Of difficult births, proceeding from causes of the bones of the pelvis

The Female Physician

1724, Chapter 9, page 245-248

John Maubray

James Holland, at the Bible and Ball, St Paul's Churchyard, London

The reader may easily conceive, by the way, that these are neither to be made bigger or lesser by art; notwithstanding which, by using them skilfully, and treating them judiciously, many a difficult birth may not only be prevented, but also many a life saved, as will manifestly appear from what follows.

Now the bones, upon which the success of the birth chiefly depends, are the os coccygis, and the point of the sacrum; which sometimes bend too much inwards, and thereby obstruct and render the passage so narrow that no birth can possibly succeed. And, again, it sometimes happens, that the infant falling down into the pelvis, and presenting itself head foremost, is opposed and stopped there by the os coccygis: as it also sometimes falls out, that the shoulders stick fast against the edge of these bones; or the buttocks falling down and offering themselves first, maybe so fastened or affixed to them, that they can never be extracted.

These misfortunes may proceed from either of these two different causes; viz. Either from the grossness or large size of these parts of the infant, or from the narrowness of the pelvis, occasioned by an ill position of its bones, particularly of the os coccygis; which bone when the head cannot make it yield or move, neither can it then possibly reach the orifice of the womb, to dilate it sufficiently: and, in short, if the head cannot effect this essential point, much less can the buttocks, or any other part be supposed capable of doing it.

But in all the above-mentioned cases, I am sensible, that most midwives (not knowing better) ascribe the whole difficulty to the orifice of the womb and the vagina; upon which they ignorantly fall atearing and dilating both the one and the other, (never minding the point of the sacrum); and finding these orifices but little opened, notwithstanding the frequent repetition of very severe pains, they imagine that their substantial hardness or thickness is the only cause: so that therefore (without regarding any adjacent part) they go on violently dilacerating sometimes the mouth of the womb, and sometimes that of the privities, (as I have found it by experience) quite to the rectum. For such is their stupidity in this condition of life (as Daventer well observes) that whilst they thus tear and rend the woman to pieces in a manner, they allow her to sit over and above with the point of the os sacrum, upon her seat or bed; or in some other wrong posture, which so presses and confines the os coccygis at the same time, that neither of these can move:

Not minding at all that the chief pressures and impulses of the head, must first bear upon the os coccygis in order to remove it, before it can effect the dilatation of the orifice or mouth of the womb. Thus they spend the woman's strength in vain, break her spirits, and ruin her constitution thro' ignorance; whilst a capable person, administring seasonable and judicious help, according to the circumstances of the case, refreshes nature, renews strength, gives courage, and fills the (otherways languishing and despairing) woman, with hopes and assurances of a happy delivery.

In short, the true method os delivering and helping the woman conveniently, in the different conditions contained in this chapter, depends entirely upon repelling or thrusting back the point of the os sacrum, together with the os coccygis. I say (therefore) the whole point of the os sacrum, and that fleshy part lying about it, is to be thrust back and dilated, so that the passage may be sufficiently opened for the infant to pass through; which patent dilatation is to be promoted by pressing also back the os coccygis. Now these things, in short, may be all done cautiously without creating any intense pain, or the least damage; and thus the obstructed passage being clear'd and open'd, the birth advances regularly of course, and the child is born with the greatest ease, in the space of a few minutes: whereas otherways (without the use of these means) both its own and the mother's destiny may be precarious or uncertain after some days labour.

Thus it is certain, that by assisting a woman in labour seasonably and skilfully, her pains are happily excited and encreased; whereas, on the contrary, by imprudent treatment they unhappily cease and vanish, to her great prejudice. Moreover, daily experience teaches us, that the very different touching of things, occasions different sensations; and from thence it is, that the dextrous midwife knows by one way of touching, how to promote the pains of labour; and by another, how to retard or put them off according as the necessity of the case requires; which hereafter will appear more at large.

But that we may more particularly satisfy such midwives, of our method of repressing these bones, and delivering the woman in the abovesaid cases; I must add, that, after placing the patient in the most convenient posture for a woman in labour, as before fully enjoin'd, I would direct her to be supported by two women, and mov'd so far off the bed or couch, that the point of the os sacrum may be free to yield or give way backwards, without any the least impediment: then I would pass my whole hand at once (being first well anointed or dipp'd in oil) into the vagina, and from thence (if the head will admit it) into the womb, as occasion should require: where, upon opening my hand broad, that it may press equally every where, I turn the palm upwards, and the back downwards against the rectum and the os sacrum: thus I extend my fingers as far as possible to the head, thrusting it a little backwards, rather than hinder my hand from being firmly placed against the os coccygis: upon my hand being thus properly placed, as soon as the pain begins to threaten (which I commonly perceive before the woman) I advise her, to make good use of the approaching pains, in order to labour mutually, and depress with all her power, promising her my most faithful assistance: by which time, as soon as the pains have seiz'd her, and she doing her part, I press my hand backwards, first softly, and by degrees more strongly, against the point of the sacrum, bringing it at the same time gradually downwards, that I may thereby make room for the head sliding the same way; so that the more severe the pains are, the more I depress still, and the harder I press down with effectual pain, the more vigorously and successfully the woman is able to labour.

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