Hints to Husbands: A Revelation of the Man-Midwife's Mysteries. George Morant
palm of the left hand—guarded, for the sake of delicacy, cleanliness, and convenience, with a soft napkin—steadily and firmly against the perineal tumour. I have already mentioned that the thighs must be drawn up towards the abdomen, and the legs bent a little back upon the thighs, and the whole person lying on the left side; and the patient is usually placed so that her feet may rest against the bed-post.[29]
“We render the shoulders also another fixed point, so as to steady the upper part of the body, by tying a long napkin, or a round towel, to the same bed-post, and desiring her to hold it in her hand. We tell her, when the pain comes on to press with her feet against the bed-post, and pull gently at the towel, cautioning her against straining violently. The consequence is she so fixes her person as to render it almost impossible for her to jump away suddenly, or to recede to any distance from us. Independently of this little manœuvring, when the head is in any degree extending the vulva the nurse must be required to raise the right knee to some distance from the other, by which means the thighs are separated, and an increased facility given to the exit of the head through the external parts, as well as some control exerted over the patient’s movements. … After having examined the uterus through the parietes of the abdomen, we must make an internal examination, more perfectly to assure ourselves in what way the placenta is disposed of. Twisting the funis umbilicalis around the first two fingers of the left hand, and bringing it to its bearing, we pass the first finger of the right hand, previously anointed, into the vagina, as in a common examination. If the placenta be entirely in utero, which, as just remarked, is most commonly the case immediately after the child’s expulsion, we shall either not be able to touch it at all, or if it be within reach, we shall only detect a very small portion of it; we may just feel it offering itself at the os uteri; but we cannot surround its volume, nor can we probably discover the insertion of the funis.
“Removal of the Placenta.—There is no part of natural labour which requires so much judgment as the conduct of the third stage; for the slightest mismanagement of the placenta may be productive of most serious mischief, by converting a perfectly natural into a most dangerous and complicated case. As long, then, as the placenta remains in utero, so long we must wait, within a certain limit—provided there be no flooding—for those contractions which are to expel it from the uterus into the vaginal cavity, &c.; while we are thus watching, we shall most likely be informed of the return of uterine action, by the woman complaining of two or three comparatively trifling pains affecting the back and loins. As it is probable that under these pains the placenta may have somewhat descended, another examination may then be made per vaginam to satisfy ourselves on this point, &c.
“The removal of the placenta from the vagina is easily effected. Twisting the funis umbilicalis two or three times around the first and second finger of the right hand, we draw it down in a line tending towards the coccyx, and receive it in the left, placed under the perineum; or we may introduce the two first fingers and the thumb of the left into the vagina, embrace the mass between them, squeeze it as we would a sponge, and slowly extract it. …
“Having perfectly satisfied ourselves on this point, we may a second time take away the napkins soiled with the accumulated discharges, and envelope the lower part of the patient’s person in others that are warm and dry. Three will be sufficient: one must be partially slid under the left hip; another may be placed over and around the right hip; and the third carried between the thighs, directly on the vulva, &c. …
“Some practitioners adapt the bandage themselves, and apply it immediately after the placenta has been removed. I think it preferable, in common cases, to leave this duty to the nurse; and that it should not be put on until the body linen of the patient is shifted; because, in the first place, it appears to me more desirable that perfect quietness should be preserved until the first changes in the uterus consequent upon labour are effected, that no disturbance may interrupt their progress; and, in the second, I cannot help thinking that there is something highly indelicate in its being applied by a man—much more so, indeed, than any of the duties we are ordinarily called upon to perform under natural labour. It is of most service when next the skin. It must be sufficiently broad to reach from the pubes almost to the ensiform cartilage; and it cannot be properly adapted unless the abdomen be quite uncovered. In addition, I would remark that the nurse must know very little of her duties, if she cannot draw a properly contrived bandage round the person, and give it the due degree of tightness without incurring danger.”
The reader of the preceding extracts will have observed that they begin with a panegyric on the extraordinary powers of nature in adapting means to an end; which, nevertheless, the author forthwith proceeds to qualify, as if he had admitted too much, in giving nature credit for the due execution of her own work, and her capability for enforcing her own laws, by enlarging on the profound and scientific knowledge required in the man-midwife, the opinion expressed by the Royal College of Physicians to the contrary notwithstanding; and in effect impiously detracting the infinite power and wisdom of God, “who created man in his own image, in the image of God created He him; male and female created He them. And God blessed them, and God said unto them, be fruitful and multiply.”
“And God saw everything that He had made, and behold, it was very good.”
After descanting on the inutility, and even positively detrimental effects of active interference in natural labour, he warms with his subject, and, in the course of the three stages by which he limits and defines the operations of nature in introducing man into the world, enjoins, in language horribly disgusting from its technical obscenity, an amount of grossly indecent interference, only to be measured by the credulity and endurance of his miserable patient. If the maxim of non-interference which he inculcates holds good, he deceives and wrongs his patient to a most shameful extent, by permitting and encouraging the delusion that by these vaginal examinations he can render her “assistance,” or mitigate the sufferings which nature has ordained; and we assert, without fear of contradiction, that the man who should dare to practise upon the weakness of women in such a manner, and at a moment when they are least able to resist his solicitations, deserves the severest condemnation. In all this foul tissue of verbiage descriptive of the practice in natural labour there is nothing which a female attendant of the most ordinary intelligence could not accomplish with the greatest ease, and yet the nurse, who is generally a well instructed midwife, is scarcely mentioned at all, and her duties appear to be confined to a trivial and unimportant after-operation, which the conscientious and sensitive doctor deems an act of far greater indelicacy than those eight times repeated examinations per vaginam, and other contact with the patient’s person, so sedulously prescribed, and which, in truth, appear to constitute the whole “art,” so far as the treatment of natural labour is concerned. One more extract will more than suffice to show the nature of this abuse, which we fear is, from its daily increasing power and influence upon the female mind, becoming more and more difficult of cure; but which, when considered in all its hideous bearings, should arouse even the most callous and indifferent to a sense of its criminality, and cause the hearts of all who reverence modesty in woman to swell with righteous indignation at the insults which a vile custom has mercilessly heaped upon the sex:—
“She now, at length, submitted to an examination per vaginam, which I made from behind, as she stood erect by the bed. The finger failed at first to reach the os and cervix uteri, until, on pressing upwards, as far as possible, I found the uterus lying transversely, the os higher than the body, pointing to the right side, and the body of the uterus lodged in the left side of the pelvis, near the groin, where it seemed to be firmly fixed. I now made her kneel on the bed, with the head low, so as to elevate the nates, and cautiously tried through the rectum, as well as per vaginam, to raise the uterus from its position into the median line, but without success. An attempt on the following day was with no better result. … After the interval of a month, I made another examination per vaginam, also of the nipples, and found no change in either. After the interval of another month I found the nipples and areolæ precisely as at first; but, to my great satisfaction, the uterus had nearly righted itself in position, and the body of it was rounded and plainly enlarged. The lady also hinted a suspicion that she had quickened.” …
“In this instance my suspicion of pregnancy (which at first was very slight) rested on the interruption of menstruation alone.