. An American text-book of obstetrics. For practitioners and students. owed for themoulding of the head and the dilatation of the soft parts. The axis-tractionforceps offers no advantages at the pelvic outlet, while it takes up more room ;many operators remove it when the head comes down upon the perineum, andcomplete the delivery with a lighter and less bulky instrument. In Occipito-posterior Positions.—When the occiput is directed posteriorly,the case should be left to nature so long as possible, in the hope that forwardrotation may take place. Some authorities recommend in such cases the us
. An American text-book of obstetrics. For practitioners and students. owed for themoulding of the head and the dilatation of the soft parts. The axis-tractionforceps offers no advantages at the pelvic outlet, while it takes up more room ;many operators remove it when the head comes down upon the perineum, andcomplete the delivery with a lighter and less bulky instrument. In Occipito-posterior Positions.—When the occiput is directed posteriorly,the case should be left to nature so long as possible, in the hope that forwardrotation may take place. Some authorities recommend in such cases the useof forceps to turn the occiput forcibly to the front. Such a maneuvre rarelysucceeds; it is capable, moreover, of seriously injuring the child by rotatingthe head upon the trunk more than it is safe to do. But if the natural effortsfail, or there is need for speedy delivery, the forceps may be applied and simpletraction be made. Natural rotation may still take place, but if it does not thehead may safely be delivered in the occipito-posterior position. The blades. Fkj. 496.—Forceps extraction in persistent occip- Fio. 497.—Over-distention of the perineum ito-posterior position: A, initial line of traction; B, in persistent occipito-posterior deliveries; the direction in which forceps-handles are lifted; (. di- nose rests under the pubic arch,rection of forceps, after occiput has escaped,in orderto deliver the lace are applied as in the ordinary low operation, and they adapt themselves usuallyto the sides of the childs head, since the long diameter is nearly or quite in theantero-posterior diameter of the pelvis. In using traction the natural mech-anism of delivery in this position should be borne in mind and the forceps beused merely to aid nature. The head becomes arrested in the pelvis because ithas undergone extension ; therefore, as Barnes aptly puts it, the essential tilingto do is to get the occiput down—that is, to restore flexion. Traction is made downward or h
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectobstetrics, bookyear1
