The extraction of a foetus, acting (in the womb) as an obstructing Salya (foreign matter lodged in the body), is the most difficult of all surgical operations, inasmuch as actual contact or actual manipulation is the only means accessible to a surgeon in the region of the pelvic cavity, the spleen, the liver, the intestines and the uterus. All surgical acts in respect of the foetus or the enceinte, such as lifting up, drawing down, changing of postures (version), excision, incision, the cutting of limbs and section, pressure, the straightening and the perforating of the abdomen, could not be done otherwise than by actual contact of the hand, which may sometimes prove fatal to the foetus or to the enciente. Hence the king should be first informed (as success in these cases is often uncertain) and all acts should be performed with the greatest care and coolness.
We have stated before that the foetus is generally presented in cases of difficult labour in eight different postures or forms. The obstruction of the child in the passage of parturition (Garbha-Sanga) may be effected in three different ways, owing to its head, shoulders or hips being presented in a wrong way and held fast in the passage. Every care should be taken and no pains spared to bring a child alive into the world, which is not already dead in the womb. The sacred verses (Mantras), possessing of the virtue of bringing out the foetus, should be recited in the hearing of the enciente in the case of a failure in the first attempts at effecting parturition. The mantras are as follows. 2.
"O thou beautiful damsel, may the divine ambrosia' and the Moon god with Chitra bhánu and the celestial horse Uchchaih-Sravas take their residence in thy room; may this water-begotten nectar, help thee, O lady, in swiftly casting off thy womb. May the Sun, the Vásavas and the Wind-god (Parana) in the company of the saline Ocean give thee peace. The incarcerated beasts have been freed from their fastenings and binding chords. The Sun god has freed his rays of light. Freed from all danger, come, O, come, O child, and rest in peace in these precincts." 3.
Proper and useful medicinal remedies should also be employed for the delivery of the child.
In the case of the foetus being dead in the womb, the enciente should be made to lie on her back with her thighs flexed down and with a pillow of rags under her waist so as to keep it a little elevated. Then the physician should lubricate his (own) hand with a compound consisting of earth, clarified butter and (the compressed juice of) S'allaki, Dhanvana and S'álmali and inserting it into the passage of parturition (Yoni) should draw out the dead foetus (downward with the hand). 4.
In the case of a leg-presentation (Sakthi), the foetus should be drawn downward by pulling its legs. In case where a single leg (Sakthi) is presented, the other leg of the foetus should be expanded and then it should be drawn downward.
In the case of the presentation of the buttccks(Sphik) breech presentation), the buttocks should be first pressed and lifted up and then the foetus should be drawn downward by the legs. In the case of a longitudinal presentation (the child coming stretched cross-wise) like a belt and arrested in the passage, its lower extremities should be pushed upward with the hand and the child should be drawn out with its upper part (viz., the head, etc.), thus pointed downward, and brought straight into the passage of parturition. In a case of the head being hung back a little on one side, the shoulder should be lifted up by pressing it (with the hand) after chafening it, so as to bring the head at the door of the passage and the child should be drawn straight downward. Similarly in the case of the presentation of the two arms, the shoulder should be lifted up by pressing it (with the hand) and, the head being brought back to the passage, the child should be drawn downward. The remaining two kinds of false presentation Mudha-garbha) previously described (in the eighth Chapter of the Nidána Sthána) should be considered as irremediable. The applications of instruments (Sastra) should be the last resort when such manipulatory measures would fail. 5.
But even in such irremediable (Asádhya) cases, surgical operations should not be made if the foetus could be detected alive in the womb, as such a course (as the cutting of the foetus, etc.) would fatally end both as regards the child and its mother. 6.