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

The trunk is in general easy of recognition. Nearly always the right or left shoulder occupies the passage, or is near to it, so that the finger may be readily passed under the arm pit. The shoulder joints, the ribs, or the shoulder blade bone, all feel very different to the head, and are not likely to be taken for it.

In presentations of the lower extremities there is still less danger of error. If the feet, or knees, occupy the passage, they can scarcely be mistaken. The breech is certainly something like the head in its form, but feels different, and is divided down the middle by the indentation between the two cheeks, along which the finger can be passed till it enters between the limbs.

In irregular presentations, as of the arms for instance, or of one leg, or an arm and leg, it is only necessary to carefully feel them, so as to ascertain their form, and the relation of their parts. Thus the fingers can be distinguished from the toes, and the feet from the hands, particularly if the ankle can be felt.

The accoucheur should ascertain the particular presentation as early as possible, because he may sometimes be of service in correcting an unfavorable one, if he is certain of it in time, and knows what he is about. He should not however, use any degree of force to ascertain it, in case he cannot do so without, but wait till the conditions are more favorable. Neither should he, with the same object, rupture the membranes too soon, for he may thereby cause considerable delay and difficulty, without any good to counterbalance it.

All the above-named presentations may, and usually do, terminate spontaneously, except those of the trunk, and even they do occasionally, though more frequently they require assistance.

Relative frequency of the different presentations.—The most favorable presentations, and positions also, are always the most frequent, while the unfavorable ones are but seldom met with. According to Madame Lachapelle, in fifteen thousand six hundred and fifty-two labors there are about fourteen thousand seven hundred and forty-nine presentations of the head and face; about five hundred and eighty-six of the breech, knees, and feet; and only about sixty-eight of the trunk, or shoulders.

Positions.—The position is generally of but little consequence, because in all the favorable presentations spontaneous delivery occurs in every position alike, and in the unfavorable presentations the same assistance is required in one position as in another. In some cases an unfavorable position of the head may be changed however, to a better one; and therefore, so far as the head is concerned, the positions are worth ascertaining.

The mode of determining the position is by feeling for the sutures and fontanelles, described in Chapter VIII; and this cannot be usually done till after the membranes are broken, when the head can be distinctly touched. By referring to Plate XXIV, the shape and position of the Fontanelles will be seen, and if the head be supposed placed with the top downwards, and the back of it to the mother's left side, they may be readily found with the finger.

In the left anterior occipito iliac position, or that when the back of the child's head is against the left side of the mother's pelvis, and nearest the pubes, while its forehead is against the right side, and nearest the sacrum,—the sagittal suture, or opening along the top, will of course run across from right to left. This opening may be distinctly felt with the finger, which should be passed along it towards the right side, and it will then reach the anterior fontanelle; afterwards it should also be passed to the left side, and then it will reach the posterior fontanelle. The difference between these two openings, in shape and size, is shown in Plate XXIV, and even if a person has never seen, or felt, the head of a newborn child, they can scarcely be taken for each other, after noticing that Plate.

If the anterior fontanelle should be felt on the left side instead of the right, and near the pubes, while the posterior fontanelles is to the right, and near the sacrum, the position must be the right posterior occipito iliac, or just the reverse of the former.