15. During the latter part of the labor the only assistance you can render the woman is to support the back, and to give her something to pull upon if she is so inclined. A sheet tied to the foot of the bed may be useful for this purpose. At the very last, bearing down efforts should be discouraged. 16. When the head is about to be expelled we always fear there may be slight or severe lacerations of the perineum. Do not in any way hasten the expulsion, even if there should be a number of pains in which a part of the head presents externally during the pain, and then recedes when the pain goes off. I have not always been able to prevent laceration, but the following directions are the best that I can give: Endeavor to have the patient extend her legs, and do not have her knees drawn up close to the body at the last. When the perineum is put on the stretch, place the thumb and forefinger of the right hand on either side of the perineum, and press so as to aid the stretching or distention. When the perineum is distended and protruding you may cover the hand with a soft napkin and apply it across the perineum, also by the sides of the vulva, and make firm, moderate pressure during the pain. Endeavor to have the pressure equable around the head of the child. 17. When the head is expelled an attendant should make steady gentle pressure upon the uterus and follow it down, keeping her hand firmly upon it for several minutes, perhaps for half an hour, or if you have given a little attention to the child, you yourself may put your hand on the contracted uterus and firmly knead it for ten minutes. 18. It is not necessary to extract the body immediately after the expulsion of the head. It is better to wait three or four minutes for the return of a pain before making any traction. 19. Although a little traction can be made on the head, it is a better way while an attendant presses on the uterus, and while you hold on to the child’s head with one hand, insert a finger of the other hand into the axilla, (under the child’s arm) and gently extract the body. 20. The child may be born apparently asphyxiated—its face swollen—and of a dark livid color, and at first make only feeble and gasping efforts at respiration; if there is the least beating of the heart can be perceived, there is fair hopes of its recovery. The cord should at once be tied and the child removed from the mother. If one or two slaps on its body does not make it cry, try immediately artificial respiration by the Sylvester method perhaps, not omitting at first and afterwards to throw a little cold water on its body. If these efforts fail I would try to induce respiration by placing my hand over its nostrils and blowing into its mouth, and immediately afterwards compressing its lungs.