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December 19, 1925

Midwifery Mechanics.

JAMA. 1925;85(25):1988-1989. doi:10.1001/jama.1925.02670250062033

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Wisdom and technical experience are exhibited in this little book. The author elaborates the theory of "pivotal points," by which he means the apex of the maternal subpubic arch and the craniovertebral junction of the child. His thesis emphasizes the necessity for recognizing before labor the presentation and the attitude of the child and the effect which the distance of the pivotal points from each other, and the ease with which they may be brought into relation, will have on the progress of labor. In the course of his argument, he finds a need for employing the term "revolution" in place of "flexion or extension" to explain the anteroposterior movement of the head on its vertebral axis. In a mechanical sense the term might carry a greater accuracy, as he contends; but, on the other hand, flexion and extension have the authority of familiarity and long usage, as well as

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