<div>­­­­­­­­­­Retrospective cohort study comparing current third stage
management to expedient squatting third stage management</div><div><b>Authors: </b> Judy Slome Cohain, CNM</div><div><b>Address:</b>  judyslome@hotmail.com</div><div>Affiliation: Private Practice- corresponding author</div><div>Snail mail: Alon Shvut 37, Israel 90433     Telephone 972545493109</div><div>Second author: Rina E. Buxbaum,
MD   rina1511@gmail.com</div><div>Affiliation: Hadassah Ein Kerem Medical Center</div><div>A shortened running title : Preventing PPH using expedient squatting</div><div>Abstract</div><div>Objective:  To compare current the third stage management to expedient
squatting at 3 minutes postpartum.</div><div>Design, Setting, Sample and Methods: A retrospective cohort study of
1,098 planned, attended low risk vaginal births in Israel using Judy’s
3,4,5 minute third stage protocol compared to 2,691 attended low risk
vaginal births in British Columbia using various forms of active or
expectant management of the third stage of labor.</div><div>Main Outcome measures:  PPH&gt;1000, PPH&gt;500 and
manual removal of placenta</div><div>Results: Among similar groups of low risk births, active management, or
expectant management resulted in 4.1% PPH over 1000 cc, whereas Judy’s
3,4,5 minute protocol resulted in 0% PPH over 500 cc.</div><div>Conclusion: Evidence supports less postpartum bleeding and postpartum
hemorrhage when women deliver the placenta in squatting 3 minutes after
birth. The risks are minimal and the data suggests the likelihood of a
very positive outcome, making it recommended for practitioners in all
settings to try it.</div><div>•       Introduction</div><div>Cochrane reviews found no evidence that active management reduces the
risk of primary postpartum hemorrhage (PPH) over 1000 cc and found
active management increases afterbirth pains, increases the need for
postpartum analgesia, increases the incidence of postpartum diastolic
blood pressure greater than 90 mmHg, and results in
increased rehospitalizations due to bleeding. [1]  The PPH rate at
vaginal birth was 5% both before and after the adoption of Active
Management. [2-4]   Active Management appears to have superior
outcomes only when compared to the 13% PPH rates associated with
Expectant Management. [1] The failure of Active Management to
prevent PPH is not surprising since it is based on the presumption that
women evolved to require external administration of synthetic Oxytocin
to avoid hemorrhage.   Humans share the same placental physiology as
apes and chimpanzees who never hemorrhage unless the birth is interfered
with by humans. [5,6] It follows that if humans deliver the placenta
the way apes and chimps do, they also would not hemorrhage. A
demonstration of this appears on
YouTube: https://www.youtube.com/watch?v=AAJPW4p6rzU<i> </i></div>