IN this _Case_, there is an absolute Necessity for _Manual Assistance_, since the PAINS (however penetrating or forcible) cannot effect the _Work_. But and if the _INFANT_ is fallen down (well turn’d) into the PELVIS, the MIDWIFE using her best and most skilful Endeavours to _dilate_ the _Passages_ below near the OS COCCYGIS, the CHILD may be easily brought forth (without any dangerous _Instrument_) by her dextrous _Hand_ only accomplishing the _Work_. In the mean Time, however, it is to be minded always, that _This_ is still more safely and commodiously done by the FEET, than by the HEAD, after carefully dilating the OS COCCYGIS, taking this Opportunity in the beginning of the LABOUR, before the _INFANT_ is too much press’d down into the PELVIS. NOW _these_ are, in fine, the most common _Causes_ on the Part of the _INFANT_, whence I come to touch upon _difficult BIRTHS_, proceeding from _Causes_ of the _Passages_; which, because they are various, I subdivide into a _Fivefold Diversity_; viz. _Difficult BIRTHS_, proceeding from _Causes_ of the MEMBRANES, from _Causes_ of the PELVIS, from _Causes_ of the BONES of the PELVIS, from _Causes_ of the BLADDER and RECTUM, and from _Causes_ of the VAGINA: And because all these require to be singularly explain’d, and particularly insisted upon, I shall assign them as many respective _Chapters_. And _First_—— [Illustration] CHAP. VII. _Of Difficult BIRTHS, proceeding from Causes of the MEMBRANES._ SUCH _Difficulties_ as These, in _BIRTH_, may arise, _FIRST_ from the _Strength_ and _Firmness_ of the MEMBRANES; when they happen to be so _gross_, _callous_, or _thick_, that the _INFANT_ cannot easily break through them. In this _Case_, when the _MIDWIFE_ finds the _Orifice_ of the WOMB sufficiently dilated, for the _Circumference_ of the HEAD, and the CHILD so forward in the _Passage_, that it is ready for _BIRTH_, and only impeded by the rigid or stiff MEMBRANE; then _she_ has just Authority to break it gently with her _Nails_ and _Fingers_; taking Care in the ACT not to draw the MEMBRANE towards _her_, because thereby the SECUNDINE (of which the MEMBRANE, tho’ distinguish’d from the PLACENTA, is in Effect, but the _Thinner Part_) would be untimely separated from the WOMB, and the _INFANT undone_, unless presently _Born_. BUT the _MIDWIFE_, after All, must always remember, not to attempt _This_, before these mentioned _Signs_ are obvious to her TOUCH; otherways the WATERS being too soon discharged, the _CHILD_ is left behind, the _Passages_ grow dry, and _that_ which might have been an _Easy_ and _Speedy_, proves a _Difficult_ and _Lingring BIRTH_.