An improved method of managing the third stage of labour : with a criticism of the theory that the placenta is then separated by the uterine pains / by D. Berry Hart.

  • Hart, D. Berry (David Berry), 1851-1920.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: An improved method of managing the third stage of labour : with a criticism of the theory that the placenta is then separated by the uterine pains / by D. Berry Hart. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    The Management of the Third Stage deductible from the view expressed. At the beginning of my practice I adopted Credo’s method of expression of the placenta. The Credo method is intended to separate and expel the placenta. I had not tried it long when I found it most unsatisfactory. Not only did it cause bleeding by forcing blood into the lacerated tissues below the placental site, but on two occasions I expelled the placenta mimes the entire membranes, and had to chloroform my patient and remove these manually. The error of this lay in the Crede method, which I consider the most dangerous plan possible for separation of the placenta. I came to the conclusion therefore, that the uterus would manage the separation of the placenta better than I could, and, accordingly, for some years I merely kept my hand on the uterus, employed manipulation of it if bleeding came on, and limited the Crede method to helping the expulsion, never employing it to separate the placenta. My guide to the period of separation was the marked decrease in the size of the uterus. This method gave good results; why, I did not know, and I fell back for comfort on the fact, unfortunately not well enough known, that non-interference with a natural process gives better results than ignorant, though well-meant, meddling. I do not at all de- preciate thorough manipulation of the uterus when haemorrhage is taking place. 1 hold this to be imperative. What I condemn is quite another matter, viz., forcible compression of the uterus to expel the unseparated placenta. The method I have now adopted gives me excellent results, and is based entirely on the view I have summarized. For conveni- ence I shall arrange my description in the form of brief rules. 1. When the child is born, note that the fundus uteri stands at or below the level of the umbilicus, and that the uterus does not contain a second child. Give an ergotine injection in a multipara, at any rate, if labour has been slow. 2. Do not tie the cord until the child has cried freely, and then tie only one ligature. 3. Cut the cord on the placental side of the ligature, and let the placental part of the cord drain thoroughly into any small dish ; then tie it, to prevent any staining of the bed linen. Tie a second liga- ture at once, however, if a second child be present. 4. Before applying the first ligature it should be thoroughly ascer- tained by abdominal palpation that the uterus is not so relaxed as to bleed. 5. Continue with the hand on the uterus; do nothing when a good contraction comes on, and allow the uterus its normal relaxa- tion after the pain is over. 6. Should bleeding from the uterus come on, or should the