458 DYSTOCIA. 



feet are still at the superior strait, or in the vagina; 2. The delivery, 

 if left to the natural powers, may be complicated with no accident, 

 or give no evidence of requiring the assistance of the hand, until the 

 lower extremities, or even the hips are born; 3. Turning has been 

 attempted on account of some position of the head or trunk, the 

 feet have been brought down, but the operator has failed to make 

 the occiput turn in front. 



1032. Let us here suppose the first hypothesis: after having got 

 hold of the limbs in the manner heretofore mentioned, the back 

 ought to be directed first towards the sacro-iliac symphysis or iliac 

 fossa, then towards the acetabulum; with each pull, as the hips 

 approach the perineal strait, they are taken in both hands, and in the 

 interval betwixt two pains the whole trunk is pushed upwards again, 

 as if we wished to make it mount up above the superior strait; as 

 soon as the womb, which is thus momentarily distended, appears t% 

 be about to contract, the pelvis should be suddenly pulled down, 

 •while at the same time we endeavor to make the body of the child 

 revolve on its axis; in this way, says Baudelocque, the cavity of the 

 womb is first enlarged, and as we endeavor in the next place to 

 empty it suddenly, the organ is in some measure surprised, and can 

 not contract so fast as to prevent the head from following the turn 

 we give to the body. These attempts are to be renewed from one 

 to ten and even fifteen times, according to the necessity of the case, 

 that is, until the anterior position has taken place of the posterior 

 one, or until the impossibility of effecting the change is ascertained; 

 when the attempt proves unsuccessful, no particular difficulties re- 

 main, and the rest of the manoeuvre is the same as in feet presenta- 

 tions in general. 



When all hope of succeeding is abandoned, we must even be 

 resigned to let the face came along uppermost; we must redouble 

 our precautions against letting the chin depart from the breast; the 

 arms should be disengaged, the hindermost one first, by pulling, them 

 from behind forwards, and in a direction from the head towards the 

 thorax; immediately after this, two or three fingers of each hand 

 should be applied to the two extremes of the occipito-mental diame- 

 ter; we should endeavor to push the head upwards, or raise it so 

 as to give it more freedom, and finally, make it execute a pivot 

 movement, by which the face is gradually carried backwards. 



Supposing it should be found impossible to turn the occiput in 

 front, the shoulders and chest should be pulled downwards, and 

 rather backwards than forwards, so as to deliver the chin, the fore- 

 head, and anterior fontanel before the occiput; if these tractions 

 should prove incompetent, the forceps should be had recourse to. 



