PLATE XXXIX.
The manner of supporting the perineum, during the passage of the head.
The right hand is placed underneath, so as to push the head gently back, when it presses on the perineum too forcibly, before it is dilated; and also to elevate it towards the pubes.
The left hand is seen above, grasping the top of the head, to assist. This may be done or not, according to the necessities of the case, or the custom of the assistant.
Plate XXXIX.
The manner of supporting the perineum, during the passage of the head.
It is also necessary to request the female at this time to moderate her efforts, and not bear down too strongly. If however she be too excited, and eager to do so, more care must be used, and the head pressed back still more forcibly, till the parts are fully relaxed. For want of these precautions there is often serious lacerations of the perineum and vulva, particularly in first labors, and when the parts are unusually rigid. If proper care be bestowed however, these accidents ought to occur but seldom, even in the worst cases, and nothing can be more hurtful to the reputation of an accoucheur than for them to happen. Sometimes it is necessary to support the perineum for hours, and to bestow constant attention the whole time. It is often useful to keep applying a little simple ointment, or lard, in the intervals of the pains, mixed with the extract of Belladonna, which will soften and relax the parts. Dr. Lee also advises the application of a sponge, dipped in warm water, and which would probably do much good in many cases.