PARTUEITION 279 



difficulty will be aggravated by the straining, -which, while forcing the 

 breech backward into the pelvis, causes the hind-limbs to be moved farther 

 forward at the same time, thus adding to the already serious difficulty 

 of the case. Here " the rational indication is, of course, to extend the 

 limbs of the foetus backwards, as in ordinary breech presentation (fig. 

 551), and to give these and the body a direction in harmony with the 

 axis and dimensions of the pelvic inlet, so that birth may be efi'ected Ijy 

 the combined efforts of the mother and the obstetrist ". But this indica- 

 tion is often most difficult to fulfil, though in some instances it is possible 

 when labour is not too advanced, and when the foetus, still in the 

 abdominal cavity, is movable, and can be pushed sufficiently from the 

 inlet to allow the lower part of the limbs to be seized and Inought into 

 the vagina. 



Pushing the foetus as far into the abdomen as jaossible, one of the limbs 

 is seized above the hock, and the thigh fiexed as completely as circum- 

 stances will permit, by lifting that joint towards the mother's sacrum. 

 Still pushing the foetus off" by means of the repeller or crutch, the hand 

 is passed down to the hoof until the toe is reached and enclosed in the 

 palm; by adopting this precaution danger of injury to the uterus or vagina 

 is averted. Then the foot is brought into the passage by flexing all the 

 joints on each other. Again, pushing the foetus forward, the same 

 manoeuvre is repeated with the other limb, if necessary, and delivery is 

 proceeded with. 



MALPOSITION OF THE HEAD 



Neck Presented, Two Fore- Limbs in the Passage.— The diffi- 

 culty in bringing about a natural presentation in this case will be in 

 proportion to the backward displacement of the head. 



Should this be slight, it may only require that the hand l»e j^assed 

 under the chin or into the mouth, and the head raised into the passage. 

 Where, however, the neck is much bent, and the head carried under 

 the brisket with the poll firmly fixed against the pelvic brim (fig. 554), 

 considerable difficulty will be experienced in restoring the parts to their 

 proper position. 



The first requirement will be to push the body backwards by means 

 of a powerful arm, or failing in this, crutches ajjplied to the front of the 

 shoulders. By doing this, room will be provided for the forward movement 

 of the head. An attempt must now be made to raise the latter by seizing 

 such parts as come within reach to which traction may be applied. The 

 ears will be first accessible, or blunt hooks (fig. 557) may be inserted 

 into the orbits, or passed behind the lower jaw or into the angle of the 



