If the cord moves
back up into the
placenta may be
attached to the
Bleeding after birth
If the cord stays in the
same place, the
placenta is probably
not attached. It is
OK to guide the
2. Guard the womb. Put one hand on the mother’s
belly, just above the pubic bone. Use just a little
pressure to keep the womb in place.
3. Wait for a contraction. When a contraction comes,
gently pull the cord downward and outward. Pull
steadily and smoothly. A sudden or hard pull can
tear the cord. Ask the mother to push while you are
guiding the placenta out.
4. If the womb seems to move down as you pull the
cord, STOP. If you feel the cord tearing, STOP.
If the mother says that the pulling hurts, or if the
placenta does not come out, STOP. The placenta
may still be attached. Wait until the next contraction and try again.
5. Gently pull the cord until the placenta comes out.
6. Rub the womb (see page 224).
If the placenta still does not come out, and the mother is still bleeding, or if she
feels faint or weak or shows other signs of shock (see page 239), she is in great
danger. Get medical help right away.
On the way to a
medical center, treat
the mother for shock
(see page 239).
I cannot stop the
bleeding. Let’s go
to the hospital.
I’ll wake my
brother so he
can drive us.
A Book for Midwives (2010)