[Illustration: Fig. 70.—Delivery in face presentation. (Bumm.)] The brow presents much more rarely than the face, possibly once in a thousand labors. It is due to the same conditions as bring about the presentation of the face. The mortality for both mother and child is higher than in face cases. The whole labor is harder and longer, besides being more dangerous to life and to tissues. This presentation, if recognized before the head is fixed, should be converted into a breech by version, but after the head comes down, it may be possible by hand or forceps to deliver either as a face or as an occipito-posterior, but otherwise the cranioclast must be considered. =Occipito-posterior position= is the name given to vertex cases wherein the occiput lies in one or the other of the two posterior quadrants of the pelvic inlet. These labors are necessarily prolonged, both in the first and second stages, because the mechanism of delivery is deranged by the larger diameters brought into relation with the bony canal and by the ineffectiveness of the contractions. The pains in the second stage may become violent and extremely painful, but the labor does not advance appreciably. After a little experience, mere observation of the course of the labor will cause the suspicion to arise in the mind of a competent nurse that the occiput is posterior. The diagnosis will be cleared up by the doctor’s internal examination, which shows the large fontanelle anterior and the sagittal suture running backward. The head is partially deflexed and it may not be possible at first to find the small fontanelle. The position terminates by delivery uncorrected, by spontaneous rotation into an anterior position, or is corrected by the doctor. Correction should not be attempted until it is apparent that the anomaly will not right itself, which it will do in four cases out of five. CHAPTER XII OPERATIONS Complications during labor may arise from abnormal positions of the head, such as face or brow; from abnormal presentations of the child, such as breech, transverse or shoulder; from twin labors; or from prolapse of a part like the foot, arm or cord. The mother may be responsible for some of these abnormalities through having a contracted pelvis, a rigid os, or a rigid pelvic floor. The uterus, too, may functionate abnormally by acting too vigorously, as in precipitate labor, or too slowly, as in uterine inertia. The membranes may rupture prematurely and produce a dry birth. There may be hæmorrhages before labor (ante partum hæmorrhage) during labor (intra partum), and after labor (post partum hæmorrhage), or the labor may be preceded, accompanied, or followed by that extreme example of toxæmia known as eclampsia.