9. When the feet of the child has passed through the os externum, wrap them in a cloth and holding them firm wait till there is a pain, during the continuance of which gently draw down the feet. When the pain ceases we must rest, we merely assisting the efforts of the patient. 10. When the child is brought so low that the funis reaches the os externum, a small portion of it is to be brought out to slacken it, and from this time the operation is to be finished as speedily as it can be with safety, but if the circulation of the funis be undisturbed, there is no occasion for haste as the child is in safety. 11. If the child should stick at the shoulders the arms must be successively brought down. 12. When both the arms are brought down the body of the child must be supported upon our left arm and hand, the fingers on each side of the neck, and if the head should not come easily away, we must introduce the forefinger of one hand into the mouth of the child to render the position of the head more convenient for passing. 12. When a child has been extracted by the feet, the placenta usually separates very easily, but in the management we are to be guided by the general rules. 13. In these cases the child usually needs to be resuscitated, and the nurse should arrange so that hot and cold water may be at hand if required. In these descriptions of the operation I have mentioned both the back and side as good positions for the mother, because some accoucheurs prefer one position and some the other. Some prefer to have the patient on the hands and knees. But if the nurse have the instructions here given well in her mind, she can operate in either position. If she ascertains at first how the child lies she may sometime reach its abdomen better if she introduces her left hand, but the main point is to proceed slowly and carefully. She should be careful in passing in her hand to change the direction of it in accordance with the pelvic axis, and should not use much force at any time. The danger to the mother is very small indeed; the danger to the child arises, as in breech presentations, from the compression of the funis, which commences about the time the buttocks appear at the os externum. But the safety is only when the operation is performed at the proper time. The nurse must never operate if the services of a physician can be obtained at that time, but when it is necessary she may proceed to turn, doing it slowly and properly, but fearlessly and confidently. If the doctor that is sent for is informed before he arrives that it is a case of hand presentation, he will come dreading the difficulties that he may encounter, and if he can have the satisfaction of knowing when he comes that the woman is safely delivered, he will be exceedingly glad. CHAPTER VI. CONCLUDING INSTRUCTIONS IN MIDWIFERY.