put in
a safe place.

Management of the Third Stage,--The contractions of the womb are renewed
and with the second or third the after-birth may be expressed. The top
(fundus) of the womb is grasped by the hand through the relaxed abdominal
walls, and squeezed, and at the same time make a downward pressure. The
after-birth is loosened from the womb and slides through the vagina and
outlet, and it may be caught in a tray which has been placed between the
patient's legs, or by the hand and given a few twists in order to roll the
membranes together; while this is being done, gentle rubbing should be
applied to the womb, when the membranes will slip out without tearing; no
drawing on the cord should be done in delivering the after-birth.

From the time of the birth of the head to the delivery of the after-birth
the womb must be controlled by the firm pressure of the hand on the
abdomen. It is well for the nurse, when the after-birth is separating from
the womb to follow the womb, throughout this whole stage, by keeping her
hand upon it and if, while the physician is attending to the child, the
womb softens and enlarges she should at once notify him. There may be
bleeding within the womb. After the womb is empty, friction should be made
over the womb whenever it softens at all in order to stimulate the womb to
perfect contraction, and it should be kept up at intervals for one hour
after the after-birth and membranes have been delivered.

[OBSTETRICS OR MIDWIFERY 535]

THE CHILD.

The eyes should be washed soon and normal respiration established. If the
child does not breathe well, cold water may be sprinkled in the face and
chest and if this fails, immersions in hot water at 106 degrees F., and
sprinkling with cold water must be resorted to. If necessary, artificial
respiration must be given. Slap the child on the back and move the arms up
and down by the side a few times, or breathing into the child's mouth.

Another method.--Face the child's back, put an index finger in each
arm-pit and the thumbs over the shoulders, so that their ends over-lap the
collar-bone and rest on the front of the chest, the rest of the fingers
going obliquely over the back of the chest. The child is suspended
perpendicularly between the operator's knees. Its whole weight now hangs
on the first fingers in the arm-pit; by these means the ribs are lifted,
the chest is expanded and inspiration is mechanically produced. The infant
is now swung up