Bleeding after birth
• The cord looks longer. When the placenta comes
off the wall of the womb, it drops down closer
to the vaginal opening. This makes the cord
seem a little longer, because more of it is
outside the mother’s body.
• The womb rises. Before the placenta separates,
the top of the womb is a little below the
mother’s navel. After the placenta separates, the
top of the womb usually rises to the navel or a
If 30 minutes have passed since the birth and
there are no signs that the placenta has separated, be
sure the baby has started to breastfeed. Breastfeeding
causes contractions, and will help the womb push
the placenta out. If the placenta does not come out
after breastfeeding, ask the mother to urinate.
A full bladder can slow the birth of the placenta.
If the placenta still does not come out, see below for
how to help the mother push it out.
The placenta has probably
separated when there is a
small gush of blood and the
cord looks longer.
Help the mother push out the placenta
If the placenta does not come by itself after an hour, or if the
mother is bleeding heavily, help her deliver it.
1. Be sure the mother is already breastfeeding. If she is not
bleeding too heavily, she should try to urinate.
2. Put on clean gloves.
3. H ave the mother sit up or squat over a bowl. Ask her
to push when she gets a contraction. She can also try to
push between contractions. Usually the placenta slips
4. The membranes (or bag) that held the waters and the baby should come out
with the placenta. If some of the membranes are still inside the mother after
the placenta comes out, hold the placenta in both hands.
Turn it slowly and gently until the membranes are twisted.
When they are twisted, they are less likely to tear inside.
Then slowly and gently pull the membranes out.
5. Feel the mother’s womb. It should be about the
size of a grapefruit or a coconut, or smaller, and it
should feel hard. If it is not small and hard, see
A Book for Midwives (2010)