PELVIC PRESENTATIONS. 81 



dant should not draw down the feet, as the inexperienced are too apt 

 to do, in the hope of facilitating the delivery by having something to 

 pull upon ; this practice always diminishing the size of the dilating 

 part, and thus prolonging the labour. As the breech escapes, it 

 should be supported and carried upwards in the axis of the pelvis, 

 allowing it perfect liberty to change its position or make such turns 

 as the mechanism may require. Mechanical assistance is rarely 

 required in these cases, the child adapting itself to the passages of 

 the mother. 



When the umbilicus appears at the external organs, the cord 

 should be seized and gently drawn down and pushed down to one side; 

 this will prevent its being torn and pressed upon. 



The strength of the pulsations in the cord^ is the best evidence we 

 have of the necessity for ajiy interference. 



When the thorax has emerged, if the arms have not escaped with 

 it, they should be brought down by passing one or two fingers over 

 the shoulders, as near as possible to the elbow, and then drawing 

 the arm across the face and chest until the elbow arrives at the ex- 

 ternal orifice; having delivered one, the other is easily extracted. 

 It is generally better to deliver the one at the perineum first. 



The slower the pelvis and body pass out, the quicker will the head 

 pass, and the greater will be the chance of saving the child's life. 



The body being born, it should be wrapped in warm flannel, and 

 raised upwards on the practitioner's arm, to a height sufficient to 

 enable the longest diameter of the head to become parallel with the 

 axis of the vagina, and the patient urged to bear down. 



If the head be delayed while in the vagina there is danger of 

 losing the child ; the extent of this danger will be estimated by the 

 pulsation in the cord. As in most cases the head will be found with 

 the face in the hollow of the sacrum, the delivery may be hastened 

 by introducing one or two fingers of the left hand into the mouth, 

 and depressing the chin upon the breast, at the same time carrying 

 forward the body of the child. (Fig. 24.) 



If this fail, the perineum should be pressed back so as to allow the 

 atmospheric air to enter to the respiratory organs. The child, in 

 this way, may be saved till the expulsive efforts effect the delivery. 

 Should these means fail, and the child be in danger, the forceps 

 should be at hand, and the child be delivered by their assistance. 



If it should happen that the body is expelled with the face ante- 

 riorly, and the chin should lodge upon the pubes, it should be carried 

 hackivards^ and the chin drawn down by the finger introduced into 

 the mouth. The remainder of the delivery and the after treatment, 

 are the same as in vertex presentations. , 



Tresentations of the inferior extremities. — What has been said in 

 relation to the danger of breech presentations, applies with even 

 more force to those of the lower extremities. In this latter case the 



