It has been supposed by some authors, and we think correctly that the
majority (if not all) of face presentations are originally cranial
presentations: if this be the case, we can easily understand why the right
side of the face presents more frequently than the left, for if the head
in the first cranial position moves round upon its transverse diameter,
and thus allows the face to turn downwards, we shall immediately have a
first position of the face. We are the more inclined to adopt this
opinion, not only from the greater number of cases where the right side of
the face presents, but also from our having more than once met with cases
where so long as the head of the child was moveable above the brim, the
presentation was midway between one of the cranium, and of the face. On
one side of the pelvis we could feel the anterior fontanelle; on the other
we could, with some difficulty, reach the orbital process of the frontal
bone: as the pains increased, and the head advanced lower, the side of the
face came more within reach; so that by the time it had fairly entered the
cavity of the pelvis, it had become a complete presentation of the
face.[79]
We distinguish the face by the bridge of the nose, which from its crossing
the os uteri may be detected at a very early period of labour: it is far
better than the eye, for not only is this liable to mislead us in our
examination, but it may also receive injury from the finger. Nor is the
malar bone a guide, for this might easily be mistaken for the tuberosity
of the ischium, or even for the shoulder. The nose not only tells us that
the face is presenting but also in which position, for at one end we
shall feel the soft cushiony extremity of it, at the other we shall reach
the broad hard expanse of the forehead.
It was not until nearly the end of the last century that presentations of
the face ceased to be accounted unnatural, and impossible to be terminated
by natural means. Although the fact had been pointed out by Portal so
early as 1685, that these presentations were very little removed from the
usual one, it seems to have excited but little attention until the time of
Deleurye in 1770. "I have," says Portal, "delivered several women whose
children came with the face foremost, and always without any great
difficulty, it being only observed, _that in such cases no violence must
be used, but nature be left to its own course; which done, there is no
danger either of mother or child_." (Portal's _Midwifery_, transl. obs.
66:) La Motte in 1721, although so accurate an observer, could not divest
himself of the general opinion that these were unfavourable positions,
even although the face was usually expelled by the natural efforts, after
he had fruitlessly endeavoured to rectify it, and although he himself
confesses never to have "seen any that had not done well."
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