Shortness of the cord may occur as a complication, and delay the labor very much. It has been known to be not more than four to five inches in length. The strongest symptoms of this state of things are found in the continued retraction of the child, time after time, after the cessation of each pain, without any perceptible advancement.
If this condition of the patient continues too long, so as to endanger the welfare of the mother or child, the aid of instruments must be invoked. When the presenting part has advanced so far as to expose the cord, it should be severed at once, about an inch and a half from the child’s body. It may be tied; or held tightly between the fingers of an assistant until a complete delivery takes place, when it may be tied. There is danger of a rupture of the cord or of a separation of the placenta, exposing the child and mother to a severe loss of blood before the child is sufficiently far expelled to expose the cord; in this event the treatment is still the same: apply the instrument necessary for hastening the expulsion of the child.
Inclined position of the foetus constitutes another cause, on the part of the child, of its tardy birth. Fig. 96 illustrates a case of this kind.. In making an examination per vaginam, one ear, the side of the head and the neck are felt. In all similar cases it is only necessary to turn the patients so that she shall lie on the side opposite to the place where we feel the neck of the child. The body falls down on the same side and soon rectifies the inclination.
Inclined breech positions can be managed on the same principle; the mother being always turned, in such inclinations, upon the same side as the anus points to.
Inclined facial positions should always be managed in the same way as any facial presentation; they should be converted at once, and without delay, into vertex presentations, as will hereafter be described.
Inclined positions of the trunk most also be interfered with at once, and converted into vertex presentations or delivered by the feet, as directed a little further on.
Complicated presentation, something similar to Fig. 97, must be managed by the application of general principles.
The child is forced quite closely down into the superior strait. Now, it is evident, the trunk cannot go back, and the head be brought down, because one foot has advanced too far. If the feet were further up, the forceps might perhaps be applied, and the head brought down, and the cord would be less liable to become compressed. All things being considered then, it is very evident that the best course to be pursued is to use a linen handkerchief as a fillet on the foot most advanced. An assistant should make powerful, but steady and careful traction upon it, whilst the accoucheur steadies the uterus with both hands placed upon the abdomen. The labor will then terminate in the most favorable manner. The exercise of mature judgment is called for in all these unusual and entirely new conditions.
