What should be considered if the placenta is not coming out after delivery?

In the scenario where the placenta has not expelled following delivery, the most appropriate consideration revolves around the use of medications to facilitate uterine contraction and placental expulsion. Immediate use of oxytocin is typically the first-line treatment in such cases, as it stimulates uterine contractions, which can aid in detaching and expelling the placenta.

The option regarding the use of cohosh and Angelica herbs does not have robust evidence supporting their effectiveness in managing retained placenta when compared to established medical interventions. While herbal remedies can be part of some midwifery practices for various conditions, in the case of retained placenta, medical measures such as oxytocin are preferred due to their proven efficacy and safety profile.

Preparing for an emergency C-section may be necessary in severe cases where there are complications, but it is not a first-line response simply because the placenta has not yet been delivered. This option may involve more invasive procedures and carries its own risks.

Performing manual removal is considered if the placenta is showing no signs of expulsion after reasonable time and medical management. However, it is generally a last resort due to the risks of trauma and infection associated with such a procedure.