. An American text-book of obstetrics. For practitioners and students. to keepit in the axis of expulsion. Contrary to the usual teaching, the writer prefersto deliver the posterior shoulder first. While the anterior shoulder lies behindthe symphysis the finger is passed over the dorsal aspect of the posterior shoul-der and is slipped into the axilla. The posterior shoulder is then folded for-ward and is cautiously lifted over the perineum. Except in emergency calling for immediate delivery in the interest of mother or child, the expulsion of the trunk is left to nature. It is not good practic
. An American text-book of obstetrics. For practitioners and students. to keepit in the axis of expulsion. Contrary to the usual teaching, the writer prefersto deliver the posterior shoulder first. While the anterior shoulder lies behindthe symphysis the finger is passed over the dorsal aspect of the posterior shoul-der and is slipped into the axilla. The posterior shoulder is then folded for-ward and is cautiously lifted over the perineum. Except in emergency calling for immediate delivery in the interest of mother or child, the expulsion of the trunk is left to nature. It is not good practice to drag the child out of the uterus. The uterus should be compelled to expel it. The presence of the trunk and the extremities stimulates contrac- 1 The Direction of the Incision in Episiotomy, Trans. Am. Gyn. Soc, 1892. THE CONDUCT OF NORMAL LABOR. 375 tions, and time is permitted for retraction. When necessary the expulsionof the trunk may be hastened by the use of friction over the uterus. The frequency with which perineal injuries occur during the delivery of. Fig. 203.—Episiotomy (R. L. Dickinson). Direction of incision: The black line shows the directionwhich the incision should have, as it appears alter delivery, in line with the axis of the vulvo-vaginaloutlet; the dotted line illustrates a faulty incision, dipping into the middle section of the pelvic floor. the shoulders is probably exaggerated. It is easy to attribute to the shouldersa rupture which had occurred undiscovered during the birth of the head. On the expulsion of the head the face should be bathed, and the skinabout the eyes should carefully be cleansed and thoroughly dried as a pre-ventive against ophthalmia. Mucus in the pharynx should quickly beremoved by the finger covered with a piece of soft wet muslin or by theuse of a soft-rubber tube with an aspirating bulb attached. Ligation of the Cord.—The time for tying the cord is by no means a mat-ter of indifference. Systematic observations have shown
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectobstetrics, bookyear1
