This should be done
AFTER the signs of separation, meaning that the placenta has detached, and is referred to as 'controlled cord traction'. It describes your caregiver applying gentle traction to the cord to facilitate the delivery of the placenta and membranes through the cervix and out of the vagina. Again the caregiver should not apply any pressure to the cord before the placenta comes away from the uterine wall. Any pulling on the cord (be it even gentle) can cause partial separation of the placenta before the uterus contracts and increase the amount of blood loss for the mother.
Once there are clear signs that the placenta has separated (such as the cord lengthening and a trickle of fresh blood loss), your caregiver will place one hand on the woman's lower belly, just above the symphysis pubis. This stabilises the contracted uterus and provides gentle countertraction.
Their other hand will hold the cord, either by grasping it firmly and winding it around their hand, or more commonly using a surgical clamp to 'grip' the slippery cord to help apply steady tension or traction. The cord is then pulled in a downward direction (towards the mother's bottom) and then upwards as the placenta becomes visible at the opening of the vagina to follow the curved line of the birth canal.
Your caregiver will apply steady tension by pulling the cord firmly and maintaining the pressure. The aim is to complete the procedure as one continuous, smooth, controlled movement. The whole procedure should be completed in one contraction, but may take more than one if the placenta has not detached readily. If the uterus relaxes and stops contracting, the tension on the cord is released until the uterus contracts again.
Image 7-12 shows a drawn image of how the cord is used to deliver the placenta.
Delivering the membranes
The caregiver will normally deliver the membranes once the placenta has emerged.