Cyclopædia of obstetrics and gynecology . hould be directed a littlemore forwards, so that when the head has reached the level of the inferiorstrait, or when the forceps are there applied at the outset, tractions arenearly hoi-izontal. (Fig. 88.) THE FORCEPS. 101 The head at the vulva, traction is made from below upward, that is tosay, the forceps are lifted up towards the abdomen of the mother. Here,indeed, traction is nearly useless, the head has simply to be disengaged,and once the occiput under the symphysis, not only must we no longerpull on the forceps, but, with the instrument towards t
Cyclopædia of obstetrics and gynecology . hould be directed a littlemore forwards, so that when the head has reached the level of the inferiorstrait, or when the forceps are there applied at the outset, tractions arenearly hoi-izontal. (Fig. 88.) THE FORCEPS. 101 The head at the vulva, traction is made from below upward, that is tosay, the forceps are lifted up towards the abdomen of the mother. Here,indeed, traction is nearly useless, the head has simply to be disengaged,and once the occiput under the symphysis, not only must we no longerpull on the forceps, but, with the instrument towards the mothers ab-domen, we must firmly hold the head, oppose its too rapid exit, and allowit to issue from the maternal parts but very slowly. (Figs. 89 to 91.) It is not enough, uideed, to sustain the perineum, as is represented inFig. 89. To prevent its rupture, we must give it time to relax, and if wedo not hold back the head enough, the perineum will tear under the sup-porting hand. Often, indeed, at this very moment, the woman, against. Fig. 88.—The Forceps at the Inferior Strait. her will, makes violent expulsory efforts, and the head,.driven violentlyoutside, tears the perineum notwithstanding the accoucheurs hand. Thebetter plan is to slowly disengage the head, holding it back as much aspossible, and completing delivery between the pains, and if the perineumseems too distended and ready to tear, to make a lateral incision, andthus avoid deep laceration. [The above method will succeed very well in multipara, but in primi-parte, where the integrity of the perineum is much more in danger, webelieve the following to be far preferable: As soon as the occiput has beenbrought well under the pubes, and the perineum begins to distend, ad-minister chloroform to the surgical degree, in order to abolish entirelyinvoluntary expulsory efforts on the part of the patient, and then, remov- 102 A TREATISE ON OBSTETRICS.
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