264 Where There Is No Doctor 2011
THE DELIVERY OF THE PLACENTA (AFTERBIRTH)
Normally, the placenta comes out 5 minutes to an hour after the baby is born, but
sometimes it is delayed for many hours (see below).
Checking the afterbirth:
When the afterbirth comes out,
pick it up and examine it to see if it is
complete. If it is torn and there seem
to be pieces missing, get medical
help. A piece of placenta left inside
the womb can cause continued
bleeding or infection.
Use gloves or plastic bags on your hands to handle
the placenta. Wash your hands well afterwards.
When the placenta is delayed in coming:
If the mother is not losing much blood, do nothing. Do not pull on the cord. This
could cause dangerous hemorrhage (heavy bleeding). Sometimes the placenta will
come out if the woman squats and pushes a little.
If the mother is losing blood, feel the womb (uterus) through the belly. If it is soft,
do the following:
Massage the womb carefully, until
it gets hard. This should make it
contract and push out the placenta.
If the placenta does not come out soon, and bleeding
continues, push downward on the top of the womb very
carefully, while supporting the bottom of the womb like this.
If the placenta still does not come out, and the heavy bleeding continues, try to
control the bleeding (see next page) and seek medical help fast.
HEMORRHAGING (HEAVY BLEEDING)
When the placenta comes out, there is always a brief flow of blood. It normally lasts
only a few minutes and not more than a quarter of a liter (1 cup) of blood is lost. (A little
bleeding may continue for several days and is usually not serious.)
WARNING: Sometimes a woman may be bleeding severely inside without much blood
coming out. Feel her belly from time to time. If it seems to be getting bigger, it may be
filling with blood. Check her pulse often and watch for signs of shock (p. 77).