88 



OBSTETRICS. 



Fig. 29. the parts mentioned into 



a more favourable condi- 

 tion. The third is the 

 mode of practice gene- 

 rally adopted, and al- 

 though more dangerous 

 to the child, it is safest 

 for the mother, since it 

 gives the attendant more 

 complete control of the 

 case. It is the mode of 

 delivery now almost uni- 

 versally adopted, both in 

 this country and Europe. 

 Method of procedure. 

 — The operation ought 

 never to be attempted 

 till the OS uteri is dilated, 

 or dilatable ; the fittest 

 moment is when the os 

 uteri is fully dilated and 

 the membranes unrup- 

 tured. If the OS uteri is 

 rigid and unyielding, the proper means of relaxing it should be first 

 adopted ; the rectum and bladder should also be thoroughly evacu- 

 ated, and the position carefully ascertained. 



The patient should be placed in the position most convenient to 

 the operator ; some recommend that on the back, with the hips on the 

 edge of the bed, and the knees supported by assistants; some on the 

 hands and knees ; others prefer the ordinary position on the left side. 

 The choice of the hand depends on the position : the rule is, use that 

 hand ivhose palm, ivhen opened in the cavity of the womb, looks 

 towards the abdomeji of the child. Some recommend the use of the 

 right or left hand, according as either is most convenient. It should 

 be well oiled on the outside, and introduced in a conical form, into the 

 vagina, during a pain ; it will then be ready to enter the os uteri as 

 soon as the pain goes off. The presenting arm is never an impedi- 

 ment, and should not be removed. 



When the membranes remain unruptured, the hand should be 

 gently insinuated between them and the uterus, until the feet, (or 

 one foot,) are found, always stopping and opening the hand on the 

 accession of a pain. 



Be certain that it is a foot that is seized. Noiv rupture the mem- 

 branes and draw the feet, or foot, with a waving motion, slowly into 

 the pelvis. By this- method the liquor amnii is retained, the uterus 



