F. Position —The position of the head is diagonal, the mento-frcntal diameter lies in the left oblique of the pelvis, the forehead points towards the right sacroiliac symphysis, the chin towards the left cotyloid cavity. The left side of the head is forward and to the right, the right side backward and to the left. The bi-malar diameter is in the right oblique of the pelvis. The face may be grasped laterally, but one of the blades will be in front and the other behind. The forceps will be applied symmetrically to the head, and asymmetrically to the pel vis. The left blade, first inserted, will lie to the left and behind, over the right malar region; the right blade will be inserted to the right and behind, and then brought spirally forward over the left malar region. The lesser curve will point towards the left maternal thigh. First, trac tions must be made downwards to lower the chin, then rotation is made from left to right to bring the chin under the symphysis, and extraction. follows, chin to the pubes. (Fig. 104.) 1141 4. Position .3f. L. T.—The head is transverse, the fronto-mental di ameter in the transverse of the pelvis, the bi-malar in the antero-posterior. The left side of the head is in front, the right side to the rear. The head cannot be exactly seized laterally, and we cannot apply the forceps to the sides of the pelvis, after the German method, since the head would be grasped from'chin to forehead, which would expose the foetal neck to great injury. The head, hence, must be seized irregularly, from one frontal protuberance to the maxillary angle. The left blade is first in serted to the left and posteriorly, as far as possible near the end of the bi-malar diameter; the right blade, inserted second, to the right and be bind, then brought forward, by the spiral movement, over the left frontal protuberance. The lesser curve is towards the mother's left thigh. Traction is made downward, the chin thus lowered, the face is rotated, and it is extracted, chin to the pubes.
S. Position Md. L.P. —Tile fronto-mental diameter is in the right oblique of the pelvis, the bi-malar in the left oblique. The left side of head is to the left, and the right to the right of the pelvis. The forceps must be applied as though we intended bringing the forehead to the sym physis. The posterior blade will be the right, and is applied, first, behind and to the right over the right side of the face, then the left blade, second, is inserted behind and to the left, and brought forward over the left side of the face. The lesser curve points towards the right thigh of the mother. Before locking, the blades must be crossed, or else Stoltz's method used. The application is oblique. Traction at first is downward and backward to lower the chin before rotation. But even as we saw in ver tex presentations in case of the occiput posterior, so in face it is difficult to bring it down when high up. It is not possible to make traction far enough backwards. Danyau has advised applying the blades inversely, in order to make traction sufficiently backward. Aside from the fact
that this recommendation is extremely difficult to follow, and contrary to all rule, the method has not given good results even in the master-hands of Danyau. It is better hence to apply the blades as we have advised, and to pull as far backward mid downward as is possible. The chin once low ered, rotate, and then remove the forceps, and re-apply directly, and de liver with chin to the pubes. If the difficulty is very great, it is better to mutilate the foetus than to expose the mother to great injury.
6. Position M.1.R.A.—The fronto-mental diameter is in the left oblique of the pelvis, the bi-malar in the right oblique. The right side of the face is to the left and forwards, the left side to the right and backwards. The right blade is inserted first, behind and to the right, and is placed over the left lateral side of the face. The left blade is inserted second, behind and to the left, and is brought forward spirally, and placed over the right lateral side of the face. The application is symmetrical to the head, and oblique to the pelvis. The lesser curve points to the right thigh of the mother. The blades must be crossed, or Stoltz's method used. Traction is made downward to depress the chin, and then rota tion from right to loft, to bring it under the symphysis. Extraction, chin to the pubes.
7. Position MI.R.T.—Face is transverse in the pelvis. The fronto mental diameter is in the transverse of the pelvis, the bi-malar in the antero-posterior. The left side of the face looks directly backward, and the right forwards. Th9 face cannot be seized regularly, and we try to grasp it as far as possible in the bi-malar diameter. The right blade is inserted first, behind and to the right, over the left maxillary angle, the left blade, second, behind, is brought forward spirally and placed over the right frontal protuberance. The lesser curve is towards the mother's right thigh. Crossing, or Stoltz's method, is necessary. Traction down ward to bring down the face and chin rotation from right to left, extrac tion with chin to pubes.
8. Position M. I. R. P.—The fronto-mental diameter points by the chin to the right sacroiliac synchondrosis, by the forehead to the left cotyloid cavity. The right side of face is forwards and to the right, the left side behind and to the left, the bi-malar diameter is in the right oblique of the pelvis. The forceps is symmetrical to head, and oblique to pelvis. The left blade is inserted first, behind and to the left, on the left lateral side of the face; the right blade, second, behind and to the right, and then is brought forward spirally over the right lateral side of the face.
(Fig. 105.) The lesser curve is over the forehead towards the left thigh of the mother. Traction downwards, rotation from right to left, re-ap plication of the blades, and extraction, chin to the pubes. The difficul ties are the same as in M.I.L.P.