PRESENTATIONS OF THE SUPERIOR EXTREMITIES. 



87 



Right shoulder. — First position. — The head of the child is to the 

 left of the mother, the back of the child is towards the front of the 

 mother, (dorso-pubic,) and the face of the child with its toes and 

 feet look towards her back. (Fig. 27.) 



Second j^osition. — The head of the child is to the right of the 

 mother, the back of the child towards the back of the mother, (dorso- 

 sacral,) and the face 



m^^ front of the child Fig. 28. 



look towards the front 

 of the mother. (Fig. 

 28.) 



Left shoulder. First 

 position. — The head 

 is on the left^ the face 

 and fro?it of the child 

 look forwards, and the 

 back is to the back of 

 the mother, (dorso-sa- 

 cral of the left.) 



Second position . — 

 The head is to the 

 right, the face and 

 fro7it of the child 

 look backwards, and 

 the back is towards 

 the front of the mo- 

 ther, (dorso-pubic of 

 the left.) 



Treatment. — Hav- 

 ing ascertained that 

 the case is a shoulder presentation, the indications are to deliver by 

 the operation of turning, or version ; by which is understood " the 

 act of turning the child with the hand, and bringing one of the ex- 

 tremities of its great diameter to the superior strait." (Velpeau.) 



There are three varieties of this operation described by obstetrical 

 writers : First. Version by the head, in which the presenting part is 

 pushed away, and the head substituted for it ; the r^njainder of the 

 labour being left to nature. Second. Version by th^%reech. — Where 

 the pelvic extremity of the child is substituted for the presenting 

 part, and the case converted into a breech labour. Tliird. Version 

 by the feet, in which the hand is introduced into the cavity of the 

 uterus, one or both feet seized and brought down, causing the child 

 to make a complete evolution, and extracting it footling. (Fig. 29.) 

 The first and second methods, although safest for the child, are rare- 

 ly employed, in consequence of the difficulty of seizing and moving 



