If the former, and the head of the child appears first,
it may be guided and directed towards the neck of the womb, as in the
case of natural birth, but if there appears any difficulty in the
delivery, the best way is to look for the feet, and draw it out by them;
but if the latter, the afterbirth may be put back with a gentle hand,
and the child taken out first. But if the afterbirth has come so far
forward that it cannot be put back, and the child follows it closely,
then the afterbirth must be removed very carefully, and as quickly as
may be, and laid aside without cutting the entrail that is fastened to
it; for you may be guided to the infant by it, which must be drawn out
by the feet, whether it be alive or dead, as quickly as possible; though
this is not to be done except in cases of great necessity, for in other
cases the afterbirth ought to come last.
In drawing out a dead child, these directions should be carefully
followed by the surgeon, viz.--If the child be found to be dead, its
head appearing first, the delivery will be more difficult; for it is an
evident sign that the woman's strength is beginning to fail her, that,
as the child is dead and has no natural power, it cannot be assisting in
its own delivery in any way. Therefore the most certain and the safest
way for the surgeon is, to put up his left hand, sliding it into the
neck of the womb, and into the lower part of it towards the feet, as
hollow in the palm as he can, and then between the head of the infant
and the neck of the womb.
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