In these instances, therefore, we prefer the classic forceps, and if trac tion downward and backward do not suffice, we try Pajot's method, and the head once at the inferior strait, we try artificial rotation, ready, if this fail, to deliver the occiput posterior.
If, notwithstanding these methods, we fail in dislodging the head, then, in the interests of the mother, we must sacrifice the child, and it is preferable to do this, and give to the mother greater chances of health, than to endeavor at all hazards to make the head descend; for, on the one hand, the injuries to the mother compromise greatly the puerperium, and, on the other hand, granting that the child is born alive, the lesions resulting from exaggerated traction and compression almost fatally mean its death in from twenty-four to forty-eight hours after birth.
C. Head movable above the Superior authorities here prefer version to the forceps, whenever possible. But it has been proved by the researches of Budin, Milne, Goodell and Champetier, that although version is preferable to forceps in pelvic deformity before term, it is not so at term.
The causes which ordinarily retain the head above the superior strait may be reduced to two: oblique positions of the head, and pronounced pelvic contraction. The first, we have seen, almost always correct them selves in course of time, if the pelvis is normal, and the accoucheur has simply to wait. If, on the other hand, we are dealing with great pelvic
contraction, it is not forceps which we must use, but perforation, or cephalotripsy, or the Caesarean section, [or better still, in suitable cases, laparo-elytrotomy. —Ed. ] There remain then for consideration the cases of considerable contrac tion, where we can hope to deliver the child at term without mutilation. The application of the forceps then becomes very difficult and delicate. Aside from the fact that the mobility of the head makes it difficult to apply the blades, the hand cannot be inserted far enough to guide them. We must first, then, make one or two efforts at traction to be sure that the head is grasped firmly, for above all we must take precautions against the instrument slipping. Sometimes the head is grasped too far in front, and it escapes from the forceps behind, or inversely, with the first tractions. Altogether, indeed, the accouchenr is not at liberty to do as he would wish; he must do the best he can; and if he is fortu nate enough to grasp the head firmly, if after a few sustained tractions the head does not budge, it is advisable to perforate, or to resort to cephalotripsy.