Method to prevent PPH at all vaginal births

What is it about?

I have now delivered 550 consecutive births using expedient delivery of the placenta and uterotonics when needed according to Judy’s 3,4,5 minute protocol (1) with no post-partum hemorrhage > 1000 cc and only 3 over 500 cc. Blood loss < 200 cc was estimated. Blood loss over 200 cc was measured in a measuring cup. Among 550 births, the average maternal age was 28.4 years, average birth weight 3,350 g, average live birth order 3.4, and average blood loss during the first two hours post-partum 129 cc. Among 104 primiparous births, the average maternal age was 23.8 years, average birth weight 3,166 gm, and average blood loss during the first two hours post-partum 150 cc. While 95% of women needed no uterotonic, 5% of women received one dose of either intra-muscular Pitocin or Methergine at 10 minutes postpartum (largely primiparous or vaginal births after cesarean). Two women underwent manual removal at 30 minutes post-partum. The protocol is as follows: Judy’s 3-4-5 PROTOCOL: At the 36-week prenatal visit, the midwife squats in front of the client to teach and demonstrate to her exactly how she will deliver her placenta 5 minutes after the birth. The client’s consent is obtained. Immediate continuous skin-to-skin contact with the baby is initiated for the first 3 1 ⁄ 2 minutes postpartum. The cord is cut at exactly 3 minutes postpartum while the baby is in her mother’s arms. The midwife keeps hands off the fundus and the cord. At 4 minutes: The midwife assists or directs the mother, as necessary, into a squatting position on the floor with both feet flat on the floor or on the floor of an empty bathtub. The mother hands the baby to someone or baby waits on the bed for one minute. The midwife encourages the woman to push out the placenta without a contraction. It is helpful to say things like: pushing out the placenta prevents bleeding and that the placenta is right there, ready to deliver. The woman is in a squatting position while she pushes out and births the placenta. The time of delivery is noted. Immediately after delivery of the placenta, the mother is dressed with a sanitary pad, assisted into the bed and immediately given the baby. The uterus is massaged once immediately to check for clots. If bleeding is above average during the next 5 minutes, a shot of either 10 u Pitocin, 0.2 mg methergine intramuscularly, or both is given at 10 minutes postpartum. Early suckling at the breast is initiated, which generally takes place between 10 and 45 minutes postpartum depending on the baby. The protocol prevents post-partum hemorrhage by expediently delivering the placenta, which allows the uterus to expediently contract, closing off the blood vessels that cause post-partum hemorrhage from uterine atony. It decreases the need for manual removal and situates the mother/baby dyad on a clean dry bed at 5 minutes post-partum, which is conducive to bonding. Two examples of Judy’s 3,4,5 protocol being performed appear on YouTube. I would very much like to hear from other practitioners who are willing to test this protocol in their own practices.

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Why is it important?

PPH is avoidable with Judy's 3,4,5 protocol