The perineorrhaphy being completed, the woman is permitted to rest though the nurse will make frequent examinations of pulse and respiration. She will note the look of the face and the hardness of the uterus. The pad should be watched and the amount of blood discharged, duly estimated. If the flow does not diminish or if the uterus should balloon up, the doctor should be notified and the nurse meanwhile should give a dram of ergot (fluid extract) by mouth or an ampoule of aseptic ergot hypodermically. The doctor should remain within call of the patient for at least an hour after delivery. In the hospital the following rules may be used as a concise guide for the conduct of the third stage: CONDUCT OF THIRD STAGE. Keep patient on back and keep a hand on fundus. Note amount of blood lost, its character, its flow, and whether steady or in gushes. The placenta should detach itself normally in thirty minutes. After thirty minutes, expulsion may be assisted by— (1) Early expression. (a) Massage, rub and knead the uterus, until it hardens under the hand. (b) Seize contracted uterus by fundus with full hand, fingers behind and thumb in front. (c) Push slowly but firmly toward the pelvic outlet. (2) Credé expression. Same maneuver as above, except that the fundus is compressed between thumb and fingers while the downward movement is progressing. Conditions for Credé expression: (a) Uterus must be contracted. (b) Uterus must be in median line. (c) Bladder must be empty. If not successful, wait ten minutes and then repeat maneuver. _Never_ make traction on the cord. _Never_ use ergot until uterus is empty. If placenta does not come away within an hour, manual removal must be considered. In case of hæmorrhage, it must be removed at once. Carefully inspect placenta and be sure it is complete. (See Post Partum Hæmorrhage, p. 232.) When the patient is put to bed, the bloody sheets and towels are put to soak in cold water, and after several rinsings, may be sent to the laundry. Drapings stained with fæcal matter must be cleansed separately. CHAPTER X THE NORMAL PUERPERIUM The puerperium is the name given to the period succeeding the birth of the child as far as the time of the complete restoration of the genitals. It may last from six to ten weeks, or even longer if complicated. When the labor is completed, the most urgent desire of the patient is for rest. She is thoroughly exhausted in nerves and body. A post partum chill may appear,—a slight shiver that may last a quarter of an hour. Since the pulse and temperature remain unaffected, this phenomenon may be regarded merely as a sign of prostration or nervous revulsion.