This time the placenta is really stuck; no amount of 'gentle cord traction' will make it separate from the uterine wall. The patient had a stillbirth during the night and was brought in because the placenta has not yet delivered. She requires a 'manual removal' or her placenta. This is exactly what it sounds like. A gloved hand is inserted into the vagina, past the cervix and into the uterus; you then sweep the blade of your hand around trying to find the plane between the placenta and the uterine wall in order to cleave the placenta off the wall of the uterus.
The problem is that we don't seem to have any long sleeved gowns, and the latex gloves only cover my hands and wrists. So we cut the fingers out of several gloves and arrange them in overlapping rings up my forearm, trying to cover all the exposed skin. I insert my right arm up to the elbow, and grip the uterus through the abdominal wall with my left hand. The placenta is free at the back but is still attached anteriorly. I am getting blood on my forearm where the rings of latex have slipped. I remove my arm, de-glove, wash the blood off, cut the fingers out of several more gloves, re-glove arranging the bands of latex up my forearm, and try again. This time it works and I can feel the placenta shear off the wall of the uterus; it now slips out easily. I de-glove and wash, no blood.