Wherefore, again, we recommend rupture of the membranes at the level of the cervix. Three methods of searching for the feet are in vogue.
The first, derived from Madame Lachapelle, consists in going directly to them, seizing them, and bringing them down. This constitutes hasty version, and requires very exact diagnosis, and while excellent in such an event, in case of error it exposes us to trouble.
The second, advocated by Dubois, consists in passing behind the fcetus, lifting it up, following the posterior wall of the uterus up to the fundus. The hand is then turned so that its dorsal surface lies against the anterior wall of the uterus, and the feet are at once found by the concavity of the hand. This is an excellent method, true enough, when the ventral sur face of the fcetus is posterior, and the feet there as well. But if the feet are in front, they cannot thus be found.
The third is the classic method. The road is longer, but more certain.
The hand in the cavity seeks the lateral or posterior surface of the foetus. Following this surface to the nates, and thence along the thighs, and thence along the leg, it surely finds the feet. Bailly advises following the anterior surface of the foetus, but in order that this method may succeed, there must exist considerable liquor amnii, the foetus be fairly moveable, the uterus not irritable, and often these conditions are not present. This proposition of Bailly's then is impracticable.
Each one of these methods possesses advantages,bnt requires special con ditions. The best plan is to follow the advice of Lachapelle, having made as precise a diagnosis as possible beforehand. If necessary, we can grope our way to the feet, until we seize a foot or a knee, or even hook the finger, as we will see, in the groin.
Seizure of the Feet.—Must we seize both feet, or one, or, in the latter event, which ? Whenever it is possible to grasp both, this is advantageous, but this only happens in easy version. Barnes prefers the knee to the foot, and insists upon this. Portal first proved that we might turn by one foot. Puzos insisted on but one foot, and this is the practice of almost every accoucheur in France, in England, in Germany. Version thus performed
is, they say, easier, quicker, less painful for the mother, less dangerous for the child. " In case of incomplete presentation of the feet, " says Schroder, "we are better able to leave the termination of labor to Nature, than where both the feet present. The first part of delivery is, true enough, a little slower and more difficult, but the after-coming head passes the more readily, because of the dilatation of the soft parts by the breech and one thigh. In the interest of the child the inferior portion of the body need not be delivered rapidly, but the superior portion ought to pass quickly." Which foot ought we to grasp? Authorities differ. The greater num ber are in favor of the nearest, or lowest foot. (Kilian, Lumpe, Seanzoni, Martin, Lange, Depaul, Bailly, etc.) It is not only easier to grasp, but it further appears anterior at the moment of extraction, that is to say be hind the symphysis. This is our practice, and that of Turnier. Others, on the contrary, advise grasping the superior foot. (Roederer, Joerg, Hohl, Simpson, Kristeller.) Barnes says that thus evolution is more complete, while Scharlau and Haselberg point out that by pulling on the superior foot it may lock with the inferior, and thus render version im practicable.
For our part, whether one or another foot is seized matters little in general. Only when the back is posterior may it be advantageous to grasp the superior foot. As Pajot says, with truth: The best foot is that which is grasped the best.
To distinguish the superior from the inferior foot, we must remember the position of the fcetus, and follow the border of the foot. In case of the superior foot, the internal border faces below, and in case of the in ferior foot, it faces above.
If we cannot reach the foot, we must grasp the knee. This is particu larly practised and recommended by Simpson, Barnes and Simon Thomas de Leyde. According to the latter, version by the knee offers the ing advantages: " 1. Whenever the uterus is not too much contracted, whatever the presentation, we reach the knee more readily than the foot.