Controlled Cord Traction During Third Stage of Labor

"1. Clamp the cord close to the perineum (once pulsation stops, or after three minutes in a healthy newborn), hold it in one hand.~2. Place the other hand just above the woman's pubic bone and stabilize the uterus by applying counter-pressure during controlled cord traction.~3. Keep slight tension on the cord and await a strong uterine contraction (2-3 minutes).~4. With the strong uterine contraction, encourage the mother to push and very gently pull downward on the cord to deliver the placenta. Continue to apply counter-pressure to the uterus.~5. If the placenta does not descend during 30-40 seconds of CCT, do not continue to pull on the cord:~ * Gently hold the cord and wait until the uterus is well contracted again;~ * With the next contraction, repeat CCT with counter-pressure."

"1. Clamp the cord close to the perineum (once pulsation stops, or after three minutes in a healthy newborn).~2. No CCT will be used and no fundal pressure. The placenta will be delivered physiologically, and signs for placental separation will be awaited (gush of blood from the vagina, descent of the umbilical cord, and increase in the height of the uterus in the abdomen as the lower segment was distended).~3. After separation, delivery of the placenta will be aided only by maternal expulsive efforts and/or gravity."