Difficult labour : a guide to its management for students and practitioners / by G. Ernest Herman.
- Herman G. Ernest (George Ernest), 1849-1914.
- Date:
- 1901
Licence: In copyright
Credit: Difficult labour : a guide to its management for students and practitioners / by G. Ernest Herman. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![fail to deliver because the occiput was behind, and nature did not effect the turn. If you know the posi- tion of the head, there is a better practice. B. .To flex. —This is a more scientific mode of meet- ing the difficulty. It imitates the natural mechanism. When the head is well flexed, the occiput meets the r(;sisla.ncc of the pelvic llooj-. Tdie resisting parts are beliind and at the sides. The occiijut, therefore, turns forward, where the resistance is least. If tlie head is not flexed the occiput does not come down, does not meet this resistance, and does not tuj’n for- wards. If we can flex the head, the occiput will come down, and this natural mechanism will Ihj brought into play. Flexing means bringing dovvui the occiput, and from what has been said, it will be seen that this is often equivalent to overcoming the hindrance to delivery. Methods.—There are two ways of doing this. The efi’ect of one is only to flex. The other produces flexion and descent. First method, to produce^ecemn. Push up the forehead with one or two fingers, and in doing so, direct the pressure in such a way as to press the forehead not only upwards, but backwards, so as to favour both flexion .and the turn of the occiput to the front. This is a mode of treatment which is harmless. The only objection to it is that it is generally ineffective, for what we want is descent of the occiput. We only value flexion as an aid to this. Second method, to produce flexion and descent. This is done with the vectis, an instrument like one blade of a pair of forceps, except that the tip of the blade is more sharply curved (Fig. 9). One blade of a pair of forceps may be used if the forceps has an excep- tionally sharp curve; but the forceps best suited to the shape of the head cannot be so used, because the blade is not curved sharply enough. The vectis is i)itroduced over the occiput, and with it the occi])ut pulled down, and at the same time forwards. This is undoubtedly an efficient way of piocuring flexion and descent, and helping rotation forwards. Were this the only or the best way, it would involve](https://iiif.wellcomecollection.org/image/b21719950_0036.jp2/full/800%2C/0/default.jpg)
