As soon as the baby is completely born a sterile douche pan should be slipped under the patient or a small sterile basin placed close to the perineum, to receive the blood which escapes during the third stage. This is partly to protect the bed, but chiefly that the blood may be measured, as in no other way can it be ascertained how much the patient loses. A loss of 600 cubic centimetres or more is regarded as a hemorrhage. [Illustration: FIG. 85.—Baby’s head appearing at the vulva at the height of a pain. (This and succeeding pictures of a normal delivery are from photographs taken at Johns Hopkins Hospital.) ] [Illustration: FIG. 86.—Advance of the head indicated by stretching of the vulva and perineum. ] [Illustration: FIG. 87.—Holding back the head at the height of a pain to prevent a perineal tear. ] [Illustration: FIG. 88.—Birth of the head immediately followed by external rotation. ] [Illustration: FIG. 89.—Wiping mucus from baby’s mouth with gauze wrapped about little finger. ] =Immediate Care of the Child.= After the baby has been brought safely into the world, it is of greatest possible importance to make sure that it begins its separate existence by crying lustily, in order fully to expand its lungs. This provides for oxygenation of its blood, which has taken place, until now, through the placental circulation. In many cases the baby cries satisfactorily without aid, but not infrequently must be stimulated to do so. In all instances the first step is to clear the air passages of the mucus lodged in the mouth and throat, by some one of the many approved methods. One is by means of a piece of wet sterile gauze wrapped about the little finger, and wiped gently about in the back part of the baby’s mouth (Fig. 89), though many doctors object to this procedure for fear of abrading the very delicate mucous membrane, no matter how lightly it is done. They prefer to hold the baby by its feet, with the head hanging down and the neck sharply curved backward, when by gravity the mucus will drop out of the mouth; or, holding the baby by the feet, to run the thumb and forefinger along the neck on either side of the trachea, toward the mouth, and force out the mucus in that way. If the baby does not cry well after the mucus is removed, it may usually be stimulated to do so if held by the feet, head downward, and the back gently rubbed (Fig. 90) or the face stroked or the buttocks spanked two or three times. When holding the baby in this position the nurse should slip one finger between the ankles and grasp them firmly. [Illustration: FIG. 90.—Stroking baby’s back to stimulate respirations. ]