990 / DR. CHASE'S BECIPE8. 



arm gently down across the front of the chest by hooking her finger into the bend 

 of the elbow. The same manceuvre is repeated with the other arm. The head will 

 then be the only part remaining unborn. It is possible that, now that the arms 

 have been brought down, the efforts of Nature may be equal to the task of 

 expelling the head. Should the pains, however, prove ineffectual, the nurse 

 may render further assistance by pressing with the fingers of one hand against 

 the back of the child's head and so tilting the head forwards, while with the 

 two first fingers of the other band, placed 'one on each side of the nose, she 

 endeavors to draw down the face. This plan is generally preferable to the one, 

 not unfrequently adopted, in which traction is made by placing the fingers in 

 the child's mouth. In all breech-cases a warm bath should be in readiness, in 

 the event of the child requiring to be resuscitated. 



The child, having been now separated, is to be wrapped in the receiver, 

 with the face alone exposed, aod placed out of harm's way on the other side of 

 the brxi. The patient must b^ warned to lie perfectly still, and to wait patiently 

 for tte one or two insignificant pains which accompany the expulsion of the 

 after birth. These genernlly occur from five to twenty minutes after the birth 

 of the child. Meanwhile the nurse must provide the medical attendant with a 

 basin or other vessel, previously warmed before the fire, to receive the after- 

 birth, and one or two wavm napkins. 



Should the medical attendant, however, be still absent, the nurse must 

 place her hand upon the abdomen of the mother and ascertain whether there is 

 another child. If she should find such to be the case, she must convey the 

 news to the mother very cautiously, assuring her that the second child will be 

 bora with much less pain than the first. If there is no second child to be felt, 

 the nurse will do well to keep her haad laid upon the mother's abdomen until 

 a slight pain occurs, when she must spread out her hand like a fan and gently 

 prers the uterus so long as the pain continues. Meantime, she is to hold a suit- 

 abh vessel in her left hand ready to receive the placenta when it is expelled, 

 taking care on no account to pull the cord. Sometimes the placenta and mem- 

 branes are expelled during the first pain; more frequently two or three pains 

 occur before this takes place. 



If the uterus can be felt, under the hand, hard, firm, and as small as a good- 

 ti^zed cricket-ball, the placenta, if it has not already made its appearance, will 

 in all probability be found lying in the vagina. In order to make sure about 

 this, the hand may be withdrawn from the front of the abdomen, and the fore- 

 finger passed gently up by the side of the cord. If the insertion of the cord 

 into the after-birth can be easily and distinctly made out, it is pretty certain 

 that the placenta has escaped from the uterus into the vagina, and it may, there- 

 fore be carefully hooked down with the finger. As the placenta passes out, it 

 is a good precaution to twist it round once or twice, so as to make a wisp of 

 the membrane and bring them all away at the same time. A slight discharge 

 of clotted and fluid blood usually accompanies the termination of the third 



When the placenta and membranes have come away, the hand should again 

 be placed over the uterus, in order to make sure that it is firm and well cob- 



