Novel third stage protocol https://www.youtube.com/watch?v=AAJPW4p6rzU reduces postpartum hemorrhage at vaginal birth.

OBJECTIVE: To reproduce the absence of postpartum hemorrhage (PPH) experienced by all mammals except humans, in humans, by implementation of the 1, 2, 3 min expedient squatting protocol www.youtube.com/watch?v=AAJPW4p6rzU. The protocol prevents postpartum hemorrhage ≥ 500 mL after vaginal birth. It only requires a digital watch to precisely time 2 min. DESIGN, SETTING, SAMPLE AND METHODS: Mean blood loss and PPH rate are reported for 2,149 consecutive planned, attended vaginal births using the 1, 2, 3 min squatting third stage protocol. MAIN OUTCOME MEASURES: Blood loss; PPH ≥ 1000 mL. RESULTS: Expedient delivery of the placenta in squatting within 3-5 min postpartum resulted in an average blood loss of 100 mL in the first 2 h after birth and no cases of PPH ≥ 500 mL in the first 24 h after birth. The lowest previously published PPH ≥ 1000 mL rate at vaginal birth is 4 %. The PPH ≥ 1000 mL using Active Management is 5 %. CONCLUSION: Less bleeding occurs when women expediently push out the placenta within 3 min of the birth of the newborn, in squatting, taking advantage of the still open cervix, gravity, and the increased effectiveness of their diaphragm and abdominal muscles.

Spontaneous first trimester miscarriage rates per woman among parous women with 1 or more pregnancies of 24 weeks or more.

BACKGROUND: The purpose of this study was to quantify spontaneous first trimester miscarriage rates per woman among parous women. A vast amount of data has accumulated regarding miscarriage rates per recognized pregnancy as well as about recurrent miscarriage. This is the second study of miscarriage rates per woman in a parous population and the first study of recurrent and non-recurrent, spontaneous first trimester miscarriage rates per woman in a large parous population. METHODS: Extraction of the following variables from all delivery room admissions from both Hadassah Medical Centers in Jerusalem Israel, 2004-2014: # of first trimester spontaneous miscarriages, # live births; # living children; age on admission, pre-pregnancy height and weight, any smoking this pregnancy, any alcohol or drug abuse this pregnancy, blood type, history of ectopic pregnancy, history of cesarean surgery (CS) and use of any fertility treatment(s). RESULTS: Among 53,479 different women admitted to labor and delivery ward, 43% of women reported having had 1 or more first trimester spontaneous miscarriages; 27% reported having had one, 10% two, 4% three, 1.3% four, 0.6% five and 0.05% reported having 6-16 spontaneous first trimester miscarriages. 18.5% had one or more first trimester miscarriages before their first live birth. Eighty-one percent of women with 11 or more living children experienced one or more first trimester miscarriages. First trimester miscarriage rates rose with increasing age, increasing parity, after previous ectopic pregnancy, after previous cesarean surgery, with any smoking during pregnancy and pre-pregnancy BMI ≥30. CONCLUSIONS: Miscarriages are common among parous women; 43% of parous women report having experienced one or more first trimester spontaneous miscarriages, rising to 81% among women with 11 or more living children. One in every 17 parous women have three or more miscarriages. Depending on her health, nutrition and lifestyle choices, even a 39 year old parous woman with a history of 3 or more miscarriages has a good chance of carrying a future pregnancy to term but she should act expediently.

The less studied effects of Amniotomy.

Amniotomy has become a routine part of obstetrical care. It was added along with other procedures adopted 50+ years ago without strong evidence. The scientific data supporting this procedure is poor while there is data suggesting it may increase the frequency of cord prolapse, neonatal GBS infection, pain and fetal blood loss if placental blood vessels are punctured. The incidence of cord prolapse overall reported in the literature ranges from 0% to 0.7%. The rate at which cord prolapse immediately follows amniotomy has not been directly studied but is reported in 4 case controlled studies.

AJOG against homebirth.

In 2009, while 99.3% of US women delivered in hospital, 0.7% delivered at home. In response to this slight rise in homebirths, The American Journal of Obstetricians and Gynecologists (AJOG) issued a warning to all doctors and midwives to refuse to attend homebirth under all circumstances. In the absence of respected medical research showing planned homebirth to be unsafe, their recommendation is based on a single maternal death reported in the Daily Mail. American obstetrics is so profit-orientated that it is willing to use misquoted newspaper articles as ammunition and pretend that 277 women don't die in the US annually from cesarean surgery at planned hospital births. AJOG articles are nothing more than publicity stunts created in an effort to maintain a monopoly on birth and not to forfeit even a small amount of business to competitors.

Amniotomy and cord prolapse.

Research shows that artificially rupturing the amniotic sac (amniotomy) can cause umbilical cord prolapse. Amniotomy became a routine part of obstetrical care with the introduction of active management, without evidence of benefit. In the 30 years since active management was introduced, the rate at which amniotomy causes umbilical cord prolapse has not been directly studied. Two controlled studies from Turkey from 2002 and 2006 are the only published studies that provide enough data to extract the rate at which cord prolapse follows amniotomy. They show that 1 cord prolapse results from every 300 amniotomies (0.3%). There is data suggesting amniotomy may also increase neonatal GBS infection, maternal pain and fetal blood loss if placental blood vessels are punctured.

Documented causes of unneCesareans.

UNLABELLED: A recently coined term, unneCesareans, concisely describes the mode of delivery for 25% of low-risk first births in most Western countries. Evaluation of Cesarean Delivery, published by the American College of Obstetricians and Gynecologists (ACOG) in 2000, showed a lack of evidence of improved medical outcomes with the widespread use of cesareans for low-risk, full-term primiparas. Therefore, the term "unnecessary" is appropriate in the sense of medical outcomes. Although the complete causality of this phenomenon has probably not been elucidated, eighteen causes for this common practice have been documented in published research. CONCLUSIONS: UnneCesareans have multiple causes and therefore, a reverse in current trends is unlikely.

Episiotomy, hospital birth and cesarean section: technology gone haywire--what is the sutured tear rate at first births supposed to be?

One hundred percent of woman having a first vaginal birth from 1940-1990 had an episiotomy. It is still used for first births at a rate of 50-60% in many places. Perineal outcomes on first births are critical because the biggest risk factor for needing suturing on subsequent births is a previous episiotomy. No scientific evidence has demonstrated improved outcomes with episiotomy. This paper documents a rate of 99% intact perineums, 1% sutured perineums, in a group of 80 primipara in their early 20s at attended homebirths, average birth weight 3150 gm. Primipara women in their late-20s with 3400 gm babies experienced a 28% sutured tear rate at planned home-births. This suggests that homebirth with a motivated attendant, young age and birth weight of 3150 gm can almost always deliver vaginally without perineal damage. Episiotomy, hospital birth for healthy pregnancies and elective cesarean surgery are commonly practiced, dangerous, out-of-date medical routines unsupported by research.

Management or care: different outcomes.

Recently a popular magazine published a birth story of a long, medically managed, first labor of a low-risk woman, which ended in a cesarean. (1) The doctor/writer was convinced that the labor could not be safely managed other than how he described it and that no safe alternative existed to a cesarean delivery. This is another example of the media trend of promoting medical birth stories and not midwifery-supported birth stories. The article below provides two versions of the same woman's labor to show how a woman's choice of birth attendant and labor support can influence the course of labor and the likelihood of cesarean surgery. judyslome@hotmail.com.

Caesareans and low-risk women in Israel.

Randomised retrospective study of the rise in caesarean surgery among low-risk women between 1990 and 2000 at Hadassah Ein Kerem Labor and Delivery Unit in Jerusalem. The CS rate in low-risk women increased from 4 per cent to 10.5 per cent. Approximately 90 per cent of the population was low risk.

The many ways to sew up a uterus. "Single-layer" vs. "double-layer" cesarean repair: what's best?

Some clinicians have used a single, poorly-designed, retrospective study of single-layer vs. double-layer repair of the uterus during cesarean surgery to justify denying women the option of a trial of labor on subsequent pregnancies. This paper reviews the latest research and suggests the adoption of four new protocols for women after a cesarean. Women should receive a full summary of the repair methods used during their surgery; Women should be counseled as to the risk of delivering another child less than two years after uterine surgery; On subsequent pregnancies after cesarean birth, women should have an ultrasound near the end of the pregnancy looking for evidence of placental growth in the area of the scar and implications of this should be explained; and Vicryl sutures should be used for sewing up the uterus.