A treatise on the science and practice of midwifery . ked up and pulled forward over the head,towards the pubis, the thumb of the same hand being placed on theadvancing head, so as to restrain its progress if needful. I haveadopted this plan frequently, and believe that it admirably answersits purpose, especially when the perineum is greatly distended, andlaceration is threatened. It must be admitted that the insertion ofthe fingers into the anal orifice, in the manner recommended, is re-pugnant both to the practitioner and patient, and the same resultcan be obtained in a less unpleasant way.
A treatise on the science and practice of midwifery . ked up and pulled forward over the head,towards the pubis, the thumb of the same hand being placed on theadvancing head, so as to restrain its progress if needful. I haveadopted this plan frequently, and believe that it admirably answersits purpose, especially when the perineum is greatly distended, andlaceration is threatened. It must be admitted that the insertion ofthe fingers into the anal orifice, in the manner recommended, is re-pugnant both to the practitioner and patient, and the same resultcan be obtained in a less unpleasant way. I mention it, however, to 276 LABOR, show what it is that the practitioner must aim at. If, when the headis distending the perineum greatly, the thumb and forefinger of theright hand are placed along its sides, it can be pushed gently forwardover the head at the height of the pain, while the tips of the fingersmay, at the same time, press upon the advancing vertex, so as toretard its progress if advisable (Fig. 101). By this means the sud- Fig. I n nit Mode of effecting relaxation of the Perineum. den and forcible stretching of the perineal structures is prevented,and the chance of laceration reduced to a minimum, while naturesmode of relaxing the tissues, by dilatation of the anal orifice, isfavored. This is very different from the mechanical support that isusually recommended, and the less pressure that is applied directlyto the perineum the better. Nor is it either needful or advisable tosit by the patient with the hand applied to the perineum for hours,as is so often practised. Time should be given for the gradual dis-tension of the tissues by the alternate advance and recession of thehead, and we need only intervene to assist relaxation when thestretching has reached its height, and the head is about to be ex-pelled. A napkin may be interposed between the hand and the skin,for the purpose of cleanliness. Should the perineum be excessivelytough and resistant, assiduou
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Keywords: ., bookcentury1800, bookdecade1870, bookidtre, booksubjectobstetrics
