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  • Ruth Wingeier CNM, MS,

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    • Ruth Wingeier, CNM, MS, is currently a nurse-midwife at Group Health, Inc., a large health maintenance organization in the Twin Cities. She received her M.S. and nurse-midwifery education from the University of Minnesota in 1982, then spent five years working as a midwife m a small rural practice in north-central Minnesota. More recently, she taught full-time at the University of Minnesota nurse-midwifery educational program and is currently an adjunct faculty member there. She is also a member of the Clinical Practice Committee and an assistant editor for JNM.

  • Rosemary Griggs CNM, MSN

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    • Rosemary Griggs, CNM, MSN, is a lieutenant colonel and Chief of the Nurse-Midwifery Service at Blanchfield Army Community Hospital in Fort Campbell, Kentucky. She received her M.S.N. and nurse-midwifery education from the University of Kentucky in 1981. She has held a vanety of positions at Ford Ord, California, Fort Rucker, Alabama, and Fort Campbell, Kentucky. She is also an adjunct faculty member of the University of Kentucky and has been a preceptor for M.S.N. students from Vanderbilt University, Troy State University, and Stanford University. In addition, she is the Nurse-Midwifery Consultant to the Surgeon General of the Army.

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Manual removal of the placenta carries significant risk of hemorrhage and infection plus the risks associated with general anesthesia, if used. Transporting the patient from home or birthing center to hospital or from birthing room to delivery room or operating room is also disruptive to the patient and the initial parent–infant attachment process. The injection of oxytocin into the umbilical vein is a safe procedure that can cause placental separation and delivery, thus preventing the need for manual removal for some women. This technique can be useful in a nurse-midwifery practice in the management of a retained placenta or prolonged third stage of labor. The following review of current research and example of a protocol used in a nurse-midwifery service will provide guidance for incorporating this procedure into practice. As with any new technique, the need to continue to collect and publish outcome data is important.