A nurse's handbook of obstetrics, for use in training-schools . the placenta over and over onitself no longer meets with general approval and is not to berecommended. All that is necessary is to extract the membranesfrom the vagina slowly and carefully, taking plenty of time andusing no force whatever. The placenta is to be preserved until the arrival of the physi-cian, in order that he may inspect it and make sure that it isintact. In precipitate breech cases, which occur when the infantis small or premature, there are two important points in themanagement which the nurse must not forget. Tra
A nurse's handbook of obstetrics, for use in training-schools . the placenta over and over onitself no longer meets with general approval and is not to berecommended. All that is necessary is to extract the membranesfrom the vagina slowly and carefully, taking plenty of time andusing no force whatever. The placenta is to be preserved until the arrival of the physi-cian, in order that he may inspect it and make sure that it isintact. In precipitate breech cases, which occur when the infantis small or premature, there are two important points in themanagement which the nurse must not forget. Traction on the body, after it has passed through the vulva, BREECH CASES. 173 must never be made, for it is essential to have the case progressas slowly as possible in order to secure complete dilatation of theparts and afford ample room for the passage of the head. Pressure must be made on the fundus as soon as the natureof the case is recognized, and maintained until the child is born,in order to prevent, if possible, the extension of the arms abovethe Fig. 68.—Delivery of the head in breech cases. The childs body is lifted up and back-ward over the mothers abdomen, and the head is pressed forward, so that the chin, mouth,nose, etc., will be successively delivered. The diagnosis of a breech presentation can often be madeby the nurse, without vaginal examination and before the ap-pearance of the infants buttocks at the vulva, by the escape ofmeconium in the vaginal discharge. As soon as the body is delivered to the level of the umbilicusthe cord is to be secured and gently drawn down a few inches,to prevent traction on it when the head is born, and the extruded 174 A NURSES HANDBOOK OF OBSTETRICS. portion of the foetus is to be wrapped in warm towels, which areto be renewed as often as they become cool. This is necessary,not only to prevent chilling the infant, but to avert the dangerof respiratory movements while the head is still undelivered, dueto the shock of cold a
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