MANAGEMENT OF LABOR. 357 



vulva, all we have to do is to assist in disengaging the legs. If one 

 of them assumes a bad direction, lodges against some part of the pel- 

 vis, or is arrested by the cervix or some fold in the vagina, it is com- 

 monly disengaged without difficulty, and brought alongside of the 

 other one. For the remainder we are to act as in feet presentations, 

 taking care not to pull unnecessarily. 



841. Presentations of the breech. AVhen the buttocks descend 

 first, and the feet tend to engage at the same time, it is sometimes 

 well to push the latter back, and keep them somewhat raised during 

 several pains; if not, there is nothing to be done until they get to 

 the bottom of the excavation. It is in this state improper to pull at 

 the breech except during the contractions of the womb ; if, how- 

 ever, its size is very great, and there should be some difficulty in its 

 passing through the vulva, the finger hooked into the groin that is 

 towards the sacrum may be of some service by enabling us to give 

 timely assistance to the woman's efforts. The hips are scarcely 

 delivered before the constriction they had experienced is transferred 

 to the child's belly. It is important then to pull on the thighs and 

 legs, which should be extended in order to diminish this dangerous 

 compression; the management of the rest of the labor is in all re- 

 spects similar to that required where the feet or knees present. As 

 the buttocks are escaping from the inferior strait, they sometimes 

 distend the perineum as much as the head does when it comes first; 

 but as they are much softer, and the flexibility of the trunk admits 

 of their accommodating themselves much more easily to the direction 

 of the axes as well as to the forms of the spaces they are obliged 

 to traverse, they much more rarely occasion a laceration; so that 

 in such cases it is not always indispensably necessary to support the 

 perineum. 



842. In oblique positions of the breech we must act as in \\\e in- 

 clined positions of the head; we must endeavor to restore them to 

 a correct state : if the posterior surface of the coccyx and point 

 of the sacrum are in the centre, the woman should be directed to 

 lie down early; she should be made to lie as much as possible on 

 the back, while the hand applied to the hypogastrium pushes the 

 womb backwards and upwards; if this precaution should not suffice, 

 we might, with a couple of fingers of the other hand, hook the 

 isohia and draw them down into the strait. If one of the buttocks 

 engages alone, with or without the corresponding hip, it should be 

 raised up during the absence of the pains, or we should try to reach 

 it directly, by passing some of the fingers up along its external sur- 

 face. 



Where, instead of one buttock or the coccyx, we meet with the 



