We see, therefore, that the special rules for the forceps in face presen tations are identical with those applicable to the vertex.
In anterior and transverse presentations: First blade behind, second blade to side where the chin points.
In posterior presentations: First blade behind, and to the side opposed to the position of chin.
In the following table are resumed the rules applicable to the forceps in face presentations: B. The Arcepe to the After-corning Head.
Without going as far as Mme. Lachapelle, Chailly and Pajot, who say that when, the body having been delivered, we cannot extract the head, it is because the method employed is not a good one, or the force em ployed not sufficient, and that the hand ought to complete labor; we must, in general, admit that the cases requiring the forceps are, if not exceptional, at least relatively rare. They tend to become rarer still, since Tarnier and his pupils have shown the utility of pressure exercised from above below through the abdominal walls on the head at the superior strait. Champetier de Ribes, in particular, has insisted on this, and he has shown that pressure on the forehead from above, combined with trac tion in the inferior maxilla, will often certainly cause the descent of the head, even where the pelvis is contracted, with surprising ease. Never theless, in infrequent cases, the forceps is indispensable, and we dwell on it briefly.
In 1874 and 1875 Grynfeltt, adjunct at Montpelier, studied this ques tion. After having shown that Chailly, Cazeaux, Tarnier and Barnes are not opposed to the method, and that Busch, Rigby, Meigs, are greatly in favor of it, he endeavors to prove that, contrarywise to the opinion in France and abroad, the forceps should always be applied underneath the sternal plane of the foetus, (Fig. 106), and exceptionally only above the dorsal plane.
After delivery of the body, the head may be retained at the superior strait, in the cavity, at the inferior strait.
I. Head in the Inferior Strait, or in the Cavity, a. Occipito-pubic Position.—Rarely requires the forceps, but when used it must be applied so as to lower the chin to the perineum, and then extract, the mouth, nose, brow, bregma, and vertex, appearing successively. In a word, the
head must be flexed.
To seek the face in the sacral excavation, the best plan is to lift the body forward towards the mother's belly, and to insert the blades below it on the anterior. or sternal plane. To extract, the handles are progress ively lifted, and traction made.
b. Occipito-sacral Position.—The head may be flexed or extended.
1. Head jlexed.—The body of the fcetus must be pulled downward, the forceps blades introduced above. The handles are then carried downward and backward to increase flexion, and deliver the occiput over the peri neum. (Fig. 107.) 2. Head chin is in front and high up, behind the sym physis. The body must be lifted above, the blades inserted below the fcetal body, and carry the handles upwards to deliver belly to belly. (Fig.108.) c. Oblique Positions.—Make forward rotation if possible, and, accord ing as the head is flexed or extended, deliver in 0.P or in O.S. The blades, hence, are applied according to the case, above or below the festal body.
d. Transverse Positions.—The head is grasped irregularly, and this is the only difference in the manoeuvre.
In this case Grynfeltt advises rotation by the hand, or by a single blade of the forceps acting as a lever.
II. Head at Superior Strait.—Usually Champetier de Ribes' method, described above, answers here—tlAe infant, however, ordinarily dies. It is not the forceps, then, which should be used, but cranioclasty or cepha lotripsy. Certain authors advise decapitation, and then forceps to the head in the uterus.
III. Head after Decapitation.—The head must be fixed at the superior strait by an assistant, and then the entiro hand in the uterus places the head in the most favorable situation, and the blades are applied to the sides of the head. The operation is very difficult. Happily, the hand alone suffices usually to extract the head.