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Created on : 12 May 2016
Modified on : 12 May 2016

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Bibliographical entry (without author) :

Towards a physiological management of the third stage that prevents postpartum haemorrhage (PDF Download Available) - Midwifery Digest - Vol. 20, 3 - p.248-51

Author(s) :

Slome Cohain, Judy

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Abstract (English)  :

Postpartum haemorrhage (PPH) rates for low-risk women having vaginal births in the Western world are reported as 5% (500ml), 1% (>1000ml), and 1% of women receiving blood transfusions as a result of these events. While it could be argued that these are accepted by-products of birth, there is a need to question why both active and expectant management appear to show no reduction in those rates and whether this is because speed of placental delivery is the critical factor that has not been emphasised. Active management causes PPH because of increased manual removal rates and expectant management causes increased atony by delaying
placental delivery. Where there is greater acknowledgement that a shorter third stage results in a
lower PPH rate, this leads to reappraisal of third stage management. The knowledge that the vast majority of
placentas deliver in five minutes was seemingly forgotten during the period of putting women under anaesthesia
during delivery. Waiting for signs of separation causes unnecessary delay in third stage, thereby increasing the
PPH rate. A protocol was devised based on timing the actions and non actions necessary at three, four and five
minutes from the birth for delivery of the placenta using a squatting position. This idea was born out of an attempt to eliminate PPH, based on the logic that vaginal delivery of a placenta weighing one kilo requires maternal effort, not passivity. In my practice, 350 consecutive attended homebirths resulted in a 0.6% PPH rate (500ml ), which compares favourably to the published PPH rates of other third stage protocols.
Towards a physiological management of the third stage that prevents postpartum haemorrhage (PDF Download Available). Available from: [accessed Apr 14, 2016].

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Keywords :

➡ 3rd stage of labor ; planned homebirth

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Import 12/05/2016 — 12 May 2016
➡ latest update : Bernard Bel — 12 May 2016

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