Chapter 13: The birth of the placenta – stage 3 of labor
If the the mother cannot push out the placenta by itself or any time the mother is
bleeding very heavily, give oxytocin to help her womb contract so the placenta can
come out. Before you give oxytocin, gently feel the mother’s belly to be sure there
is not a second baby in the womb.
To help the placenta come out
• inject 10 Units oxytocin ��������������������������������������������������������in the side of the
You can give 10 more Units of oxytocin after 10 minutes.
(See page 345 for how to safely give an injection.)
• give 600 mcg (micrograms) misoprostol ���������������by mouth, 1 time only
Guide the placenta out by the cord
If the mother is bleeding a lot and cannot push the placenta out herself, the
midwife can gently guide the placenta out by the cord.
If the mother is not bleeding, and there is no danger, do not pull on the cord.
Only remove the placenta by the cord if there is an emergency.
WAR NING! Pulling on the cord is dangerous! If the placenta is
still attached to the womb, the cord may break or you may pull
the woman’s womb out of her
body. If the womb is pulled
out, the mother may die.
Only guide the placenta out
by the cord if you know that
the placenta has separated.
1. Check if the placenta has separated by gently pushing the womb
upward from just above the pubic bone.
Find the bottom of
the womb. Push the
womb up and watch
A Book for Midwives (2010)