ABSTRACT
The accoucheur will attempt to deliver the placenta in the normal way, but must be careful not to pull too hard on the cord. If excessive traction is used, the cord will normally break before damage is done, although a relaxed uterus can be inverted (turned inside out) by this technique. If the placenta is retained and bleeding is not excessive, other methods may be attempted to deliver it. A vaginal examination may reveal that it is half expelled, with a significant amount protruding through the cervix into the vagina. Under these circumstances, it would be permissible for a midwife to grasp the protruding edge of the placenta and try to ease the whole organ through the cervix; better traction may be achieved by using a sponge holding forceps. However, it is never acceptable for a doctor or midwife to pass their fingers or their hand through the uterine cervix in the unanaesthetised patient or to pass an instrument up into the body of the uterus unless a proper anaesthetic has been given.
