When delivery is near, the midwife must wait patiently until the child’s head, or some limb, bursts the membranes, for if the midwife through ignorance, or through haste to go to some other woman, as some have done, tears the membrane with her nails, she endangers both the woman and the child; for by lying dry and lacking that slipperiness which should make it easy, it comes forth with severe pains.

When the head appears, the midwife must hold it gently between her hands, and draw the child, whenever the woman’s pains are upon her, but at no other times; slipping her forefingers under its armpits by degrees, and not using a rough hand in drawing it out, lest the tender infant might become deformed by such means.  As soon as the child is taken out, which is usually with its face downwards,—­it should be laid upon its back, that it may receive external respiration more freely; then cut the navel string about three inches from the body, tying the end which adheres to it with a silk string, as closely as you can; then cover the child’s head and stomach well, allowing nothing to touch its face.

When the child has been thus brought forth, if it be healthy lay it aside, and let the midwife attend to the patient by drawing out the afterbirth; and this she may do by wagging and stirring it up and down, and afterwards drawing it out gently.  And if the work be difficult, let the woman hold salt in her hands, close them tightly and breathe hard into them, and by that she will know whether the membranes are broken or not.  It may also be known by making her strain or vomit; by putting her fingers down her throat, or by straining or moving her lower parts, but let all be done immediately.  If this should fail, let her take a draught of elder water, or the yolk of a new laid egg, and smell a piece of asafoetida, especially if she is troubled with a windy colic.  If she happen to take cold, it is a great obstruction to the afterbirth; in such cases the midwife ought to chafe the woman’s stomach gently, so as to break, not only the wind, but also to force the secundine to come down.  But if these should prove ineffectual, the midwife must insert her hand into the orifice of the womb and draw it out gently.

Having thus discussed common births, or such as are generally easy, I shall now give directions in cases of extremity.

* * * * *

CHAPTER XVI

     What ought to be done in cases of extremity, especially in women
     who, in labour, are attacked by a flux of blood, convulsions and
     fits of wind.

If the woman’s labour be hard and difficult, greater care must be taken than at other times.  And, first of all, the situation of the womb and her position in lying must be across the bed, and she must be held by strong persons to prevent her from slipping down or moving during the surgeon’s operations.  Her thighs must be put as far apart as possible, and held so, whilst her head must rest upon a bolster, and her loins be supported in the same manner.  After her rump and buttocks have been raised, be careful to cover her stomach, belly and thighs with warm clothes, to keep them from the cold.