544 DELIVERY OF THE PLACENTA. 



of the perineum; which is an inconvenience frequently met with 

 when the placenta is pulled along in what is properl)'^ called the axis 

 of the strait, rather than in that of the vulva. 



As soon as the after-birth appears at the vulva, the left hand is 

 placed underneath it, crossvvays, and supine, in order to sustain it; 

 the right hand, in pronation, takes it with the ends of all the five 

 fingers, and rolls it four or five times round, drawing it moderately 

 and slowly downwards; without these rotatory motions the mem- 

 branes might separate from the placenta, and remain within the female 

 organs, while if twisted in this way they are collected together and 

 resemble a rope, and become easy to extract. 



During these various manoeuvres, the womb rarely fails to contract 

 with more or less force, and seems to assist the accoucheur; the wo- 

 man herself is generally induced to make some efforts as soon as the 

 womb has descended into the vagina, and these efforts rigorously 

 speaking, would suffice to terminate the delivery, provided they al- 

 ways took place; but, in reality, they are not very necessary, and 

 may often be injurious: they only favor the expulsion of the placenta 

 indirectly, and are capable of directly producing the descent or in- 

 version of the womb; the woman ought therefore to be urged to 

 moderate rather than enforce them; it would not only be useless or 

 ridiculous, but also in some cases very dangerous to administer ster- 

 nutatories, or advise her to blow into a bottle, or in her hands, or on 

 to a grain of salt to hasten the delivery; for if ever such measures 

 have any effect, it is merely by occasioning certain succussions, or 

 those straining efl"orls that I just now was condemning. 



The extracting force necessary in this operation ought never to be 

 carried so far as to rupiure the cord: if the placenta resists, the cause 

 of it ought to be sought for in the direction of the orifice, its closure, 

 &;c.; we should wait, or else pull in another direction, and be 

 assured that force is never necessary to enable us to triumph over 

 such obstacles. 



1180. It is recommended that the after-birth should be examined 

 as soon as it is delivered, to make sure that no part of it is left with- 

 in the genital organs: it will be well to follow this advice, no doubt, 

 whenever the delivery has been attended with some difficulty, or any 

 peculiar circumstances; but in other cases, it would be puerile to 

 trouble one's-self about it, especially, considering that even should 

 some small pieces of the placenta or shreds of membranes be left in 

 the womb, we should not be authorised on that account to introduce 

 the hand in search of them. 



