PRESENTATIONS OF THE SUPERIOR EXTREMITIES. 



89 



kept distended, and the child turned with as great facility as in a 

 " bucket of water." 



The act of turning should be accomplished during an interval of 

 pain, thus the danger of rupturing the womb will be avoided. Ex- 

 ternal pressure with the unoccupied hand favours the version very 

 considerably, and should never be neglected. In turning the child, 

 the feet should be brought over the front of the child, and not over 

 the back, thus avoiding dislocation of the spine. 



The extraction of the child should be accomplished durmg a 

 pain, always remembering the axis of the pelvis, and being careful 

 not to place the foetus in a wrong position, but endeavouring to 

 make the face fall into the hollow of the sacrum. The case is now 

 a footling one. When the membranes are ruptured, and the waters 

 drained off, additional care is necessary not to force the uterus, but 

 to endeavour to promote relaxation by the proper means, and above 

 all to use gentleness in overcoming the contractions. 



It is considered advisable by some practitioners to turn by one 

 foot only, inasmuch as the breech with the thigh turned up, is more 

 bulky than the hips with 



the thigh extended; the Fig. 30. 



passage will be better 

 prepared to admit the 

 quick transit of the 

 child's head, upon which 

 the safety of the infant 

 depends. After the case 

 has been converted into 

 a footling, it should be 

 treated as though it were 

 so originally, that is, left 

 as far as possible to 

 the natural expulsive 

 powers. 



Version in cephalic 

 'presentations^ is accom- 

 plished by the same me- 

 thod of proceeding : the 

 same rules applying for 

 the choice of the hand, 

 &c., as in shoulder pre- 

 sentations. This opera- 

 tion sometimes becomes 



necessary in hemorrhages before delivery, either accidental or un- 

 avoidable ; convulsions ; prolapsus of the cord ; syncope, &c., thus 

 converting, what would otherwise have been a natural, into a pre- 

 ternatural labour. (Fig. 30.) 



8* 



