27. The craft of midwifery.
Midwifery is a craft that shows how to proceed in bringing the new-born child gently out of the womb of his mother and how to prepare the things that go with that. It also shows what is good for (a new-born child), after it is born, as we shall mention. The craft is as a rule restricted to women, since they, as women, may see the pudenda of other women. The woman who exercises this craft is called midwife (qabilah, literally, "the woman who receives"). The word implies the meaning of giving and receiving. The woman in labor in a way gives the embryo to the midwife, and the latter receives it.
This is as follows: When the embryo has gone through all its stages 140 and is completely and perfectly formed in the womb - the period God determined for its remaining in the womb is as a rule nine months - it seeks to come out, because God implanted such a desire in (unborn children). But the opening is too narrow for it, and it is difficult for (the embryo to come out). It often splits one of the walls of the vagina by its pressure, and often the close connection and attachment of (its) covering membranes with the uterus are ruptured. All this is painful and hurts very much. This is the meaning of labor pains. In this connection, the midwife may offer some succor by massaging the back, the buttocks, and the lower extremities adjacent to the uterus. She thus stimulates the activity of the (force) pushing the embryo out, and facilitates the difficulties encountered in this connection as much as she can. She uses as much strength as she thinks is required by the difficulty of (the process). When the embryo has come out, it remains connected with the uterus by the umbilical cord at its stomach, through which it was fed. That cord is a superfluous special limb for feeding the child. The midwife cuts it but so that she does not go beyond the place where (it starts to be) superfluous and does not harm the stomach of the child or the uterus of the mother. She then treats the place of the operation with cauterization or whatever other treatment she sees fit.
When the embryo comes out of that narrow opening with its humid bones that can easily be bent and curved, it may happen that its limbs and joints change their shape, because they were only recently formed and because the - substances (of which it consists) are humid. Therefore, the midwife undertakes to massage and correct (the new-born child), until every limb has resumed its natural shape and the position destined for it, and (the child) has again its normal form. After that, she goes back to the woman in labor and massages and kneads her, so that the membranes of the embryo may come out. They are sometimes somewhat late in coming out. On such an occasion, it is feared that the constricting power (muscle) might resume its natural position before all the membranes are brought out. They are superfluities. They might become putrid, and their putridity might enter the uterus, which could be fatal. The midwife takes precautions against that. She tries to stimulate the ejection, until the membranes which are late in coming out come out, too.
She then returns to the child. She anoints its limbs with oils and dusts it with astringent powders, to strengthen it and to dry up the fluids of the uterus. She smears something upon the child's palate to lift its uvula. She puts something into its nose, in order to empty the cavities of its brain. She makes it gargle with (swallow) an electuary, in order to prevent its bowels from becoming obstructed and their walls from sticking together.
Then, she treats the woman in labor for the weakness caused by the labor pains and the pain that the separation causes her uterus. Although the child is no natural limb (of the mother), still, the way it is created in the uterus causes it to become attached (to the body of the mother) as if it were an inseparable limb (of her body). Therefore, its separation causes a pain similar to that caused by the amputation (of a limb). (The midwife) also treats the pain of the vagina that was torn and wounded by the pressure of (the child) coming out.
All these are ills with the treatment of which midwives are better acquainted (than anyone else). We likewise find them better acquainted than a skillful physician with the means of treating the ills affecting the bodies of little children from the time they are sucklings until they are weaned. This is simply because the human body, at this stage, is only potentially a human body. After (the child) is weaned, (its body) becomes actually a human one. Then, its need for a physician is greater (than its need for a midwife).
One can see that this craft is necessary to the human species in civilization. Without it, the individuals of the species could not, as a rule, come into being. Some individuals of the species may be able to dispense with this craft. God may arrange it for them that way as a miracle and extraordinary wonder. This, for instance, may be done for the prophets. Or there may be some instinct and guidance given to the child through instinct and natural disposition. Thus, such children may come into existence without the help of midwives.
The miraculous kind (of births) has often occurred. It has, thus, been reported that the Prophet was born with the umbilical cord cut and circumcised, placing his hands upon the earth and turning his eyes toward heaven. The same applies to Jesus (who spoke) in the cradle,141 and other things.
The instinctive kind (of births) is not unknown. Since dumb animals, such as, for instance, bees and others 142 have remarkable instincts, why should one not assume the same for man who is superior to them, and especially for those human beings who are singled out by acts of divine grace? Furthermore, the common instinct of new-born children that causes them to seek their mother's breast is a clear testimony to the existence of an instinct in them. The ways of divine foresight are too great to be grasped completely.
This explains the incorrectness of the opinion of alFarabi and the Spanish philosophers. They argue for the non-existence of (the possibility) of a destruction of the various species (of beings) and the impossibility of an end of created things, especially of the human species. They say that once there has been an end to (the existence of) individuals of (the human species), a later existence of them would be impossible. (Their existence) depends upon the existence of midwifery, without which man could not come into being, since even if we were to assume that a child might (come into existence) without the help of this craft and without being taken care of by (this craft) until it was weaned, still, it could certainly not survive. (For not only midwifery but also other crafts are needed. However,) the crafts cannot possibly exist without the ability to think, because they are the fruit of thinking and depend on it.
Avicenna undertook the refutation of this opinion, because he was opposed to it and admitted the possibility of an end of the various species (of beings) and of the destruction of the world of creation and its subsequent re-establishment as a consequence of astronomical requirements and strange (astral) positions which, he thought, take place rarely over very long intervals of time. It requires the fermentation, with the help of appropriate heat, of a kind of clay that corresponds to the temper of (the being to be created). Thus, it comes to be a human being. Then, an animal is destined for that human being. In that animal, an instinctive (desire) is created (which is directed) toward bringing that human being up and being kind to him, until he exists fully and is weaned. Avicenna explained this lengthily in the treatise which he entitled the Treatise of Hayy b. Yaqzan.143
His argumentation is not correct. We agree with him in regard to the (possibility of the) end of the various species (of beings), but not on the basis of his arguments. His argumentation depends on relating actions to a cause that makes (them) necessary. The theory of the "voluntary agent" 144 is a proof against him. According to the theory of the "voluntary agent," there is no intermediary between the actions and the primeval power, and there is no need for such (a difficult) task. If we accepted (Avicenna's argumentation) for the sake of the argument, (we might say that) it is saying no more than that the continued existence of the individual is the consequence of the instinctive desire to bring him up which has been created in dumb animals. What, then, would be the necessity that might call for (such a procedure), and further, if such an instinctive desire can be created in a dumb animal, what would prevent its creation in the child itself, as we (for our part) assumed at the beginning? It is more likely that an instinct directed toward his own interests is created in an individual than that one directed toward the interests of someone else is created in (someone). Thus, both theories (that of al-Farabi and that of Avicenna) prove themselves wrong in their particular approach, as I have established.
God is "the Creator, the Knowing One." 145