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The Position of the Child in Labour

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THE POSITION OF THE CHILD IN LABOUR.

The Attitude of the the womb, even in the early months of pregnancy, the child usually beads forwards, and in the later months the head is bent forwards upon the chest, and the thighs bent upwards to the belly, the knees and elbows also, and the arms crossed and folded over the breast. This is called the attitude of the child, and it suits best the cavity in which it is placed.

The Presentation of the Child. — It is usually the head that is directed downwards towards the mouth of the womb. At full time this is the rule in 97 per cent of cases. But other parts of the child may present themselves first at the mouth of the womb, and the word presentation is used in referring to the part of the child that thus offers itself first at the opening of the womb.

Head Presentations, in which the head of the child advances, occur, as already mentioned, in 97 out of every 100 cases.

Breech Presentations are those in which the other extremity of the oval, which the child forms in the womb, is in advance, the buttocks that is to say. This occurs once in every 45 births.

Cross or Transverse Presentations are those in which the child lies across the mouth of the womb, and so a shoulder or hand, &e., descends first. These are happily rare, for they are very unfavourable.

The Position of the atti tude expresses the relation of the child's trunk and limbs to one another in the womb, and presentation expresses the part of the child which offers itself first at the outlet of the womb, the word position is technically em ployed to express the relation which the child bears to the body of the mother. 6 The child's head is usually downwards, towards the outlet of the womb, and with the head downwards the child's back may be towards the front, that is, towards the mother's abdominal wall, or the front of the child may be towards the mother's abdominal wall.

With the child's head downwards, and its back in front, it is the back part of the child's head which presents itself at the outlet of the womb, and the face is looking backwards. But with

the head downwards and the front of the child towards the mother's abdominal wall, the back of the child's head still presents itself first at the outlet of the womb, but the face 18 looking forwards.

The child's position in the womb is never, however, exactly in the middle line, with its back directly facing the mother's abdominal wall, or its chest directly facing the front. It lies, on the contrary, sideways, because it has thus more room, and thus the back of the child comes to be either to the mother's left side or to the mother's right side. In the same way, when the child's chest is to the front, it faces the mother's left side or right side.

The First Position. — When the child is head downwards, and its back facing the mother's left side, the hack of the child's head will present first, and will be directed to the left, while the child's face will be looking backwards, and to the right. This is called the first position.

The Second Position. — When the child's back is to the mother's right side, the back of the child's head will present at the outlet of the womb, and will be to the mother's right, while the child's face will look backwards, and to the left. This is the second position.

The Third Position.— Similarly there are two positions when the child's chest is to the mother's front. In both of these the back of the child's head will still present at the out..

let of the womb, but the child's face will be looking forwards. In one of them the child's face will look to the left, and the back of its head will be directed backwards, and to the mother's right. This is the third position, and is exactly the reverse of the first.

The Fourth Position.—On the other hand the back of the child's head may still present at the outlet, with the face looking forwards but to the mother's right, and the back of the child's head directed backwards, and to the mother's left. This is the fourth position, and is the revere of the third.

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