When the labor begins, the bag of waters must be kept from rupture as long as possible and when it finally breaks, an internal examination should be made to see if the cord has come down. If this happens it may be necessary to expedite the delivery by external assistance.
Fig. 64.—Breech delivery. Extraction of the trunk by pulling on the hips. (Hammerschlag.)
The doctor brings down a foot, if it is not already down, or pulls on the breech until the feet drop out. Compression of the cord must be always in mind. It is always compressed after the umbilicus has passed the navel. The shoulders are delivered by seizing the feet with the operating hand and swinging the body out of the way. This brings the posterior shoulder, which should be first, into the hollow of the pelvis. Extraction is then completed by what is called the Smellie-Veit maneuver. The child is put astride one arm, the first finger of which is hooked into the child’s mouth to maintain flexion. The fingers of the other hand then grasp the shoulders of the child astride the back of the neck and traction is made downward in the axis of the inlet until the head slips into the excavation.
Fig. 65.—Breech delivery. Delivering the shoulder. The body is swung strongly upward and outward to bring posterior shoulder into the pelvis. (Hammerschlag.)
Fig. 66.—The delivery of the after-coming head by the Smellie-Veit maneuver. (Hammerschlag.)
If the head is delayed at the inlet, it may be necessary to put the woman in the Walcher position (q. v.) and for the nurse to use the Wiegand compression (q. v.). The feet must not be fastened in stirrups for breech cases.
