Text Appearing Before Image: Fig. 6i.—Granny knot. BREECH CASES. 155 In nearly every case, after a reasonable period of time, thewoman will have another labor-pain and the placenta will appearat the vulva much like a miniature counterpart of the fetal head.It should be received in the palm of the hand and directed into asterile bowl held for this purpose, and the string of membranesthat trails behind is to be extracted with the utmost gentlenessand deliberation, to prevent the detachment of any tags or frag-ments (Fig. 62). The method, formerly advised, of twisting themembranes into a firm cord by turning the placenta over and Text Appearing After Image: Pig. 62.—Delivery of placenta and membranes. (Bumm.) No traction should be used, butthe membranes allowed to fall out of the vagina by their own weight. over on itself no longer meets with general approval and is notto be recommended. All that is necessary is to extract the mem-branes from the vagina slowly and carefully, taking plenty oftime and using no force whatever. The placenta is to be preserved until the arrival of the physi-cian, in order that he may inspect it and make sure that it isintact. In precipitate breech cases, which occur when the infantis small or premature, there are two important points in themanagement which the nurse must not forget. Traction on the body, after it has passed through the vulva, c56 A NURSES HANDBOOK OF OBSTETRICS. must never be made, for it is essential to have the case progressas slowly as possible in order to secure complete dilatation of theparts and afford ample room for the passage of the head. Pressure must be made on the fundus as soon
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