Preventing Postpartum Hemorrhage Using Expedient Judy’s 3,4,5 Protocol:
Retrospective Cohort Study
Abstract
Background: Postpartum hemorrhage (PPH) was deadly prior to blood
transfusions, and therefore either never existed or was eliminated by
evolution millions of years ago. No animals hemorrhage. Human PPH
appears to be a relatively recent occurrence, perhaps coinciding with
the decrease in the use of squatting. The first documented case of human
postpartum hemorrhage appears around 1400 AD. Regardless of which third
stage protocol is used, 95% of low risk women do not hemorrhage, but
about 5% do. A protocol called Judy’s 3,4,5 calls for squatting out the
placenta between 3 and 5 minutes postpartum in order to lower the 5%
PPH rate to the same rate as experienced by other mammals, i.e. zero.
Methodology: A retrospective cohort study of 1,027 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. Results: Among similar groups of low risk births,
active management, or expectant management resulted in 4% PPH over 1000
cc, whereas Judy’s 3,4,5 minute protocol resulted in 0% PPH over 500
cc. Conclusion: Judy’s 3,4,5 minute protocol is logical, using gravity
to deliver the placenta expediently. It results in 0% postpartum
hemorrhage over 500 cc and an average blood loss of 100 cc in the first
hour after the birth of the newborn, which compares favorably to any
other third stage protocol.