The cord should be divided at some little distance from the ligature, so
as to prevent all chance of its slipping off, and it should be done with a
pair of blunt scissors, by which means the vessels of the cord are so
bruised as to be rendered nearly impervious. There is no need to apply two
ligatures; in fact it is better not, for, as Dr. Dewees justly observes,
"the evacuation from the open extremity of the cord will yield two or
three ounces of blood, which favours the contraction of the uterus and
expulsion of the placenta." It has been recommended, in case of twins, to
apply a second ligature, to prevent all chance of the second child
bleeding through the cord of the first. There is, however, no connexion
between the two placentæ, although they usually form what appears to be
one mass. We only know of one case where the umbilical arteries of one
cord anastomosed with those of the other, an anormality of very rare
occurrence: still, however, it is better to apply a second ligature upon
the cord, where we find that twins are present, as a precaution: and also
to prevent it being said, in case the second child is still-born, that it
had died from no ligature having been applied upon the placental extremity
of the cord. It has been questioned whether it was really necessary to tie
the cord before separating the child from the mother, from the well known
fact that nothing of the sort is required in animals; and that, in cases
of rapid labour, where the child has been unexpectedly dashed upon the
floor and the cord broken, no hæmorrhage has resulted. This arises from
the bruised and lacerated condition of the cord under these circumstances:
animals not only bite the cord, but also draw it through their teeth
several times, so as to contuse the vessels for a considerable extent;
whereas, if it was merely divided with a sharp instrument, there is no
doubt but that the new-born animal would quickly bleed to death.[71]
Public-domain text, read in full here on John Shaqi.
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