University of Virginia Library

C. HORIZONTAL, OR RECUMBENT.

We finally come to the horizontal or recumbent position, and by this I mean especially, 1. The Dorsal Decubitus, the obstetric position of the present day on the continent of Europe and in America, the head merely elevated by the ordinary pillow; 2. The Position on the Side, as customary in England; and 3. Horizontal, Prone on the Chest and Stomach.

1. The Dorsal Decubitus.

The semi-recumbent position held sway in Europe before the time of the obstetric chair, and after a period of great popularity soon disappeared, although its traces remained, especially in the slowly progressing country districts, until

the last thirty or forty years, when it finally yielded completely to the dorsal decubitus, which is now almost universal among civilized people. In England, where, however, it has now yielded almost entirely to the left lateral position, it began to grow in favor in the beginning of the last century; in Scotland toward the end of that century White, of Manchester, it may be of interest to note, was the first to advocate the dorsal and lateral decubitus in England (1773).

The Chinese women are frequently confined in bed.[129]

Although this is the position which is taught by the laws of modern obstetrics, so perfect in all other respects, nature does not seem to have designed that woman should in this way free herself from her burden; at least it appears very strange that instinct, the correct guide of uncivilized people, should so rarely lead them to adopt the recumbent position; and it appears strange that, notwithstanding the most careful inquiry as to the position adopted by the savages, and notwithstanding the information I have received from surgeons who have come in contact with all of our Indian tribes, I have found scarcely any who assume a strictly recumbent position. Among some the women are confined in the dorsal decubitus, but rarely in the horizontal position. Among the Cheyennes and Arapahoes we sometimes find the dorsal decubitus in simple labors.[130] The Oregon Indians on the Siletz Reservation are invariably confined on the back with the feet drawn up. I am also told that others of the tribes on the Pacific coast follow this custom, especially those of the Grand Ronde Agency, Oregon; the parturient usually keeps on her feet during the first stage of labor, but when the expulsion pains set in she lies on her back, her head very slightly elevated (her bed always on the floor), her thighs well flexed on the abdomen; an assistant supports each knee and foot; the patient presses her hands against her thighs, or, when the pains become severe, she presses

upon the fundus uteri; later an assistant carefully manipulates the fundus and follows the uterine globe.[131]

The Nez-Percés and Gros-Ventre squaw assumes the stooping posture during the earlier stages of labor, with an assistant at her back, who clasps her body with her arms, and locking the fingers, brings the palms of the hands over the base of the uterus, making steady pressure backwards and downwards during the pains; in some instances, during the stage of expulsion, however, the patient lies down indifferently on either side or on the back, while if on the side, pressure by the hands of the assistant is kept up continuously, if on the back, the assistant remains by the side of the patient and keeps up the pressure in the before-mentioned directions.

Upon the Antilles the recumbent position is also assumed, though we have seen that other postures are equally common there. Among one of the African tribes, the Wanika, the parturient woman lies flat upon her back, and this is perhaps the only instance where the horizontal position is so decidedly described.[132] Of the Indian women, Susruta says, page 368, "When the child is to be born, let the woman be placed with the back upon a carefully spread couch, giving her a pillow, let the thighs be flexed, and let her be delivered by four steady, aged, and knowing midwives whose nails are well trimmed.''

In Southern India we find a similar custom to that observed among the Nez-Percés; the patient walks about in the earlier stages, then sits down with the legs stretched, her back supported by an assistant, whilst in the moment of expulsion she is placed upon her back.[133]

In Siam the patient is placed upon her back with a woman seated upon either side; these two assistants begin by forcibly pressing the abdomen downward and backward, the pressing of which is continued from three to five hours. If by that time it has failed to expel the fetus, one attendant

is supported by the hand while she tramps the abdomen of the patient, always placing her feet above the fetus, as a dernier ressort. All other means having failed, they suspend the parturient by means of a band beneath the arms, as we have already mentioned.[134]

The Burmese practice is to strip the patient naked and to compel her to run about the room, while half a dozen

women are about who squeeze her abdomen and beat it with pillows; this process is continued until finally she falls upon the floor exhausted, and some of the women still keep pressing the child down with their hands, trying to expel it forcibly; and there are instances, as the author is credibly informed, in which the woman is placed upon her back and the midwife sits upon her or stands up and presses against the child with one of her feet.[135]

In Australia other positions are assumed in simple labor,

but it seems that in difficult cases the parturient woman is treated in the same barbarous way. She lies upon her back between two assistants, one of whom places her knee in the small of the patient's back, whilst the other, lying more in front, awaits a labor pain and then presses her knees into the patient's abdomen.[136]

In Astrakhan the Russian women are made to walk about unceasingly during the earlier stages, and only at the very last moment are permitted to lie down.

In Sumatra, if we may judge from a single case,[137] the patient is also confined in the recumbent position; and in Brazil, according to an old authority cited by Ploss,[138] the native women were confined upon the ground. Several other such vague authorities are cited, but they are hardly sufficiently reliable for our purpose.

2. The Lateral Decubitus.

The position upon the side seems almost entirely a product of modern civilization, and, I must say, of prudery rather than science; it is not adopted as the obstetric position by any of those people who still lead a natural life, though assumed, in a few rare instances, in certain stages of labor. The Nez-Percés squaws squat in the earlier stages, and lie upon the side or back during the expulsion of the child. The Modocs, on the contrary, first lie upon the side, and at the last moment take the knee-hand position. The women of the Laguna Pueblo, New Mexico, who follow their own inclination almost altogether in the position which they assume, stand or walk about in the early stages, but are confined standing, suspended in a half squatting position, or, if tired, on the back or side, with pillows between the knees; this latter position is also occasionally found among the Kootenai Indians, of Washington Territory; as Dr. Morgan writes, the woman is placed on her left side, under

which is placed a pillow, or bundle of skins; another roll of skins, or a blanket, is between her knees, which are separated, so as to be about a foot apart; the patient holds a stake or cord, the arms are flexed, and the head touches the hands.

With the exception of these few data, I can find no other reference to this position.

3. Prone upon the Stomach.

This peculiar position has but few adherents; in fact, I can find no traces of it elsewhere than among the Creeks, who assume an over-done knee-chest position; i. e., prone upon chest and stomach, in ordinary cases. "When the fetus is about to be expelled the mother straps the belt

across her chest, allowing it to extend somewhat on to the abdomen. As the labor proceeds the strap is buckled tighter and tighter, until the expulsion is accomplished; meantime the position assumed by the mother is prone upon her face, her chest and abdomen across the pillow; in this position she remains until the expulsion. She then stands up, resting on a stick of some sort, with the feet spread wide apart. This is to let the blood flow more freely, and, so they think, to allow the placenta to be more rapidly and easily delivered.''[139]

Upon the Island of Ceram, as well as in Loango, and other districts of Central Africa, the patient is placed upon her stomach if labor does not progress in the ordinary position,

and the expulsion of the child is hastened by kneading or tramping upon the back of the sufferer.

A peculiar custom may yet be mentioned which is still observed, to the great discomfort of the parturient woman, among some of our western Indians, as well as among the more civilized natives of Syria; and that is, to toss the suffering patient in a blanket, the four corners of which are held by stout men, so that she is well shaken, with a view, probably, of rectifying the malposition, and shaking out the fetus from the unwilling womb.