MANAGEMENT OF LABOR. 355 



tural processes. When the head sinks into the excavation ahnost 

 immediately after the evacuation of the waters, we endeavor to 

 make it deviate to the right or left, in the intervals between the con- 

 tractions, by passing two or three fingers up in front of the sacrum. 

 During the pain, we prevent it from returning to its original posi- 

 tion, by leaving the fingers, with which we displaced it, betwixt it 

 and the median line; these attempts are repeated as often as they 

 may be deemed necessary, and if we cannot always succeed in con- 

 verting the fourth or fifth positions of Bandelocque into the first or 

 second, we are at least sure that we occasion the mother and child 

 both, no additional hazard where the maneuvre is properly execut- 

 ed. The perineum is in more danger of being lacerated in this than 

 any other position; in order to support it efficiently, we should take 

 care not to incline the hand too much forwards, for the point of the 

 head would fall almost perpendicularly upon it, and would rather 

 turn backwards towards the anus than glide in the direction of the 

 vulva. This is the situation in which M. Flamant's precept is espe- 

 cially applicable. 



836. Face positions. Although the face positions do not render 

 delivery much more difficult than those of the vertex, yet, as they 

 are less exactly according to nature, it is always prudent, where it 

 appears easy to do so, to change them into positions of the vertex. 

 It can no longer be thought of after the head has once reached the 

 excavation; it should be attempted while it is still movable at the 

 superior strait, and that in two difierent ways: we may either try, 

 with two fingers, to push the chin towards the breast by acting on 

 the forehead, or we may endeavor to hook the occiput, to draw it 

 down and produce the same effect. In both cases we leave the 

 fingers in place until a contraction comes on, so as to transfer to 

 the occipital branch of the lever represented by the head, the power 

 that previously acted upon the facial or anterior branch of it. 

 It would be particularly important to efliect this conversion in the 

 mento-sacral position, if it should ever be met with. Further, 

 where the face emerges first, it is not so easy to support the peri- 

 neum as it is in the vertex positions; but the rupture of the peri- 

 neum is the less to be feared, because the front of the neck, and not 

 the bregma, presses against the lower edge of the symphysis, while 

 the upper oval of the head passes along the perineum to reach the 

 vulva. The hand ought therefore to press but moderately, and not at 

 all until the forehead is without; otherwise we might increase the dan- 

 ger to which the foetus is exposed, or at least interfere with the ter- 

 mination of the labor. 



837. Inclined positions of the head. When the whole forehead, 



