To effect delivery while the foal is in this abnormal condition (fig. 548) is practically impossible.
Fig. 548. - Head presented, Knees doubled back.
What is required is to bring the legs into the position of a natural presentation, i.e. into the passage, with the head resting upon them. To effect this the canon bone must be straightened on the knee and the leg extended. The limb most easy of access is the first to be dealt with. If the head is in the passage it must be forced back into the uterus by planting the flat of the hand on the front of the face. When necessary, this may be effected with a crutch made to press on the front of the chest. While this is being done by an assistant, the operator will pass his hand along the under side of the neck until the forearm is reached. A push in a backward direction should then be made, until the arm can be raised and the leg brought bodily forward. The hand should now pass down to the canon, seize it, and through it push the knee up towards the neck.
Fig. 549. - One Fore-limb displaced backwards.
The hand while drawing the limb forward gradually moves towards the pastern, which it firmly grips, and after extending the fetlock-joint, draws the foot into the passage. The limb having been secured by cords, the recovery of the next one may be proceeded with, after which delivery will be effected in the usual way.
Still more difficult is that presentation where one fore-limb with the head is in the passage, and the other is lying far back under the body (fig. 549). Here the advantage of a long arm and a strong man to use it will be clearly obvious, for, as in the last presentation, the success of the operation will depend upon the displaced fore-limb being secured and brought into position. The passage must first be cleared by pushing back the head. The hand should then be passed along the under part of the neck, should seize the fore-arm and bring it forward into the passage.
If this cannot be accomplished, then the front parts of the dam must be raised by underpacking the fore-feet with litter so as to give the body an inclination backward. When the forearm is reached the hand should follow it downward to the knee, or as near it as possible. The limb is then firmly grasped and drawn forwards.
When the arm has been brought in a straight line with the pelvic inlet, it should then be used to push the body backward and clear the way for the leg being brought into the passage. To do this it may be necessary to push the body back into the uterus with a crutch implanted against the breast.
Fig. 550. - Porte-cord.
Fig. 551. - Breech presentation, Hind-legs in Passage.
If it should happen that the arm cannot be reached, an attempt must be made to pass a cord round it by means of a Porte-cord (fig. 550). Should such an instrument not be at hand, a hooked walking-stick carrying a cord through a hole in the handle may be employed. The leg will then be pulled forwards by assistants, while the operator, seizing the canon and then the pastern, will engage himself in directing it into the passage.