Chapter 13: The birth of the placenta – stage 3 of labor
When the womb comes out with the placenta
Rarely, the womb turns inside out and follows the
placenta out of the mother’s body. This can happen
if someone pulls on the cord before the placenta has
separated from the womb wall, or if someone
pushes on the womb to get the placenta out. It can
also happen by itself — even if no one does
anything wrong. An inside-out womb can bleed
heavily, so work quickly but calmly.
When you see this,
the womb has
What to do
1. S crub your hands and arms up to the elbows
(see page 53) and put on sterile gloves.
2. Q uickly pour antiseptic solution (like
povidone iodine) over the womb if you have any.
3. Gently but firmly put the womb back
through the vagina and cervix into its
normal position. If you cannot push it
back up, you may have to roll it up with
Push the part of the womb closest to the
cervix in first, and work your way along
to the top of the womb, pushing that
part in last. Do not use too much force.
This will be painful for the mother.
Reassure her and have her breath deeply
and try to stay relaxed.
If you cannot push the womb back into
the right place, put it into the vagina and
take the woman to a medical center.
Treat her for shock (see page 239).
4. After the womb is back inside, rub it to make it hard. You may need to use
2-handed pressure to stop the bleeding (see page 237). Give oxytocin,
ergometrine, or misoprostol to stop the bleeding (see page 231).
A Book for Midwives (2010)