Immediately after delivery of the baby, the placenta is still
attached inside the uterus. Some time later, the placenta will detach
from the uterus and then be expelled. This process is called the "3rd
stage of labor" and may take just a few minutes or as long as an hour.
Signs that the placenta is
beginning to separate include:
A sudden gush of blood
Lengthening of the visible
portion of the umbilical cord.
The uterus, which is usually soft
and flat immediately after delivery, becomes round and firm.
The uterus, the top of which is
usually about half-way between the pubic bone and the umbilicus,
seems to enlarge and approach the umbilicus.
Immediately after the delivery of
the baby, uterine contractions stop and labor pains go away. As the
placenta separates, the woman will again feel painful uterine cramps.
As the placenta descends through the birth canal, she will again feel
the urge to bear down and will push out the placenta.
If the placenta is not promptly
expelled, or if the patient hemorrhages while awaiting delivery of the
placenta, this is called a "retained
placenta" and it should be manually removed.
After delivery of the placenta, the
uterus normally contracts firmly, closing off the open blood vessels
which previously supplied the placenta. Without this contraction,
rapid blood loss would likely prove very problematic or worse.
To encourage the uterus to firmly
contract, oxytocin 10 mIU IM can be given after delivery.
Alternatively, oxytocin 10 or 20 units in a liter of IV fluids can be
run briskly (150 cc/hour) into a vein. Breast feeding the baby or
providing nipple stimulation (rolling the nipple between thumb and
forefinger) will cause the mother's pituitary gland to release
oxytocin internally, causing similar, but usually milder effects.
A simple way to encourage firm
uterine contraction is with uterine massage. The fundus of the uterus
(top portion) is vigorously massaged to keep it the consistency of a
tightened thigh muscle. If it is flabby, the patient will likely
continue to bleed.