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

In presentations of the lower extremities also the same, excepting that they are sacro iliac and so on, instead of occipito.

In presentations of the trunk we have but two positions for each side, the right and left cephalo iliac; according as the head is on the right or left side of the mother's body. The child always lying, in presentations of the trunk, crosswise—the feet on one side and the head on the other.

Most authors enumerate many more presentations and positions, but they are of little practical utility. When the head presents, for instance, the delivery takes place in nearly the same manner, let it be in what position it may. And in presentations of the face, or of the lower extremities, the particular position is of little consequence, the delivery being usually effected much the same in them all. Some of the positions are, it is true, much more favorable than others, but a spontaneous delivery, generally speaking, occurs in all of them, when the head, face, or lower extremities presents. Very frequently indeed, the less favorable positions are changed to the more favorable ones, and the worst seldom do more than impede delivery for a time, unless there be some malformation, or loss of power. I therefore refer to them more for convenience in future explanations, and to enable my readers to know what is meant by them, when they read other books; not because they are really necessary to be understood, or of any great practical use.

The celebrated Baudelocque admitted seventy-four positions, and twenty-two presentations; and the number might be made still greater, if all the variations were to be enumerated. Such classifications however, are more ingenious than useful, and they are but little noticed even by medical men.

I shall merely describe the mechanism of labor in the most frequent positions, in each presentation, because the others usually change into these; and even when they do not, the process of delivery is essentially the same, and also the mode of assisting it.

MODE OF ASCERTAINING THE PRESENTATION AND POSITION.

The Presentation.—Although in general it is not possible to ascertain with certainty, what part of the fœtus presents to the mouth of the Womb, until labor commences, yet a tolerable judgment can frequently be formed before. In head presentations, on performing ballotment, the head is felt, like a firm round tumor, occupying all the space which the finger can reach, very differently from any other part. The peculiar cramps in the female's lower limbs, and frequent inclination to urinate, mentioned in the signs of labor, are also strong indications of this presentation, being seldom experienced in any other. When the labor has actually commenced there can be but little uncertainty in these cases, for, immediately the mouth of the Womb is sufficiently open, the finger can be introduced, and the head felt like a smooth, round, and elastic bony tumor, not likely to be mistaken for anything else, if ordinary care be taken. After the waters have escaped, it can of course be felt still more distinctly. If even an inexperienced person bears in mind the shape of the head, and reflects how it must fill up the passage, and how it must feel, from being composed of separated thin bony plates, lying on a soft yielding substance like the brain, he can scarcely fail to recognize it. The sensation is very much like that of pressing a piece of firm card board on an inflated bladder, which forms a tolerable representative of the fœtal head. Sometimes there is a difficulty from a great quantity of water being intruded between the membranes and the head, which somewhat obscures the touch, but this only necessitates greater care. The water however, may be in such quantity as to entirely prevent the touch, in which case nothing can be done till the membranes break; the presentation can then be ascertained with certainty, and it will be quite early enough to render assistance, if it should be an unfavorable one. I have known some inexperienced persons mistake the bag of water itself for the head, and commit great errors in consequence.

The Face can seldom be mistaken, because the nose, or mouth, may be felt; and, by passing the finger up the side of the head, the ears also.