Mother, Nurse and Infant / A Manual Especially Adapted for the Guidance of Mothers and Monthly Nurses, Comprising Full Instruction in Regard To Pregnancy, Preparation for Child-birth, and the Care of Mother and Child, and Designed to Impart so Much Knowledge of Anatomy, Physiology, Midwifery, and the Proper Use of Medicines as Will Serve Intelligently to Direct the Wife, Mother and Nurse in All Emergencies.

by S. P. Sackett

The right time to turn the child is when the os uteri is dilated, either before or immediately after the rupture of the membranes, and if a doctor cannot be soon obtained, it is better that a skilled nurse should turn the child, and if she is properly instructed, she should do it carefully and slowly, but without any fear and confidently. She can assure the patient that she will be able in a short time to relieve her sufferings.

In England the ordinary position for turning is on the left side. I prefer that the patient be placed across the bed on her back with her legs drawn up and supported by assistants. I now describe my own mode of operating.

I bare my right arm and hand (sometimes the left), lubricating it freely. If the waters have only recently escaped, and the os be dilated, the operation is performed with ease, especially after we have determined the position of the child.

I press the fingers together in the form of a cone, the thumb between the fingers—slowly and carefully press them into the vagina in an interval between the pains, and constantly and slowly press the hand in, only when the contractions of the uterus remit; never using any force, gently pass the fingers into the os; gently open the fingers a little occasionally to dilate the os sufficiently, and when it is expanded pass the hand into the uterus, make out the presentation accurately, so as to keep my hand to the abdomen of the child; always keep the hand still during a pain; when there is an interval between the pains, carefully search for the feet; when one of the feet is found, clasp the leg at the knee with one finger; flex the leg at the knee so that the finger has a good hold of it, draw it down in the absence of a pain; as the knee approaches the os when it is drawn down over the abdomen of the child, the shoulders and head recede towards the fundus, and when the head has reached the fundus and the knee is brought through the os, the case is converted into a knee presentation, and I deliver slowly but without needless delay—making a little traction during each pain, the management being conducted as in feet presentations, and the whole process being assisted by pressure made on the uterus by my left hand, or by the hand of an assistant.

Possibly these directions will be better understood if I use the language of another who directs:

1. That the patient be placed on her left side near the edge of the bed.

2. The os externum is then to be dilated with the fingers reduced into a conical form, acting with a semi rotary motion of the hand.

3. When the hand is passed through the os externum it must be slowly conducted to the os uteri. We may perforate the membranes with the finger if they are not broken.

4. The hand must then be passed along the thighs and legs of the child until we come to the feet. If both the feet lie together we must grasp them firmly with one hand, but if they are distant from each other we may deliver by one foot.

5. Before we begin to extract we must be sure that we do not mistake a hand for a foot. The feet must be brought down with a slow, waving motion into the pelvis, when we are to wait till the uterus contracts, still retaining them in the hand.