If by mischance, or in spite of her efforts, the baby so far descends that the brow appears before the doctor’s arrival, the nurse cannot safely hold it back longer because of the danger of the baby becoming asphyxiated. She should, up to this point, hold the head back during pains in order that the perineum may be stretched slowly, with the hope of preventing a tear. (See Fig. 87.) It is the sudden distension of the perineum and expulsion of the baby’s head at the height of a pain that frequently causes lacerations. If fecal matter is expressed during pains, the field should be wiped, downward, with sterile sponges and bathed with the antiseptic solution at hand. After the brow is born, the nurse may gradually release the pressure and allow the head to emerge, and remembering the position of the child and the mechanism of its birth, assist Nature in its complete delivery. After the head is born, it drops down toward the mother’s rectum, after which external rotation, or restitution, takes place. (See Fig. 88.) A finger should be slipped around the neck in search of coils of cord, which, if felt, should be slipped over the baby’s head. Otherwise, pressure upon the cord in that unnatural position might so interfere with the circulation as to asphyxiate the baby. The shoulders may be born spontaneously or the nurse may grasp the head with both hands, curving the fingers of one hand under the baby’s chin, and of the other, under the occiput, and make gentle, downward traction (See Fig. 69.) in order to slip the anterior shoulder from under the symphysis; and then pull gently upward, to deliver the lower or posterior shoulder (see Fig. 70.), after which the rest of the body follows easily. This description of how a nurse may conduct a normal delivery by fairly typical and generally approved methods is only intended to guide her in an emergency, when there has been no understanding between her and the doctor about what she should do in event of his absence; or when he has authorized her to use her best judgment in safeguarding the lives of mother and baby. It is obviously of extreme importance for the nurse to ascertain definitely the doctor’s wishes in this connection, as he sometimes will be unwilling to have the nurse give any attention to either mother or baby, even to tie the cord, before his arrival. =Prolapsed Cord.= If the umbilical cord should prolapse at any time during labor, in the absence of the doctor, or lacking instructions, the nurse should elevate the patient’s hips, in order that gravity may lessen the pressure on the cord as it lies between the presenting part and the pelvic brim. Otherwise, the interference with the placental circulation may result in asphyxiation of the baby. (Fig. 102.) [Illustration: FIG. 102.—Drawing showing how prolapsed cord may be pressed between baby’s head and pelvic brim, thus cutting off placental circulation. ]