A sterile dressing about 4 inches square should be placed over the cut end of the cord at the baby's navel and should be held in place by wrapping a "bellyband" or folded diaper around the baby. If a sterile dressing is not available, no dressing or bellyband should be used. Regardless of whether a dressing is applied or not, no powder, solution, or disinfectant of any kind should be put on the cord or navel.
If the afterbirth has not yet been expelled, cover the end of the umbilical cord attached to it (and now protruding from the vagina) with a sterile dressing and tie it in place.
[Illustration: Cut between the square knot by bringing the left tape over right tape for first loop and right tape over left for second loop. Tighten each loop firmly as tied. Use scissors or a razor blade to cut cord.]
THIRD STAGE OF LABOR
Usually a few minutes after the baby is born (although sometimes an hour or more will elapse) the mother will feel a brief return of the labor pains which had ceased with the birth. These are due to contractions of the uterus as it seeks to expel the afterbirth. Do not pull on the cord to hurry this process.
Some bleeding is to be expected at this stage. If there is a lot of bleeding before the afterbirth is expelled, the attendant should gently massage the mother's abdomen, just above the navel. This will help the uterus to tighten, help the afterbirth come out, and reduce bleeding.
It may be desirable to put the baby almost immediately to the mother's breast for a minute or two on each side even though the mother will have no milk as yet. This helps the uterus contract, and reduces the bleeding.
Someone should stand by the mother and occasionally massage her abdomen gently for about an hour after the afterbirth is expelled. After that the mother should feel the rounded surface of the uterus through the abdomen and squeeze firmly but gently with her fingers. The bedding should be cleansed and the mother sponged. Washing and wiping of the vaginal area should always be done from the front to the back in order to avoid contamination. A sanitary napkin should be applied.
Keep the mother warm with blankets. She may have a slight chill. Give her a warm (not hot) drink of sweetened tea, milk, or boullion. Wipe her hands and face with a damp towel. She may drop off to sleep.