Dropsy may also occur in the chest, or abdomen of the child, causing similar difficulty with dropsy of the head. If the natural or artificial expulsion of the child cannot be effected without, the part must be carefully punctured, and the fluid evacuated.
Tumors on the Fœtus.—Sometimes various kinds of tumors form on the child's body, but they are rarely so large as to prevent delivery, though they may delay it. If they should be too large however, it will be necessary to remove them, as in the case of tumors in the Pelvis.
OSSIFICATION OF THE HEAD.
Occasionally the bones of the head will be so hard, and so closely united, that they will not overlap, in which case the labor may be very difficult, unless the head is small, or the pelvis very large. If after waiting a reasonable time, there be no prospect of the labor terminating naturally, and the female is exhausted, it must be terminated artificially, as if it were a case of deformed pelvis. It is seldom however, that the head does not eventually give way.
VARIOUS PRESENTATIONS AND POSITIONS OF THE FŒTUS, FROM WHICH THE LABOR MAY BE DIFFICULT OR PROTRACTED.
Presentations of the Face.—These are usually more difficult, and longer, than those of the head. They will nearly always however, terminate spontaneously, or with ordinary assistance; but, if they should not, artificial delivery must be practised, either by turning, if the case be not too far advanced, or with the forceps. Some of the most celebrated authors recommend that all these cases should be treated like cases of natural labor. Dr. Merriman says that in some very favorable instances turning may be practised with safety and advantage; but Dr. Lee says, "My firm belief is, that the child, even under such favorable circumstances, would have a far better chance to be born alive if the labor were left wholly to Nature; or, if the natural powers were inadequate, to be extracted with the forceps." In such cases there is often too little patience, and too much interference.
The forehead inclined against the Pubes.—In this position the labor may be long delayed, and difficult, and most practitioners endeavor to turn the head round, if they cannot bring down the feet, or else apply the forceps at once. Dr. Lee however remarks, and very properly, "From all that I have seen of these cases, I am disposed to believe that it is best to leave them to the natural efforts, and to avoid all interference, all attempts to change the position, while the pains continue regular, and the head advances, however slowly." If the labor does not progress at all, or the female becomes exhausted, of course artificial delivery is necessary.
Several varieties of head and face presentations may also retard labor considerably, but Nature nearly always overcomes the difficulty; or if she cannot do so mere ordinary assistance is required.