354 EUTOCIA. 



proper, it is even important, as soon as the parietal protuberances 

 have passed the level of the tuberosities of the ischia, to engage 

 the woman to moderate her efforts, instead of exciting her to bear 

 down more and more, as is too commonly done. This is the moment 

 that the parts, being surprised, or astonished, are lacerated, if the 

 head, pressed too rapidly forwards, does not give them time to yield 

 and mould themselves by it. Therefore, the slower the progress 

 of the head, the greater will be the chance of preserving the perineum 

 uninjured. 



I am far from saying that laceration of the perineum is in all cases 

 a serious accident; on the contrary, I believe it to be very rarely 

 dangerous; but the accoucheur ought nevertheless to do all he can 

 to prevent it from occurring; and I cannot too strongly condemn the 

 negligence, in respect to it, of which most of them are culpable. 

 If it be not in our power to prevent the woman from suffering, it is 

 at least a duty to preserve the natural form of her organs as far as 

 possible. The wound will heal up, no doubt; but the dimensions 

 of the external orifice of the vagina remain too large, and we cannot 

 divine what distress may be indirectly produced by this accident, 

 though in appearance a slight one. 



834. To support the head of the fcetus . As soon as the head has 

 passed out of the vulva, it should be supported by both hands; the 

 fingers being separated, are applied under the occiput, the ear, and 

 lower jaw on each side, being careful not to prevent the act of re- 

 stitution from taking place. Rigorously speaking, we might dis- 

 pense with any tractive effort; for the remainder of the foetus is 

 often expelled with the same pain that delivers the head; or else 

 another pain soon comes on to complete the delivery; however, as 

 there is no advantage to be derived from retarding the termination 

 of the labor, and the woman has nothing so much at heart as to 

 be prompdy delivered, it is best to follow up the impulsion given by 

 the womb, and whilst it is still contracting, to draw very prudently 

 and moderately upon the head or armpits, in the axis of the inferior 

 strait. 



The conduct I have just above indicated is particularly applicable 

 in the three true varieties of the occipito-anterior position. It may, 

 and indeed ought to be slightly modified in most of the other presen- 

 tations. 



835. Occipito-posterior position. When the occiput looks to- 

 wards the back part of the pelvis, delivery being in general more 

 difficult, it is natural that we should profit by its tendency to turn for- 

 wards, in order that we may by degrees convert it into an anterior 

 position, in which we may sometimes succeed by imitating the na- 



