The vast majority of women here in southern Sudan deliver their babies at home. So when a woman presents to the clinic for a pregnancy related problem, it is usually serious. These are my thoughts as I walk the short distance from the compound to the in-patient tukuls.
The patient delivered her baby at midnight, but at 7 am this morning the placenta is still not out. In medical jargon it is called a 'retained' placenta. Sometimes a retained placenta is stuck firmly to the wall of the uterus and its removal is difficult and bloody. Fortunately for the woman (and for me) this placenta has already separated from the uterus and is sitting in the vagina. I clamp the cord and apply some 'gentle traction' (doctors and midwives never 'pull' on a cord) along with some counter traction against her uterus. The placenta slips out easily.
The baby, by the way, is a beauty.
I return to the compound in time for breakfast and the company of my fellow missioners. The day is starting out well.