ding the upper shoulder by pushing it gently behind
the pubic bone of the mother. When the shoulders are through, the rest[101]
of the body of the child slips out without effort.

DUTY OF NURSE IMMEDIATELY FOLLOWING BIRTH OF CHILD.--As soon as the child
is born the nurse should sit by the side of the mother and hold the womb
until the after-birth is expelled. The womb can be easily felt in the lower
part of the woman's abdomen as a hard mass. It feels about the size of an
extra large orange. The object of holding it is to prevent the possibility
of an internal hemorrhage. It can be readily appreciated that the interior
of a womb, immediately after a child is born, is simply a large bleeding
wound. So long as the womb remains firmly contracted there is very little
chance for an extensive bleeding to take place. As a rule the womb remains
sufficiently contracted to preclude a hemorrhage until the after-birth is
out. After the after-birth is expelled, the womb usually closes down firmly
and the liability to bleed is very much reduced. Because there is a
distinct chance or tendency for the womb to bleed freely during the time
the after-birth remains in, it is customary, as stated above, to watch it
closely and to hold it securely. It is best held with the right hand. The
fingers should surround the top of the womb and exert a slight downward
pressure. Should it show any tendency to dilate or fill with blood, get it
between the fingers and the thumb and squeeze it, pushing downward at the
same time.

EXPULSION OF AFTER-BIRTH.--The after-birth is usually expelled in about
twenty minutes after the child is born. Great care should be experienced in
its expulsion. It should not be pulled at any stage of its expulsion. If it
does not come easily give it a longer time,--it takes time for the womb to
detach itself from the after-birth; and some after-births are very firmly
attached. Eventually it will come out with a little encouragement in the
way of frictional massage of the womb through the abdominal walls. If the
membranes remain in the womb after the body of the after-birth is out, do
not pull on them. Take the after-birth up in the palm of your hand and turn
or twist it around, and keep turning it around gently, thereby loosening
the membranes from the womb instead of pulling them, which would surely
break them, leaving the broken ends in the womb, and, as a result, the[102]
chance of developing serious trouble.

The patient