Chapter 13: The birth of the placenta – stage 3 of labor
Take out the placenta by hand
If you think the woman will bleed to death before you can get to a medical center, you
may need to put your hand inside the womb to loosen the placenta and take it out.
WAR NING! Taking out the placenta by hand is very dangerous.
It can cause serious infection, or tear the cervix, the placenta, or
the womb, and cause worse bleeding. Taking the placenta out by
hand is very painful for the mother, and can easily cause her to go
into shock (see page 239). Do not take the placenta out by hand
unless it is the only way to save a mother’s life.
1. Quickly scrub your hands and arms up to the elbows with soap and boiled
water. Splash your hands and arms with alcohol or betadine if you have it.
Put on sterile gloves, long ones if you have them. Then do not touch
anything except the cord and the inside of the mother.
2. Put one hand on the cord to hold it steady. With your other hand, follow the
cord up into the mother’s vagina — you will have to fit your whole hand
inside. The placenta may be detached but just sitting in the vagina or in the
bottom of the womb. If so, take the placenta out, rub the womb until it is
hard, and give an injection of 10 Units of oxytocin.
3. If the placenta is still partly stuck to the wall of
the womb, you may need to reach inside and
peel it off the womb wall with your fingers.
Move your outside hand up to the mother’s
belly to support her womb. With your inside
hand, keep your fingers and thumb close
together, making a cone shape. Gently follow
the cord up into the womb.
Find the wall of the womb and carefully feel for
the edge of the placenta with your fingers. This may
be very painful to the mother. Have someone support
her, and ask her to take deep breaths.
Pry the edge of the placenta away from the
womb wall using the side of your little finger.
Then carefully peel the rest of the placenta off
by sliding your fingers between the placenta
and the womb. (It feels a little like peeling the
skin off an orange or other thick-skinned
fruit.) Bring the placenta out in the palm of
your hand. Be careful not to leave any pieces or
A Book for Midwives (2010)