No doubt many physicians have made the same observations that I have made in the treatment of a large number of confinement cases, which are in line with the statements recently made by Landau, who claims that immediate resort to the forceps in many labor cases is unnecessary and unjustifiable.
When the head is descending slowly within the pelvis and other conditions are natural, much assistance can be given to the labor by assisting the natural dilatation of the cervix.
In my own experience I have found that when the natural dilatation has reached a point equal to the size of a silver dollar or more, the position being normal, if the index finger is inserted between the head and the upper edge of the cervix during a pain, and moved carefully around within the cervix with some pressure against the cervix, the pains are not only increased, but the dilatation of the cervix is promoted.
It will be found in many cases that the anterior lip is too far downward and beneath the head, and by reaching well under and hooking the finger into this lip during a pain, applying a steady but very careful force, sometimes the head will quickly slip out through the opening, and the cervix will assume a normal position.
Again, when the head is low, the finger may be pressed against the upper lip and the lip pushed back, when the head is pressing against the pubic bone. All this favors the descending of the head and the dilatation of the cervix. There is no danger of laceration if gentleness and care be exercised.
Furthermore, when the head presses against the perineum and the pains are insufficient, these may be increased and naturally strengthened by pressing the finger in between the floor of the pelvis and the head of the child and pressing outward, not when the perineum becomes greatly distended, but before this period while the progress of the labor is somewhat slow. These measures are sometimes of great service and do away with the necessity of instrumentation.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.