placenta
and umbilical Vessels and Membranes, _&c._ whereas it would be
no less serviceable to those, who assist Women in Travel, to be
acquainted with the Viscera, liable to suffer by a difficult
Labour; for the _Liver_, _Spleen_, _Sweetbread_ and _Kidneys_,
if not the principal Contents of the Chest, may be so injured by
the ill _Position_ of the Child, Compression of the Parts, and
rash Assistance, as to prove fatal, more or lets immediately;
occasioning _Inflammations_, _Suppurations_, _Mortifications_,
_Schirrhu’s_, _Cancers_, or _Consumptions_.

The best Writers of Midwifry, such as _Mauriceau_, _Deventer_, _De
la Motte_, _Heister_ and others, explain the Causes of difficult
Births, and the proper Methods of Assistance; but instead of
improving most _Country_ Midwives, fill them with Conceits of what,
it is impossible, they should understand, and thereby occasion the
Loss of great Numbers of Women and Children.

In order therefore that Midwives may acquit themselves with
Reputation, and that _Child-bearing_ Women may be the better
Judges for themselves, or the charitable Part of the Sex, who are
past these Dangers, the better able to assist their Friends and
Neighbours, I shall endeavour to shew how far they may act with
Safety under the Disadvantage of Country Practice, and describe
those Symptoms, which for the most Part accompany hard Labours,
very probably beyond their Abilities; when they will justly incur
the Censure of Inhumanity and Rashness to depend upon their own
Skill.




CHAPTER II.


In this Chapter I have avoided the Use of Terms of Art, or
explain’d them, in Regard to those for whom I chiefly write, as
far as my Regard to Decency admits; but if any Word should occur
not easily understood by any of my Readers, almost any _English_
Dictionary will explain its Meaning; and it cannot be expected that
any Book can instruct those who cannot read, tho’ I am sorry to say
too many such assume the Office of _Midwives_.

As Curiosity may reasonably induce many of the Sex concern’d in
the Subject of these Sheets, to be inform’d of somewhat of the
Provision supreme Wisdom has made for the Existence of Children in
the Womb, I shall briefly mention the most obvious _Instruments_
relating to their Breeding and Birth, without puzzling my Readers
with minute _anatomical_ Descriptions.

The Vagina, or Passage, lies between the Neck of the _Bladder_ and
the large or strait Gut; it is connected at the inward extreme to
the _Womb_, and called the _outward Orifice_ at its beginning.

The _Womb_ lies between the _Bladder_ and _Strait Gut_, and is
connected to both; during the Time of _Breeding_ it increases in
its _Dimensions_, and rising higher in the Body, by Reason of
the Weight and Substance of it, with its Contents, at the Fund,
or remote End of it, may be liable to swag too much _forward_ or
_backward_, or incline more or less to either Side, especially in
such, as by their Occasions of Industry in Life are obliged to
a Variety of _indirect_ Situations; by which Means the _inward_
Orifice is perverted from a _direct Site_ with Respect to the
Passage, and obstructs an easy Exclusion of the Infant in Travel.

The _Placenta_ or _After-birth_, adhering to the _Fund_ of the
_Womb_, receives the _Mother_’s Blood, by the _Umbilical-Vessels_,
or _Navel-String_, conveys it to the Child for its Nourishment, and
retransmits what is superfluous; maintaining by the Intercourse of
_Arteries_ and _Veins_, the Circulation of the Blood between Mother
and Child.

The _Membranes_ closely connected to the _Placenta_, and the _Fund_
of the _Womb_, between both which they seem to take their Rise,
contain the _Humours_ in which the Infant swims, the better to
preserve it from Injuries, by its Pressure against _unyielding_
Parts, and the _Humours_ before, and after the _Breaking_ of the
_Membranes_, commonly call’d the _Breaking of the Waters_, in the
Birth, very much facilitate it, by opening the _inward Orifice_
of the _Womb_, and lubricating the _Passage_ for the Child: These
_Membranes_ come away with the _Placenta_, under the Name of the
_After-birth_, or _Secundines_, indifferently.

The _Pelvis_ or _Bason_, wherein the _Uterus_ or _Womb_ is seated,
is form’d by the _forward_ Bones, commonly call’d the _Share-Bone_,
the _Hip-Bones_ and their Continuation on each Side, and the lower
Part of the _Back-Bone_, all which are so contiguous to each other,
as to form this Cavity, generally much larger in Women than Men,
cloathed with Muscles, between which the _Vagina_ is inserted.

The right Formation of the _Pelvis_, is of the greatest Consequence
in Favour of an _easy_ Birth; when the _Bones_ forming it,
_forward_ and _backward_, and on _each_ Side, both above and below,
don’t too much approach each other, and prevent the Exclusion of
the Child between, by a free Admission.




CHAPTER III.

_The Symptoms preceeding_ Natural Labours.


I shall pass over the Symptoms of Pregnancy, and the Distinctions
of true and false Conceptions, as Things of which Midwives can
seldom be expected to be _proper_ Judges, and proceed to their
Business, _Natural Labours_; comprehending, under this Name, all
such Cases, which require no further Assistance than _Midwives_, in
a general Way, may easily give; or in their Absence a Nurse, or any
sensible Woman, who has attended Deliveries.

After the Woman has gone her due Time of Nine Months, the most
usual Term; the Signs preceeding Labour are Pains about the Back,
Navel and Loins; a considerable Falling of the Tumour of the Belly,
by the Burden’s sinking lower; and incommoding the Woman in
walking; a more frequent Inclination to make Water: These Symptoms
increase in Proportion as the Birth approaches; but as the most
certain Knowledge of _natural_ Births, can only be obtained by
_Touching_ the Woman in Labour, after having premised some Things
concerning her _proper_ Situation; I shall direct how it ought to
be done.




CHAPTER IV.

_Of_ SITUATION.


Many in the Country choose to be on their _Legs_ or _Knees_,
supported by a Woman on each Side, or _lean_ on a Chair or Bed, and
pass well enough through the present Scene of their Miseries: But
I would preferably advise a Posture between _lying_ and _sitting_,
on a _Pallet_ or _common_ Bed, the _Head_ and _Shoulders_ being
_rais’d_ by Bolsters or Pillows, the Feathers _beat back_ from the
Bed’s Feet, to support the hollow of the Loins, and prevent the
Pressure of any Thing against the _Bottom_ of the Back Bone, to
obstruct the Passage of the Child.

This _Situation_ is most commodious, during Labour, for a Woman to
_assist_ her Pains with the greater Freedom of Respiration, and the
least Fatigue and Expence of Spirits; especially if the _labouring_
Woman lay hold of a _folded_ Napkin, held stiffly for that Purpose,
drawing her Feet _upwards_ towards her Seat, _separating_ her
Knees, and _fixing_ her Feet against something that will not easily
give Way.

If the Person in Labour will not be in Bed, the End may be
answered by her _sitting_ in _another_’s Lap, with the _Bottom_ of
her Back-Bone situate between the other’s Knees, with her _own_
separated and supported, and Feet fixed as aforesaid, to favour
her bearing down.

’Tis inconsistent with the Design of my Writing to describe all
the _convenient_ Situations, necessary in Cases of Difficulty, yet
when the Operator has rectified all Obstructions to the Birth, the
same Situation of the Body upon a _Slope_, from the Head downwards
is most suitable, even altho’, for Conveniency, she should be
deliver’d lying on one Side.

I shall, on this Occasion, observe, what I have found Advantageous
in my own Experience, as well as consonant to the Advice of the
best Writers on the Subject: That the Delivery on the _Back_, by
the Assistance of one placed on _each Side_, supporting her by
the _Hams_, with her Knees _separated_, and raising her _Back
Bone_ a little from the Bed during the _Activity_ of Pains, and
the _Midwife_’s _Assistance_ of either Sex, is vastly preferable
to the Delivery on _one Side_, to which I impute the Loss of many
Children brought by _Turning_, as well as a more _tedious_ Labour
in other Cases; because this Posture, in some Degree, _contracts_
the _Passage_, and only admits the proper Separation of _one_ Knee.




CHAPTER V.

_Concerning_ TOUCHING.


This ought to be put in Practice, as soon as, from the Symptoms
given in the Third Chapter, it is reasonable to expect the Birth
approaching; and a _Child-bearing_ Person would be very much her
own Enemy to refuse the only Means of giving a _true_ Information
of her Case, and the Knowledge how to do her the most effectual
Service.

The Midwife, having her Nails well pared, and very smooth, and her
Fingers anointed with Oil or Lard, must introduce the two _fore
Fingers_ of either Hand into the _Passage_ or _Neck_ of the _Womb_,
as far as its _inward_ Orifice, directing them with a _gentle_
and _easy_ Motion, somewhat upwards, as it were with a Tendency
through the _Passage_ towards the _Navel_; in this Search she will
find the _internal_ Orifice, joining the _Passage_ or _Neck_ of
the _Womb_ more or less open, relaxed, and thinner than usual;
and cautiously protruding her Fingers farther, she may possibly
touch the _Crown_ of the Child’s Head; she will easily, by the
_Sutures_, or _Opening_ between the Bones of the Skull, distinguish
the _Crown_: Keeping her Fingers in this Situation, _during_ the
Beginning, and Continuance of _strong_ Pains, she will observe the
_Waters_ contain’d in the _Membranes_ including the Child, and
After-birth _forming_ within the _inward_ Orifice, as if something
like a Bladder _blown_, or _distended_ with Water, presented to
the _Touch_, dilating the _Orifice_ with each _Throw_; these
Appearances presage a _speedy_ and _easy_ Birth.




CHAPTER VI.

_Of a natural_ Birth, _and the_ Office _of the Midwife._


As the _Birth_ approaches, the Woman grows _hotter_ and _red_ in
the Face; the Pains bear more _strongly_ down; the _internal_
Orifice _opens_; the _Vagina_ or _Passage_, at its _Entrance_,
becomes more swell’d, as the Child’s Head advances; and the
_Membranes_ are more and more _tensely_ stretched; before the
_Birth_, the Person is often seized with a _Vomiting_, and
_universal_ Tremor, without the Coldness of an _Ague_; and very
often a _Humour_, _discolour’d_ with _Blood_, immediately preceeds
the _Breach_ of the _Membranes_; when these Symptoms, or several
of them, become urgent, ’tis Time to put the Woman in a proper
Situation, as describ’d in the preceeding Chapter: The Midwife
ought by no Means to break the _Membranes_, but _encourage_ the
Woman now to make the best of her Pains, by _strongly bearing
down_, as if going to Stool; the Midwife with her Fingers well
anointed, putting them gently within the _internal_ Orifice, may
cautiously, by separating them, assist its _opening_, and Removing
it more behind the Child’s Head, thereby gradually promote its more
easy Transmission, and at the same Time prevent, if necessary, the
Womb from being too far protruded: After the _Waters_ are _broke_,
as it is called, and the _Head_ of the Child comes into the
_Passage_, the Midwife may lay hold on each Side of it, taking Care
not to bruise it by rough Handling, and drawing it, by _Waving_ her
Hands, if necessary, to loosen it, when fixed, rather than in a
strait Line, assist the Birth; and if obstructed by the Shoulders
in the Passage, inserting a Finger under each Arm-Pit, extricate
them by the like Action.

’Tis true, it happens, tho’ unobserv’d by Writers, as far as
I remember, that _many_ Women have no _Waters breaking away_,
either before or after the Birth; whether absorbed or not, in
Time of Labour, I shall not at present determine; this is called,
by the Country People, a _dry_ Labour, and often attended with
Difficulty; however, if the _Crown_ appear _forward_, the Issue may
nevertheless be favourable.

The Child being born, the next Business is to tie the
_Navel-string_ with a _waxed_ Thread, so _doubled_, as not to
endanger _cutting_, about _two_ Inches from the Child’s Body,
making another Ligature near the Body of the Mother, so far distant
from the former, as may be convenient for _Cutting_ between _both_
Ligatures, and separating the Infant from its _After-birth_.
Midwives are too apt to leave a greater Length, which can be of no
Service, but has been thought, on the contrary, by our Countryman
CHAPMAN, to occasion _Navel_ Ruptures.

After the _Separation_ of the _Navel-string_, the Care to get the
_After-birth_ succeeds; this will often come by the Assistance of
Nature, with a gentle Motion of the Hand gradually drawing and
loosening it, by the Navel-string: But if it adheres to the _Fund_
of the _Womb_, which is frequently the Case, whether from the
_Waters_ being come away before the Birth or otherwise; it must
cautiously be separated, and extracted by the Hand, to prevent the
most mischievous and fatal Consequences.

The Assistant holding the _Navel-string_ with _one_ Hand, must
with great Caution introduce the _other_ into the _Womb_, avoiding
_all Violence_ to any Part in the Way, ’till she reaches the
_After-birth_, some Part of which probably, being loosened, will
be found more _forward_ than the rest; which _taking_ between her
_Thumb_ and _Fore-Fingers_, she must, by an easy Motion of her
other Fingers, between the _Womb_ and _After-birth_, gradually
_separate_ the Parts adhering all _round_, ’till finding the
whole free, before the Palm of the Hand and Fingers, she brings it
intirely away; for should any Part remain, the poor Woman’s Labour
would still continue, and occasion _dangerous_ Floodings, requiring
the immediate Assistance of an able Hand, to rescue the Patient
from the immediate Hazard of Death.

Sometimes when the _Womb_ has discharged its _Waters_, and the
_Child_, by Reason of a Defect of Pains, or otherwise, remains
_long_ very _forward_ near the _Birth_, the _Womb_ so _contracts_
about the _After-birth_, as to make the _Separation_ of it very
difficult; in which case Assistance is requisite, from one well
acquainted with the Structure of the Body; and the longer this is
delay’d, the more Danger there will be of all the bad Consequences
of the Retention, and Corruption of the _After-birth_ in the Body.

It requires great Care to prevent the _Protrusion_ of the _Womb_ in
some Women of a _large Pelvis_, or _Opening_ between the _Bones_;
or if the _After-birth_ remains closely fixed, the _Womb_, in a
very _open Pelvis_, may be _thrust_ by the Violence of the Pains;
or _drawn_ out of the Body by an _unskilful_ Hand, which is
