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

These curious movements cause the child to pass in a spiral direction, so that each part may pass through the Pelvis in the most favorable position. Sometimes all these movements are not effected, and yet the delivery may occur, though not so speedily, or safely, as when they are. The shoulders do not always fully rotate, but may nevertheless pass the opening, if the parts be large, and well relaxed. It is questionable however, if the head can ever pass the lower strait without rotating, when it enters the Pelvis diagonally, the occipit on one side and the forehead on the other; as it is necessary for either one or the other of these parts to pass under the pubes.

MECHANISM OF DELIVERY IN ALL OTHER POSITIONS OF THE HEAD.

The right posterior occipital position.—This position, called the second by some authors, and the fourth by others, is exactly the reverse of the one just described, the head lying in the same direction, but the back of it being behind, to the right of the Sacrum, and the forehead to the left of the pubes.

Precisely the same movements are gone through in this position as in the other, excepting that the head has to rotate considerably further. In the former position the back of the head is only a little to the left of the pubis, and therefore has not far to turn to pass under it; but in this position the back of the head is behind, and therefore has to turn very far round to reach the same position. The rotation is therefore more difficult, not so soon effected, and sometimes likely to be dangerous to the child.

In the other movements there are no difference worthy of notice, but it must be borne in mind that they all occur the reverse way, to what they do in the first position, because the occiput is on the right side instead of the left.

The right anterior occipital position.—This position is precisely the same as the first, but on the other side. The back of the head is in front, but to the right of the pubis instead of the left, while the forehead is behind, to the left of the Sacrum. This will be apparent enough by observing Plate XXXI.

PLATE XXXI.

This is the second most frequent position; the left anterior occipito iliac being the most frequent.