Fig. 99.—Delivery of the placenta.
Having been inspected, the placenta should be placed in a covered receptacle to be disposed of as the doctor directs, as many physicians make a routine laboratory examination of the placenta and wish to have it kept for this purpose.
With the birth of the placenta comes a gush of blood, as the uterine vessels, some of which are as large as a lead pencil at this time, are left wide and gaping. The bleeding usually subsides very shortly, however, as the blood vessels are closed by involuntary contraction of the network of uterine muscle fibres in which they are enmeshed, and which are sometimes referred to as “living ligatures.” If the bleeding continues, these contractions should be stimulated by massage. This is done by grasping the uterus through the abdominal wall firmly with one hand and kneading vigorously. Rubbing the top of the fundus with the fingers usually is not enough. The fundus should be grasped by the entire hand; the thumb curved across the anterior surface and the fingers, directed deep into the abdomen, behind it. (Fig. [101].)
Pituitrin or ergot, or both, are frequently given to further stimulate contractions of the uterine muscles. Since the action of pituitrin is quick, but evanescent, and the effect of ergot is slower and more lasting, both a quick and lasting effect is obtained by giving them together.
Fig. 100.—Twisting the membranes while withdrawing them from uterus.
The expulsion of the placenta ends the third stage and completes the process of labor.
Fig. 101.—Grasping fundus through abdominal wall in giving massage to stimulate uterine contractions.
Immediate After-care of the Patient. The patient should be bathed and dried about the thighs and buttocks, the vulva being bathed with alcohol or an antiseptic solution, and a sterile perineal pad applied. The douche-pan, wet towels, delivery pad and draw sheet are replaced by a dry draw-sheet and a towel or pad slipped under the patient’s hips, while a fresh nightgown is put on if the one worn during labor is wet or soiled. The perineal pad is very commonly held in place by a T. binder, with which all nurses are familiar, but some doctors prefer an abdominal binder to which a perineal strap is attached. This abdominal support may be a straight swathe or a Scultetus bandage, varying with the wishes of the doctor, and it may or may not be used in conjunction with a pad, so applied as to make pressure over the fundus. Other doctors forbid the application of any kind of a perineal dressing from the time of delivery, but instead, have a large, sterile pad slipped under the patient to receive the discharge.