. Obstetrics for nurses. ulders, as it may lead to injury of the nerves in the cervical regionwhich supply the arm, and a birth palsy of the extremity may the birth of the shoulders, all obstacles have been overcomeand the body and legs are promptly born. The Third Stage.—The first part of the placental stage usually pro-ceeds spontaneously, so that the attendants can ])usy themselves withthe care of the child and with the repair of any existing perineal lacera- THE CONDUCT OF LABOR 139 tions. In the absence of excessive bleeding, the uterus should be leftstrictly alone, excep
. Obstetrics for nurses. ulders, as it may lead to injury of the nerves in the cervical regionwhich supply the arm, and a birth palsy of the extremity may the birth of the shoulders, all obstacles have been overcomeand the body and legs are promptly born. The Third Stage.—The first part of the placental stage usually pro-ceeds spontaneously, so that the attendants can ])usy themselves withthe care of the child and with the repair of any existing perineal lacera- THE CONDUCT OF LABOR 139 tions. In the absence of excessive bleeding, the uterus should be leftstrictly alone, except that it should occasionally be palpated to makecertain that it is contracting well, and to note when the fundus risesfollowing separation of the placenta. Constant massage of the uterusduring this period does more harm than good, by producing abnormalcontractions which interfere with the normal mechanism of placentalseparation. Traction upon the cord is only to be condemned—it maydo serious harm but never any Fig. 75.—Delivery of the shoiildere—upward traction. (Bumm.) As has been stated previously, the placenta usually separates fromits attachment to the uterine wall within fifteen minutes and passesinto the lower uterine segment and upper part of the vagina. Thisseparation is indicated by a considerable rise in the height of the fundus,as well as by an increase in the length of the exposed part of theumbilical cord. After these changes have occurred the fundus of theuterus is grasped through the abdominal wall with tlie four fingers be-hind and the thumb in front (Fig. 76), and firm pressure is made alongthe pelvic axis. The uterus is not kneaded or compressed, l)ut is simplyemployed as a piston to expel the placenta, which is lying free in thelower part of the birth canal. Most of the blood which is normally 140 TEXTBOOK OF OBSTETRICS FOR NURSES lost during the third stage escapes at this time. The fetal membranes—amnion and chorion—trail out after the p
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