USE OF THE FORCEPS. 473 



1064. Thus the forceps may be applied to the head when the ver- 

 tex or the forehead comes first, and even when the trunk escapes be- 

 fore the head. 



To render this application indispensable, it is necessary: 1. That 

 the head shall not require to be reduced more than two or three 

 lines, or that it shall be possible to displace it, and direct it more ad- 

 vantageously through the straits; 2. That there shall be a pressing 

 need for terminating the labor without delay, or that no further re- 

 liance can be placed on the powers of the woman in the expulsion of 

 the child; 3. That the head shall be engaged so far that it would be 

 impossible without difficulty to return it and proceed in search of 

 the feet; 4. That the membranes shall have been ruptured and the os 

 uteri completely dilated for a greater or less period of time. 



1065. Previously to commencing the operation the same precau- 

 tions should be taken as for turning: the woman should be situated 

 in the same manner; however, there may be circumstances in which 

 the accoucheur need not alter her position; for example, in case of 

 convulsions, hemorrhage, or extreme debility, indeed any circum- 

 stances which would render any shock or movement dangerous; 

 but then the head must have cleared the abdominal strait, in which 

 case a short forceps may be made use of, such as Smellie's, for ex- 

 ample. 



The posture on the side adopted by the English for spontaneous 

 delivery is also preferred by them as most favorable for the applica- 

 tions of the forceps, which I can hardly conceive of. 



As it is wrong to iutroduce the forceps into a woman's organs, 

 without advertising her of it, I think the best mode of quieting and 

 reassuring her is to show her the mechanism of the instrument. 



There should be in readiness some warm water to attemper the 

 instrument; and some butter, oil, or mucilage, to make it slip more 

 easily over the surfaces; when every thing is properly disposed of, 

 and the position of the head has been ascertained, nothing remains 

 but to introduce the blades; but as there is some difference in this ma- 

 noeuvre, according as the occiput is directed in this or that manner, as 

 the head descends before or after the trunk, I shall now proceed to 

 examine these different cases. 



§. I. Occipito-anterior Position. 



1066. This position, the most advantageous, and most frequent of 

 of all, requires that the left branch should be introduced first. Two 

 or three fingers of the right hand, in a flattened position, are to be 

 passed up betwixt the left side of the vagina and the parietal protu- 



41* 



