In the hospital the following rules may be used as a concise guide for the conduct of the third stage:
Conduct of Third Stage.
Keep patient on back and keep a hand on fundus. Note amount of blood lost, its character, its flow, and whether steady or in gushes. The placenta should detach itself normally in thirty minutes. After thirty minutes, expulsion may be assisted by—
(1) Early expression.
(a) Massage, rub and knead the uterus, until it hardens under the hand.
(b) Seize contracted uterus by fundus with full hand, fingers behind and thumb in front.
(c) Push slowly but firmly toward the pelvic outlet.
(2) Credé expression.
Same maneuver as above, except that the fundus is compressed between thumb and fingers while the downward movement is progressing.
Conditions for Credé expression: