. On the theory and practice of midwifery . terfacility for so doing ; but, from what I have said, it must be evident thatit is more necessary that the labour should be let alone. There can be nooccasion to interfere until the pressure upon the funis is felt, and then the 394 MAL-PRESENTATION OF THE CIIILD. risk to the child must decide upon whether assistance is to be given or notThe same method must be adopted for extricating the arms, and for facil-itating the expulsion of the head; and in the more difficult cases we havethe same remedies at command. 609. 3. Presentation of the superior ext
. On the theory and practice of midwifery . terfacility for so doing ; but, from what I have said, it must be evident thatit is more necessary that the labour should be let alone. There can be nooccasion to interfere until the pressure upon the funis is felt, and then the 394 MAL-PRESENTATION OF THE CIIILD. risk to the child must decide upon whether assistance is to be given or notThe same method must be adopted for extricating the arms, and for facil-itating the expulsion of the head; and in the more difficult cases we havethe same remedies at command. 609. 3. Presentation of the superior extremities. — In almost allcases of this kind it is the shoulder which primarily presents, and after-wards the arm prolapses; occasionally, however, we find the hand at thebeginning of the labour at the os uteri, and more rarely the elbow. In all cases the back of the child either looks forward towards the abdo-men of the mother (fig. 132), or backward towards her spine (fig. 133):the former being twice as frequent as the latter. Fig. In the majority of cases, with such a position of the child, labour maybe considered as impracticable, unless assisted by art; and yet, even withsuch an untoward position, the natural powers have occasionally succeededin expelling the child. Dr. Denman, in 1772, first noticed the fact, thoughhe appears to have mistaken the process: he supposed that, during an in-terval of uterine relaxation, the shoulder and arm receded, and the breechcame down into the pelvis ; hence the name he gave to it, spontaneousevolution of the foetus. We are indebted to the accurate observation andingenuity of my friend, Dr. Douglass, a distinguished practitioner of Dub-lin, for the true explanation of the process in an essay published in 1811,from which the following short description is extracted. Before its expul-sion the situation of the fetus resembles the larger segment of a circle;the head rests on the pubis internally, the clavicle presses against the pubise
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