CONDITIONS REQUISITE FOR THE APPLICATION OF THE FORCEPS.
These are four in number: 1. The os must be dilated or dilatable.
2. The membranes must have ruptured.
3. The forceps should be applied only to the head.
4. The pelvis must not be too contracted.
These four fundamental conditions seem to exclude the application of the forceps to the pelvic extremity. We believe, however, that the dangers of so doing have been very much exaggerated, and in a case of breech presentation, where the hand could not reach the feet, we would follow the example of Depaul, Dubois, Stoltz and Tarnier, and apply the for ceps. We cannot sum up this question better than in the words of Tar nier: " The reasons given by those who reject forceps to the breech, seem at first sight excellent. In fact the blades do fit badly over the nates, and are very likely to slip; further the pelvic bones are too slight to stand readily the compression necessary for solid hold, and the blades, by pres sure on the abdomen, may tear the viscera. But what are we to do in a case of pelvic presentation, when it is urgently necessary to end labor promptly, and the hand does not suffice ? Shall we use the blunt hook ? But this has its disadvantages; and so, in such cases, Stoltz and Dubois have used the forceps and extracted living children." Tarnier has him self done so successfully in a number of cases, and, under the head of Presentation of the Pelvic Extremity, we saw that this method had suc ceeded with a number of German and English accoucheurs.
5. Finally Pajot, without making of it an indispensable condition, men tions engagement and fixation of the head at the superior strait as a very favorable circumstance.
1. The 08 must be Dilated or Dilatable.—This is the pnme mdispensable condition for the application of the forceps, and we have already dwelt sufficiently at length on the meaning of dilatation and dilatability. It is usually when the head is retained at the superior strait that the cervix is dilatable rather than dilated. We must recognize this dilatability, there fore, and in urgent cases act without waiting for dilatation. If the cervix is rigid, and delivery is imperative, we must, without hesitation, knick the external os in several places, which will suffice to make the cervix supple enough to not only allow the introduction of an instrument, but also its removal increased in size by the contained foetal head.
If nothing urgent calls for the termination of labor, we ought to wait as long as the state of the mother and the child will allow. This is an absolute rule, unfortunately for the mother and the foetus too often in fringed. One of the qualities which we as medical men should, possess, is the ability to resist the entreaties of friends and the patient, particu larly a primipara—to know how to wait, and do nothing. How many labors would have ended happily, and yet have terminated in the death of the mother and the child, because inexperienced or hurried physicians have used the forceps prematurely, and thus compromised through ignorance the issue of labor I How many unfortunate women die, as the result of dangerous premature use of the forceps, which not only does not allow the termination of labor, but produces grave lesions of the vagina or the cervix ! It is particularly in primiparte that we note these effects, so that we cannot emphasize enough the fact that every application of the forceps, where the cervix is neither dilated nor dilatable, is not only useless, but is also dangerous.
We should never forget that, in primiparre, dilatation of the cervix takes place always slowly, especially when the membranes have ruptured pre maturely; it is not exceptional, in such cases, for dilatation, even where the head is deeply engaged, to require from fifteen to twenty-four hours, and that application of the isreeps before dilatation is completed will not only prove an exceedingly difficult and delicate operation, but possibly dangerous. It is only exceptionally that we are called upon to interfere before dilatation is completed, and where only, in case of absolute necessity, is it allowable to knick the external os. Aside from absolute necessity, the rule is absolute, wait for dilatation, and only interfere when the condition of mother or of child calls for it.