_Importance of ascertaining that the uterus is contracted._ As soon as the child is separated from its mother and removed, or even sooner, if this process has gone on slowly, we ascertain if the uterus has contracted: this we shall know by its feeling like a large hard ball behind the symphysis pubis: if there be one rule more important than another, it is this, for without it we cannot be certain of the patient's safety for a single minute: so long as we feel the fundus to be hard, we know that the uterus is contracting, and that it will expel the placenta quickly, and ensure the patient against hæmorrhage; but if it be soft and relaxed, she cannot be considered safe even if their be no hæmorrhage; for the placenta may have been separated, and may be lying across the os uteri, or the os uteri itself may be contracted, or blocked up with coagula, so as to prevent the blood from escaping; it therefore collects in the cavity of the uterus in large quantities, to the imminent danger of the patient. Even where the uterus has contracted, the patient is not permanently safe, for it may again relax and grow soft, and hæmorrhage come on. _Management of the placenta._ The placenta sometimes follows the child immediately, and occasionally is expelled by the same pain; usually, however, a few minutes intervene, during which time the uterus remains more or less in a state of inaction; it then begins to contract, and the dull and peculiar pains which characterize the separation of the placenta are now felt. The interval after the birth of the child varies considerably, and depends in many cases on the degree of rapidity with which the uterus has been emptied: hence in some cases we feel the fundus hard almost immediately, whereas, in others some considerable period elapses before it resumes its state of activity, a period which, if any separation of the placenta has already taken place, will be attended with the greatest danger. The occurrence of pains indicates fresh contractions, and therefore we should now examine to ascertain if the placenta has been detached. As a general rule it may be stated, that if we can reach the insertion of the cord with our finger we may presume that the placenta is ready to be expelled; if not, that it is still partially or wholly attached to the uterus. So long as this latter is the case, the less we meddle with the cord the better, for by pulling at it we only excite the os uteri to contract, and thus seriously impede its removal.