PELVIS PRESENTATIONS. 459 



1033. In the second case, provided the head has not as yet arrived 

 at the straits, we should act as in the first case, that is, the fcetus 

 should be pushed upwards every time we wish to give the body a 

 turn; but we must expect to succeed still more rarely. 



1034. In the third, these attempts are of no use; we may ne- 

 glect them altogether, and immediately disengage the arms if it be 

 not already done; we then conform, as to the head, to the principles 

 established higher up: some of the fingers must be applied to the 

 chin, which we endeavor to turn from right to left, while with the 

 other hand we act on one of the shoulders or the occiput, so as 

 to favor the complete rotation of the head and trunk, and then 

 proceed to deliver. 



B. Position of the Breech. 



1035. As the knees occasion no difhculty, by their presentation 

 merely, in delivering a lying-in woman; as their presence does not 

 at all alter the principles, nor even the practical details of the ma- 

 noeuvre; as one or more fingers are all that is required to disengage 

 them, or give them a regular position when in the vagina; and lastly, 

 inasmuch as, where this presentation does not return into the class 

 of breech presentations, it is always an easy matter to reduce it 

 among the presentations of the feet, I shall not devote a special arti- 

 cle to the consideration of it, but shall pass at once to the considera- 

 tion of breech presentations. 



1036. The left hand should be preferred in breech presentations, 

 as in those of the feet, whenever the back is turned more or less to 

 the left, and vice versa for the right hand. The child being doubled 

 up, with the thighs and legs raised up along the abdomen, if the 

 hips have cleared the orifice of the womb and descended into the 

 excavation, or even to the inferior strait, the groin that is most 

 backwards should be hooked with a finger or two, while the thumb 

 of the same hand is applied to the outer surface of the anterior hip. 

 If any resistance is experienced, there will be some advantage in 

 substituting one or two fingers of the other hand for the thumb, 

 and if that will not answer, the blunt hook should be made use of. 

 As soon as the hips have cleared the vulva, it is generally very easy 

 to extend the limbs, and the rest of the process is merely a footling 

 delivery. 



1037. Previously to the rupture of the membranes, and where 

 the breech is not yet so far engaged as to render it impossible to 

 push it up again above the superior strait, whether the fcetus be dou- 

 bled up or merely in a squatting attitude, we should always endeavor 

 to bring down the feet. 



1038. In order to push the breech up, the hand is placed under it 



