After the rupture of the membranes the replacing of the cord becomes a much more difficult matter, and frequently cannot be effected at all; particularly if the head be descended far down. Every effort however must be made, and if unsuccessful the delivery should be hastened as much as possible. In many such cases the forceps are applied, and the child brought away at once, because every moment's delay increases the risk to its life.
Several different kinds of instruments have been invented to return the cord, but they are seldom at hand when needed, and none of them are so good as the hand itself.
If the return of the cord cannot be effected, and the progress of the labor will allow of it, the hand is introduced and the child turned, unless the position of the head will allow of the advantageous application of the forceps, in which case they are mostly resorted to. The only general rule is, to terminate the labor as speedily as possible, consistent with the welfare of the mother. In spite of all that can be done the pulsation is often found to cease, and when the child is born it is either quite dead or breathes but a few times.
A very frequent indication that the fœtus suffers from compression of the cord, is a greenish color of the water discharged, owing to the discharge of Meconium from the child's bowels. This is brought about, most probably, by its straining, and its efforts to relieve itself.
SHORTNESS OF THE CORD.
The cord is sometimes too short, and this may operate very unfavorably in many ways. It may keep the fœtus up in the Womb, and prevent it from descending to the bottom of the Vagina,—it may cause the placenta to be torn away too soon, and so lead to serious flooding,—it may pull down and invert the Womb,—or it may make the labor very tedious, and cause the death of the child.
Unfortunately there are but few signs of this accident, even after the rupture of the membranes, and none at all before, that can be depended upon. If the head has descended properly, and the parts be fully relaxed, but still the expulsion is delayed from no obvious cause, it may reasonably be supposed that shortness of the cord exists; and if so there is very soon given a proof of it by a discharge of blood. This is owing either to the breaking of the cord, or to the separation of the placenta, and is frequently the first intimation the assistant has of the accident. All that can be then done is, to conclude the delivery as soon as possible, and in the best way that circumstances will allow.
In some cases the cord is not too short absolutely, but is made so by being twined round the body or limbs of the child, which are often cut off by it. M. Tasil saw a case where the cord round the neck had nearly severed the head; and Montgomery gives several instances in which the limbs had been amputated in this way. Two of these are represented below:—