The Matron's Manual of Midwifery, and the Diseases of Women During Pregnancy and in Childbed / Being a Familiar and Practical Treatise, More Especially Intended for the Instruction of Females Themselves, but Adapted Also for Popular Use among Students and Practitioners of Medicine

by Frederick Hollick

A Foot and Arm.—The proceeding is the same as with the foot alone. If the limbs cannot be returned the head and arm must be pushed up, while the foot is brought down.

TWINS AND TRIPLETS.

In most cases where there are two or more children the delivery is easier than with one, because they are generally small, and the first one so prepares the way that the rest are born without difficulty. It is also a fact that twins are nearly always born before full term, and consequently are not quite grown.

The expulsion of the second fœtus usually takes place, immediately after the first, though sometimes the Womb stops contracting, and it is not born for half an hour or more, and it may even remain for hours or days. It is a question whether, in such a case, the second delivery should be left for Nature to finish, or whether the accoucheur should terminate it sooner artificially. The most general practice is to wait only about half an hour, and then, if the Womb is still inert, use friction, or other necessary means, to excite it, and accomplish the second delivery as soon as possible. If there be more than two the proceeding is still the same.

Some difficulties may arise however with twins, which it is necessary to be prepared for. Thus the two heads may come together, and mutually impede each other. In this case the one which moves the easiest must be pushed up till the other is descended sufficiently low. One head may also descend with one or two feet; in which case, if the feet cannot be returned, the head must be pushed up, and they must be brought down. The force exerted however, must not be very great at first, because one may belong to each of the children, and much injury may be done; a little gentle traction will soon detect this however, with ordinary care. If two arms, or one arm and a foot descend, the same care is also required, before pulling upon them, to ascertain that they are not parts of the two children. Sometimes when the head of one twin descends along with the feet of the other they may, if small, descend together. But if this is impossible, and interference is needed, we must first try to push up the head; and if this cannot be done, it must be drawn upon, not the feet; because if the feet were drawn down the two children would soon occupy the passage together, body and head, and would perhaps become firmly wedged. In nearly every case one of the twins presents by the head and the other by the feet, as formerly shown.

EXCESSIVE SIZE OF THE FŒTUS, OR THE DISEASED DEVELOPMENT OF CERTAIN PARTS.

Fœtus too large.—It is very rarely the case that the Fœtus is so large as not to pass easily through a well-formed Pelvis, though such cases have been known. The mode of proceeding is of course precisely the same as if the pelvis were too small. If no means will succeed in abstracting the Fœtus whole, it must be made less; but Nature should be first allowed full time to act with all her force.

Hydrocephalus.—This consists of an accumulation of water in the head of the child, and is usually termed watery head. The bones of the cranium will sometimes be widely separated by it, and the head be made so large that it cannot possibly be born till made less. The causes which produce this disease before birth are unknown.

In cases of hydrocephalus the head does not descend into the straits, owing to its size, and is felt to be full and firm, during a pain, but soft and yielding during the intervals, especially at the fontanelles and sutures, which are also very large. The bones are usually very wide asunder, or even totally separated, as if floating in the fluid.

In some cases, when the quantity of fluid is but small, the delivery may terminate spontaneously; the head lengthening, from being so soft, and thus adapting itself to the size and form of the strait. Most frequently however, assistance is rendered in such cases, either by the forceps, which will sometimes succeed, or by puncturing the head, and letting out the fluid. This operation has been performed and the child saved, though such an occurrence can never be reasonably anticipated. Such instances however, show that great care should be taken not to injure the brain, as that would destroy the small chance there is.