Fig. 97.—Resuscitating the baby. (See also Fig. [96].)
The outstanding requirements in resuscitating a baby are to stimulate its respiratory movements, by alternately expanding and contracting the chest; to promote its circulation by keeping it warm, and to avoid exhausting the very frail little body. Gentle handling, therefore, is important.
THIRD STAGE
After the birth of the baby, some doctors request the nurse to rest one hand on the mother’s abdomen in order to feel the fundus as it rises while expelling the placenta, and to keep him informed concerning its consistency. Others regard this as a dangerous practice and forbid it.
As a rule, there is little bleeding until the placenta has separated. If bleeding does occur, it is the practice of some doctors to have the uterus gently massaged through the abdominal wall, to stimulate contractions, while others consider this inadvisable.
Fig. 98.—Stimulating respiration by means of direct insufflation, the baby’s face being covered with clean gauze. (From photograph taken at Johns Hopkins Hospital.)
After the placenta separates and descends into the lower uterine segment, it produces a bulging just above the symphysis, while the fundus may be felt as a firm, hard mass above the umbilicus. Since the placenta is entirely separated from the uterus at this time, its complete expulsion is usually aided, when it does not occur spontaneously, by gentle pressure upon the fundus. The accoucheur holds his hand just below the vaginal outlet, to receive the placenta (Fig. [99]), which he turns over and over in his hands, thus twisting the membranes, and gradually draws it away from the mother, the membranes trailing after in the form of a tapering cord. (Fig. [100].) It is important that the placenta and membranes be carefully examined to make sure that they are intact, for if fragments of either are retained within the uterus they will prevent its firm contraction and thus may be a cause of post-partum hemorrhage. For this reason, only very gentle pressure and traction are used in expressing the placenta and withdrawing the membranes, for the use of force might leave small particles adhering to the uterine lining, which would otherwise separate with the rest, in due time, as a result of the uterine contractions.
