. The science and art of midwifery . t of shonlder and headmechanism as these engage in the pelvis. So soon as the breechreaches the pelvic floor, traction should be made more in an upwarddirection, to facilitate the passage of the buttocks over the the breech has cleared the vulva, the index-linger of the freehand should be carefully inserted into the fold of the posterior thigh,while the thumbs of both hands are placed upon the sacrum. Duringthe subsequent extraction of the trunk the lower leg falls from thevagina without special assistance. If both extremities present, they
. The science and art of midwifery . t of shonlder and headmechanism as these engage in the pelvis. So soon as the breechreaches the pelvic floor, traction should be made more in an upwarddirection, to facilitate the passage of the buttocks over the the breech has cleared the vulva, the index-linger of the freehand should be carefully inserted into the fold of the posterior thigh,while the thumbs of both hands are placed upon the sacrum. Duringthe subsequent extraction of the trunk the lower leg falls from thevagina without special assistance. If both extremities present, they should be seized so that the mid-dle finger is placed between the feet, while the index- and ring-fingersencircle the external malleoli. After they have passed sufficiently faroutside the vulva, the left leg should be seized with the left hand andthe right foot with the right hand. During extraction the normalrotation of the child may be aided by dragging with somewhat greaterforce upon the limb, which should be turned to the FlO. 160. izine thf breech. Extraction by the Breech.—When the breech alone presents, withboth extremities reflected upward parallel to the anterior surface of the25 386 OBSTETRIC SURGERY. child, spontaneous delivery is sometimes, as pointed out by Tarnier,prevented by the facl that the extended Limbs act as splints which in-terfere with the lateral flexion of the trunk, and, consequently, with itsaccommodation to the curve of the parturient canal. If, in purebreech cases, obstetrical aid becomes necessary, the operator is em-barrassed by the absence of a natural handle by means of which extrac-tion can be effected. Theoretically, cephalic version by external manipulations, performedduring the latter part of pregnancy or in the early stages of labor,most completely fulfills the required indications, viz., the saving of thechild with the least possible risk to the mother. That, in cases wherethe breech is not engaged in the pelvic cavity
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