356 EUTOCIA. 



or one side of it, the anterior fontanel, one of the parietal protuber- 

 ances, the upper part of the nucha, the chin, or one of the cheeks 

 is substituted for the frank vertex or face positions, they do not 

 always prevent the delivery from being spontaneous, because the 

 woman's efforts generally succeed in causing the occiput or face to 

 descend. Nevertheless, as these intermediate or bastard positions 

 may to a certain extent embarrass the progress of the pains, or of the 

 labor in general, we ought, as soon as they are discovered, to attempt 

 to change them to the regular positions to which they correspond. 

 As long as the head continues at the superior strait, and the womb is 

 not too strongly contracted upon the body of the child, we might 

 hope, by introducing a couple of fingers behind, in front, or on the 

 sides of the occiput, to bring it back to the centre of the strait, or at 

 least, if we could do no better, force it to enter fairly with the face 

 in the opening. 



838. Presentations of the feet. In maintaining that footling labors 

 commonly terminate without assistance, I did not mean to have it in- 

 ferred that we must never touch the foetus in any way until it is com- 

 pletely expelled; but merely, that it is unnecessary, and even dan- 

 gerous, to exert any tractive force upon it. 



As soon as the legs appear, they should be supported, after wrap- 

 ping them in a napkin; the same is to be done with the hips, the 

 arms, the breast and shoulders; when only the head remains in the 

 excavation, we place a couple of fingers on the chin, in the mouth, 

 or what is still better, on the sides of the nose; two or three fingers 

 of the other hand are slid under the symphysis pubis, so as to sup- 

 port the occiput, and as soon as the least contraction comes on, we 

 draw the whole downwards in the direction of the axes of the in- 

 ferior strait and vulva, as if we were trying to turn the child's back 

 up over the mons veneris, and upon the hypogastrium of the mo- 

 ther. 



839. The head now having nothing to pass through except the 

 perineal strait, is beyond the influence of the uterus, and may be 

 extracted without difficulty; but while ever it has not traversed the 

 uterine orifice, or the abdominal opening of the pelvis, the least at- 

 tempt to accelerate its escape could tend only to produce a case of 

 real dystocia. As to the perineum, it is easily managed, since it 

 depends upon the accoucheur to pull the head with more or less 

 force, or to incline it more or less forwards, as it passes through the 

 vulva. 



840. Presentations of the knees. The knees present very ievr 

 peculiar indications; if they present in a regular position, they should 

 be allowed to come down of themselves, and when they reach the 



