Preternatural Labour. We now pro ceed to a consideration of the third class of labours, into which we have divided our subject, and which are generally de nominated preternatural, or cross-births; including all presentations but those of the head. This class is naturally, there fore, divisible into presentations of the lower and presentations of the upper ex tremities; and to this tubdivision we shall adhere.
We know little of the cause of preter natural presentation ; perhaps it depends on a peculiarity of form either in the uterus or pelvis. It is said to arise from accidents, because there are more instan ces of it in the lower walks of life ; that is very true ; and there are more aquiline noses among the poor people than among the rich, and more noses of every kind ; because the truth is, there are more Individuals in one class than in the other. Preternatural births are most likely the effects of peculiarity of shape in the parts.
Presentation of the lower Extremities.
This constitutes our first division of la bours of this kind, and is capable of be ing finished by the powers of nature alone ; and the only consequence would be upon the child, to whom such deli very is not always safe ; for when the feet present, and the child is gradually ex pelled, the child in figure forms a cone, which all along increases to the shoulders, and the head is born last of all ; the navel string would be born long before the shoul ders were disengaged, the effect of which would be, that the circulation would be interrupted in the cord, and perhaps sus pended; for pressing the navel-string before birth is the same as pressing the throat after it ; each produces death. After this observation, we have only to remark, that when the cord comes down by the navel passing through, a portion of the cord should be drawn slack after it, that it may not be stretched by the child's passing under the pubes.
When the feet or breech have present ed, there is plenty of time to turn the occiput to the pubes, long before the head is down. Whether one foot or the breech presents, it is better to let it come so, than to go up and bring down either one or both feet : because, in breech presentations, the parts are grad ually and well dilated, before the cord is likely to be compressed, therefore it is safer; besides, the inferior extremities, in breech cases, lie upon the sides of the abdomen, by which they protect the na vel-string lying between the two from any pressure whatever. So that we see all breech cases should be left unturned; and we may ascertain the breech from the head, by feeling the parts of generation, as well as various depressions, without that uniform defined resistance which is given by the head. When the breech presents, the meconium will generally come away by the pressure squeezing it out of the abdomen. Suppose that in a
breech presentation any accident hap pen to the woman needing immediate delivery ; it has been said that the forceps may be applied ; but from frequent trials we can say that they are of no use ; they are not calculated to hold such parts, and always slip off. Another plan recom mended is, to get a handkerchief between the thighs and the hotly: this is an ex ceeding good purchase, but in the liv ing subject we can scarcely do it ; we cannot get it between the legs and body. If neither of these plans succeed, there is only one remaining; this is the carry ing up the blunt hook, and so placing it over the thighs ; this certainly com mands the delivery ; and where a small equally applied force is sufficient, it will be both successful and safe: but as it is self-evident that iron must be always stronger than bone, there will be a great risk of breaking the thigh-bones by this instrument. Yet the woman is not to die to save the child's thigh-bone from the risk of being broken; and it is certainly better to have to treat a child with its thigh broke, than one whose brains have been all scooped out. We should, how. ever, be careful never to employ the least unnecessary force.
The feet being born and the breech passed, the part which next presents is the umbilicus ; and as the body afterwards passes further down, the cord wilt be both pressed and dragged ; and if a cylindri cal yielding cavity be dragged, the cavity of that cylinder is diminished in its cali bre, and the tube will ultimately be obli terated; so that the best practice will be, as soon as a part of the umbilicus can be felt, to pass up,the finger and bring down sufficient to prevent its stretching in the progress of the expulsion ; and as soon as the head is in the pelvis, to bend the face down, bringing it forward upon the breast of the infant, and opposite the os externum, by which means the child will commence breathing; and if the navel string only pulsate up to that time when breathing commences, the child is safe in all that regards suffocation ; and as to the head remaining within the os exter num, it is of no consequence whatever. If the child's head cannot be brought through, we must pull, drawing it with caution. Some practitioners will pull the child very hard, which is quite improper; not that it is any material object to the woman, but to the child ; the force being applied with the hopes of the child's be ing born but is it very likely that its life will be saved after a leg or an arm is pulled off, or after the body is pulled so hard as nearly to be separated from the head ? Second division of Preternatural Labour.