H. F. Biggar
1919 Journal of the American Medical Association  
Is it not surprising how many cesarean sections are being performed by the younger class of obstetric surgeons? An obstetric surgeon reports that, though he has not been in practice more than ten years, he has already passed his one hundred and fiftieth cesarean section. It may be questioned whether the conditions warrant the operation. Has not nature perfected the proper way for normal birth? Cesarean section is justifiable only when the following conditions are present; contracted, deformed
more » ... diseased pelvis; placenta praevia; eclampsia; fibroid tumor; kyphosis; osteosarcoma of the pelvis; hypertrophic elongated cervix; uterine fibroma; malignant disease of the cervix uteri; face presentation with chin directly posterior; funnel pelvis; inoperable carcinoma of the uterus; presentation of the head, cord and foot; atresia of the vagina; deformities of fetus of abnormal development, including the hydrocephalic fetus; ruptured uterus; hydramnios; suppurating ovarian cyst; double uterus; adherent placenta and ruptured uterus; Bright's disease; difficult labor after ventral fixation of the uterus; scar of old operations for other conditions; vaginal occlusion; dyspnea; cyanosis; anasarca and albuminuria; dermoid cyst of the pelvis; malignant ovarian tumor: labor with impaction; rigid os; pendulous abdomen; malignant disease of the rectum, and anteversion of the gravid uterus. Why not try the Watcher posture before using the knife? I have found this posture sufficient in quite a number of patients, even though cesarean section was advised by reputable surgeons, and the patients were willing to submit to the operation. THE WALCHER POSTURE The patient is placed in the decubitus position on a table with one end so elevated thaf the nates project well over the edge, the legs hanging perpendicularly, the feet not touching the floor. When the head presents in the soft parts the end of the table is lowered so that the top is level. The patient is then put in the extreme lithotomy position and delivered with or without instruments. This position increases the diameter of the superior strait of the pelvis one-quarter inch or more.
doi:10.1001/jama.1919.26120380001012 fatcat:kw4nihvrzbgqpbv5p7p65phigq