2. The Membranes must have Ruptured.—This condition is as indis pensable as the preceding; for if we should apply the forceps before rup ture, we might separate the placenta, and have more or less serious hem orrhage.
3. The Fbrceps should only be applied tc the Head.—This condition, we have seen, is too absolute, for we are fortunate at times, in pelvic presen tations, to be able to extract the foetus by it. It is otherwise exact.
The instrument may be applied either to the before-coming or to the after-coming head; or again to the head left behind in the uterus after decapitation. (We will consider this later.) 4. The Pelvis must not be too contracted.—( Vide under head of con tracted pelvis, comparison between forceps and version.) 5. Finally, we have seen that Pajot considers it a favorable condition that the head is engaged and fixed at the superior strait.
Up to the time of Smellie, all authorities agreed in preferring version with the head above the brim; as for instance, Levret, Mme. Lachapelle, Baudelocque. Depaul, Cazeaux and Tarnier, without entirely rejecting the forceps, reserve it for cases where the pelvis is deformed. Abroad version is preferred.
In these instances, indeed, the application of the forceps is very diffi cult. Aside from the mobility of the head, it is rarely seized regularly and symmetrically ; the instrument can only rarely be directed sufficiently backwards to engage the head readily ; it further slips easily, and we may thus injure deeply the cervix and the vagina. It is, therefore, to version that we ought to resort above the superior strait. But if the uterus, on account of the escape of the liquor amnii, has contracted on the foetus, then version is impossible, and, before resorting to embryotomy, it is our duty to try the forceps.
The same holds true of relatively marked contraction of the pelvis. If .the child is alive we should try the forceps, but we must never use over much traction-force. The accoucheur alone should make it, in order that the woman may not be so injured that complications result which may threaten, if not end, her life.
When, on the contrary, the head is engaged, and more or less fixed at the pelvic brim, the forceps only is indicated. The head being immovable,
the blades are more readily applied. The lock must often lie in the vagina, otherwise the head will be imperfectly seized, the instrument may slip, and produce damage which we will speak of later.
Without going as far as Baudelocque and Mme. Lachapelle, who advised showing the woman the forceps and explaining its method of action be fore application, we believe that it is of advantage to prepare her for it, by making her understand the necessity of terminating labor in her inter est as well as in that of the child, by calming her fear of pain, by appeal ing, in a word, to her heart and her reason. The aid of both friends and relatives should also be invoked, and it is exceptional then that we cannot triumph over her instinctive repugnance, which varies, indeed, with the woman, for many from previous personal experience, or from what they have heard from their friends, call loudly for the instrument. Chloro form is of great assistance, of course.
[We are decidedly opposed to saying anything to the woman about in. strumental interference. The friends, of course, should be informed, but as for the woman herself, the mere thought of instruments will often alarm her, so that when we come to the administration of the anaesthetic this is the more difficult owing to the nervous fears of the patient. See ing that only exceptionally ought we to apply the forceps without awes-• thetizing, any pretext may be found for the latter, even if the woman does not call for it herself, and she usually does, and when once under the influence of the anaesthetic we may place the woman in the proper posi tion, and only then produce our forceps.—Ed.] As for chloroform, although we need not use it where the forceps are applied at the inferior strait or at the vulva, that is to say in the simple cases, we believe it to our interest to resort to it whenever the head is high up, or we anticipate any trouble. We should always call to our aid a professional friend or trained assistant, and this may frighten the woman, still we ought not to dispense, on this account, with one of the things which make anaesthesia safe. The anaesthesia should be deep, to the sur gical degree.