Birth of the Placenta

8/8/2019 Birth of the Placenta

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BIRTH OF THE PLACENTA

DELIVERY OF THE PLACENTA



After birth of baby, the cord stopspulsating and is cut, severing thebaby from the mother. The midwifefollows the cord and grasps it atthe vaginal opening, taking up any

cord slack, pulling it straight outthe vaginal opening.

A large ring forceps is clampedonto the cord at the entrance to thevagina and let it hang down by itsown weight.

Placenta Delivery: PlacentalSeparation, Uterine Configuration.Checking for placental separationand release along with uterine toneand contraction by placing a handon the uterus. Do not massage theuterus. Allow it to contract on itsown. When the uterus contracts, itwill form a hard globular ball whichrises slightly under your hand. Tellthe mother to let you know whenshe begins to have contractionsagain.



Placenta Delivery: Noting whether there is a gush of blood and/or lengthening of the cord may notalways be readily apparent. Keeptrack of time since the birth to

when separation occurs. At home,this may take longer (usually 15 to45 minutes) than the hospital (5 to20 minutes) because manyhomebirth midwives do not givemedications to stimulatecontractions like they do in ahospital setting. Checkingplacental separation and releasefrom the uterus by placing a hand on the uterus and using the other hand for cordtraction. Uterine firmness is noted.

Cord traction is applied, using thering forceps to obtain a firm hold(the cord is very slippery), taunttraction is done, pulling gently butfirmly away from the vagina. Themother should be havingcontractions at this point. There isusually a little gush of blood as theplacenta begins to pull away fromthe uterine wall. Placentaseparation may be apparent by theincreasing cord length between theforceps and the vaginal opening.

Placenta Delivery: Controlled cordtraction. Have the mother beginpushing with her contractions. If there is a gush of blood andlengthening of the cord, have themother push whether or not thereis a contraction.



Placenta Delivery: Using one handto apply suprapubic pressureagainst the fundus of the uteruswith your cupped hand, and your thumb placed just above the pubic

bone to keep the uterus fromentering the pelvis and causingspurious cord lengthening or other false evidence of separation, or even inverting the uterus. Providesome steady cord traction to notwhether there is a sense of "give"as the placenta moves into thevagina and the cord lengthens, or conversely, does not progress, inwhich case cease your maneuvers and wait. If you are uncertain whether the

placenta has actually separated, you may follow the cord with your hand in thevagina, up to the cervix, to determine if the placenta is trapped in the cervical os,or whether the cord disappears into the uterus.

NOTE: In the absence of heavy bleeding, there is no hurry to deliver the placenta.It is normal and safe, if there is no bleeding, to wait up to an hour, checking for separation periodically. The placenta has been known to stay attached to theuterine wall for days after a delivery. If this occurs because there is acreta, this isthe safe state until the problem can be evaluated more completely.

Conversely, if you do not make an accurate diagnosis of separation and

separation has indeed occurred, then the uterus may be silently filling with blood.This is another reason for keeping your abdominal hand over the uterus at alltimes until the delivery of the placenta is imminent at the introitus.



Placenta Delivery:Use maternalefforts to deliver the placenta,assisted by the followingmaneuvers, as needed, when youbelieve the separation has

occurred. Maintain your abdominalhand over the uterus, using your flattened fingers just above thepubic bone to aid the placenta as itexits the cervical os into thevagina. Instead of pressure withflattened fingers, the BrandtAndrews maneuver may also beused, but this is moreuncomfortable for the mother.Place your fingers around the ring

forceps at the point where the cordis attached, and apply steady cord traction with a downward motion. The UpwardPlacental Lift: then upward along the curve of Carus as the placenta traverses thevagina to the introitus. When the placenta is visible at the introitus, lift it partiallythrough with the hand holding the ring forceps.Placenta Delivery: Remove your other hand from the abdomen andlet the placenta fall into your hands. At this point, drop the cordand ring forceps. Encompass theplacenta using both hands tosupport it during delivery, makingsure the membranes do not tear.



Placenta Delivery: Using an Up-Down-Rotation method to bring itthrough the os.

Placenta Delivery: Once theplacenta is delivered, continue torotate it and the membranes toform a thicker cord of membraneshelp the membranes release intactwithout tearing or shredding.



Placenta Delivery: Grasping themembranes with the ring forceps tohelp in delivery and to aid inmaking a thicker cord of membranes.

Placenta Delivery of theMembranes: Rotating the ringforceps to "tease" the membranesloose from the uterine liningwithout shredding them by a slightup and down movement. NOTE:Slow controlled delivery isnecessary to avoid tearing of thecord or membranes.

Placenta Delivery Cleanup: Oncethe placenta is out, massage thebelly once or twice above theuterus to get the uterus to contractand form a grapefruit size firm ballunder your hand. Wipe out theblood from the introitus (vaginalopening) after the delivery of theplacenta to determine if you have

additional bleeding.

Birth of the Placenta

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