PELVIS PRESENTATIONS. 457 



acetabula; the operator can also pull with all the force that circum- 

 stances may require, an advantage not to be obtained by adopting an 

 inverse order in the application of the hand. 



Whenever, therefore, it is intended to deliver in the first position 

 of the feet, that is, whenever the child's back shall look more or less 

 towards the left of the pelvis, or even directly towards the pubis or 

 sacrum, the left hand should be introduced; and the right hand in all 

 the other cases. 



A. Positions of the Feet. 



1030. Inasmuch as the positions of the feet previously to the rup- 

 ture of the membranes, are scarcely distinguished from those of the 

 breech, there can hardly be any question concerning them until after 

 this rupture. The accoucheur then may be called under two diffe- 

 rent circumstances, which it is important that he should not confound 

 with each other: either the feet have not cleared the vulva, or the 

 trunk has more or less completely emerged. 



In the former case, if the two feet present together at the orifice or 

 in the vagina, all he has to do is to take hold of them and draw them 

 down so as immediately to extend the legs, and that the hips may 

 soon arrive at the inferior strait; provided only one of them can at 

 first be found, some attempts should be made to discover the other, 

 which it is rarely difficult to do; should the attempt not succeed, the 

 first one should be brought down, then secured by a fillet, and made 

 use of as a guide to the second, which may perhaps be found reversed 

 towards the breech, moved off far in a state of abduction, or with the 

 leg and thigh doubled up on the belly, &c. 



In the latter case, the presence of the feet offers no particular 

 indication; nothing is to be done, as was mentioned in speaking of 

 turning in head positions, but to pull the different parts that are 

 still unexpelled downwards. 



A very necessary precaution, when extracting a child by the feet, 

 is, to act in such a way that at the moment when the child is passing 

 the straits, the occiput may look towards some part of the anterior 

 semicircumference of the pelvis. The thing is easy; and no skilful 

 practitioner will ever fail in bringing it about, when he goes in 

 search of the feet in a head or trunk presentation. But it is no 

 longer the case where the pelvis presents spontaneously at the supe- 

 rior strait; mistimed or unskilful tractions may have been instituted 

 in his absence, or when he reaches the bed-side of the patient the 

 hips may have been already expelled and the face turned in front. 



1031. The position of the feet where the child's dorsal surface 

 looks backwards may give rise to three particular cases: 1. The 

 40 



