It will of course be understood that the pressure only needs to be made _during the pains_; when the head draws back the ointment or warm sponge may be applied. The knees of the female should be held up by some one, if she bears down too much, so as to prevent her from doing so too powerfully. When it is felt that the parts are fully relaxed, and sufficiently distended, the head is left at liberty, during a strong pain, and it immediately passes the outer ring, or is born. It should then be held up, towards the pubes, and the mucus should be cleaned from the mouth with one of the fingers, so that the child may breathe. A careful examination should also be made round the neck, to see if the umbilical cord is around it. If it be so, but is not tight, it may be left alone, or pulled a little over one shoulder, or even passed clean over the head, if it can be _easily_ drawn out long enough. When it is very tight, and cannot be eased, it must be cut through, or it will strangle the child. In most cases the shoulders follow immediately after the head, the uterus resting only a few moments; but if they do not the head may be _slightly_ drawn upon, or the fore-finger of the right hand may be linked under the arm, and a _little_ force employed, though very carefully. It is better however to wait even two or three minutes, and only resort to these means when there is evidently a partial suspension of the natural efforts. Sometimes also the contractions may be brought on again by merely pressing the hand over the fundus of the uterus, and this should therefore be tried first. In all cases it being better to let the uterus expel the child than to bring it away by manual force. During the passage of the shoulders the perineum needs as much care as during the passage of the head, and must be supported in the same way. Indeed some authors are of opinion that most cases of laceration are caused by the shoulders. After the shoulders are expelled the limbs and body speedily follow. The child should be received in the hands of the accoucheur, and laid on its side, at a little distance from the vulva, so that it may not be suffocated by the discharged fluids. He should then take a strong ligature and pass it _twice_ round the umbilical cord, about two inches from the navel, and also at about four inches, and then cut the cord through, between the two bands, with a pair of sharp scissors. The child may then be handed to the nurse.