The practice of obstetrics, designed for the use of students and practitioners of medicine . , pelvis,or maternal soft parts are not toostrong. In instances in which thereis reason to suspect this complicationthe patient may be instructed to as-sume the knee-elbow position for fiveor six minutes morning and eveningfor a fortnight or even longer preced-ing labor.* This to be followed by thelateral posture. I have found in pri-vate practice that it is often a physicalimpossibility for patients to remainmore than a minute or two in theknee-chest position by reason of theintense cerebral congestio
The practice of obstetrics, designed for the use of students and practitioners of medicine . , pelvis,or maternal soft parts are not toostrong. In instances in which thereis reason to suspect this complicationthe patient may be instructed to as-sume the knee-elbow position for fiveor six minutes morning and eveningfor a fortnight or even longer preced-ing labor.* This to be followed by thelateral posture. I have found in pri-vate practice that it is often a physicalimpossibility for patients to remainmore than a minute or two in theknee-chest position by reason of theintense cerebral congestion and dis-comfort produced. In such a case inthe latter part of pregnancy and dur-ing the first and second stages of labor I have the woman placed in an exaggeratedlateral prone position with a pillow or several sheets under the lower buttock inorder, as far as possible, to reverse the condition of the dorsal position. The choiceof side for the patient to lie upon is the one toward which the occiput points. (See* Reynolds: Practical Midwifery, page 211, 1892. Fig. 751.—Before Fig. 752.—After Moulding. Note depres-sion at anterior fontanelle caused by thepubic arch. 548 PATHOLOGICAL LABOR. Operations, Part X.) Operative: It should be clearly understood that operativeinterference in occipito-posterior position is not to be undertaken until labor hasadvanced to a point at which the interests of fetus or mother demand interven-tion. It must be remembered that operation is applicable only to persistentcases of this kind; that most of the originally occipito-posterior positions ter-minate anteriorly spontaneously, and that only between one and four per cent, ofall vertex positions result in persistent posterior positions, the remaining beingeither originally anterior positions or terminating spontaneously as such. Beforedeciding upon interference in all cases of delayed labor at the pelvic inlet I alwaysmake a thorough examination under chloroform, introducing the whol
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectobstetrics, bookyear1
