OCCIPITO-ANTERIOR POSITION. 477 



power. I prefer trusting to the depression of the handles, to such an 

 extent as to keep the blades in the axes of the superior strait, and to 

 tractions performed in the same line of direction. 



1073. If the head is locked, or too firmly fixed at the superior 

 strait, we first attempt to start it as we start a cork in a bottle or a 

 nail that we want to draw: it is then to be pushed up so as to oblige 

 the occiput to deseend in a more favorable manner. We are to 

 pull obliquely downwards and backwards until the strait is com- 

 pletely cleared; as soon as the rotation movement is efi'ected, and 

 the head is in a direct anlero-posterior position, we ought, in pulling 

 to move the handles of the forceps alternately right and left, until 

 the parietal protuberances have passed the ischiatic strait. These 

 tractions ought to be at once powerful, slow, and moderate; should 

 there be no reason for haste, we need not pull except during the 

 uterine contractions, which besides, rarely fail to become very ener- 

 getic and frequent, as soon as we commence the operation; but 

 when the very moments are counted, or the womb in a state of in- 

 ertia, it would be useless or dangerous to wait; we ought to act 

 immediately. 



1074. When the head reaches the vulva and is retained only by 

 the soft parts, we leave off" pulling from handle to handle. We 

 ought even not to pull at all, provided the womb appears to have 

 preserved a sufficient degree of energy to enable it to terminate the 

 labor; for at this juncture it is highly important not to proceed too 

 rapidly, and to be assured that the best way of managing the peri- 

 neum is to retain the head as long as it may be at the vulva. In- 

 stead, then, of engaging the woman to bear down, and pulling at 

 the same time with great force, as we had previously done, she is 

 urged to be careful of making strong efforts; it is often best even 

 to withdraw the instrument, which, if the head be born, requires no 

 particular precaution, while, in the contrary case, the blades are re- 

 moved one after the other, holding them in the same way as when 

 they were introduced, and beginning with the right branch, which is 

 uppermost. Should it be afterwards necessary to exert any tractive 

 force, it might be effected by placing the fingers upon the temples or 

 under the arm-pits of the foetus, as is done in some cases of spon- 

 taneous delivery. 



1075. Authors have expressly advised that the noise made by the 

 striking or rubbing of the two branches of the instrument together 

 should be avoided, because, say they, this noise might frighten the 

 woman. It would doubtless be imprudent to take no precaution on 

 this head, and to clash the blades together as we would the foils at a 

 fencing match; but I can perceive no reason for the minute precau- 



