The Matron's Manual of Midwifery, and the Diseases of Women During Pregnancy and in Childbed: Being a Familiar and Practical Treatise, More Especially Intended for the Instruction of Females Themselves, but Adapted Also for Popular Use among Students and Practitioners of MedicineHollick, Frederick
Science
The Matron's Manual of Midwifery, and the Diseases of Women During Pregnancy and in Childbed: Being a Familiar and Practical Treatise, More Especially Intended for the Instruction of Females Themselves, but Adapted Also for Popular Use among Students and Practitioners of Medicine
Hollick, Frederick
Chloroform; Gynecology; Indian Territory; Midwifery; Obstetrics; Pregnancy
Before the rupture of the membranes the head presents its occipito
frontal diameter, which measures four inches, to the right oblique
diameter of the Pelvis, which measures four inches and a half; while
its bi-parietal diameter, which measures only about three inches and
a half, is presented to the other oblique diameter, also measuring
four and a half--(See Plate XIX.) Even here it will be seen that the
passage is larger than the head which has to pass through it, but a
more favorable position still can be obtained, by a slight movement of
the Fœtus, which nature accordingly accomplishes, and also follows by
others, to preserve the advantage, which will next be described.
_Movements of the Fœtal Head._--There are three of these peculiar
movements, each of which takes place at a particular period of the
labor, and must be described separately.
_First movement, flexion, and descent._--Immediately after the
Membranes are broken, the contractions of the Uterus force the head
into the upper strait, by the occipito frontal diameter of four inches,
as already shown; but then commences the first movement, which consists
in a bending of the child's chin down upon its breast, so that the
forehead is carried up into the Womb; and the most prominent point of
the back of the head presents to the middle of the passage, by the
_occipito bregmatic_ diameter, which is only about _three inches_
instead of four. This of course makes the passage so much easier, and
generally, immediately after this change, the head descends into the
basin of the Pelvis.
It is not absolutely necessary however, for this movement to occur, for
in a well formed Pelvis the head can descend without it, though not so
easily; and sometimes, in fact, it does not take place, but this is
unusual.
It must be recollected that this shifting of the head alters the
position of the _fontanelles_--the posterior one being brought more
to the centre of the strait, and the anterior one carried up out of
reach, while previous to the movement they were both on a level. If an
examination is not made therefore, till after this change, it may be
difficult to determine the position, unless this is borne in mind. The
following Plates show this very well.
PLATE XXVII.
It will be seen here that the neck is straightened out, and that the
two fontanelles are on a line with each other.
_Note._--The front of the bones are represented in this and the two
following Plates, as if transparent, so that the head may be seen
through them.
[Illustration: Plate XXVII.
This Plate represents the head just entering the upper Strait.]
PLATE XXVIII.
At this time the anterior fontanelle can scarcely be reached, but the
posterior one is easily to be reached, being in the open passage, on
the left side. The head is now fairly within the Pelvic cavity, but
still lies across from right to left.
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