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.

Midwifery management of face presentation.

The 1980 edition of Oxorn and Foote (1980) urges the midwife not to be hasty in employing cosarean (CS) for face presentation because, with patience, babies are usually born vaginally, with better outcomes. Reviewing how to manage face presentation can prepare the practitioner for this rare event, and decrease CS management. A hundred and ninety six midwives from the US, UK, Hungary and Israel were emailed, asking them to describe their experience, if any, with face presentation. Twelve midwives responded, demonstrating the rarity of the event. Face presentation was most often diagnosed at full dilation. Mode of birth was dependent on the size of the fetus, the motivation of the woman and the experience and motivation of the practitioner, not on the position of the chin. Where the posterior chin was blocking birth, CS could be avoided by rotating the head to occiput anterior (OA) or by swimming for 45 minutes in a large birthing pool.

The latest research on preconception and prenatal nutrition.

The quality of daily food intake is the most important and most ignored factor determining pregnancy outcomes. In the absence of chromosomal issues, the health of the fetus is determined by the woman's diet, exercise and lifestyle choices. The placenta is continuously remodeled with old villi being constantly replaced by new ones as the placenta migrates upward, giving women the ability to improve fetal nutrition during pregnancy. Prenatal care including intensive hours spent improving diet has the potential to optimize pregnancy outcomes.

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.

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.

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.

Management of true shoulder dystocia at attended homebirth.

At attended homebirth, shoulder dystocia poses less of a challenge and has better outcomes compared to hospital birth. If you don't panic, but do call someone into the room to help you with suprapubic pressure if needed and run thru the maneuvers systematically, you will get the baby out by six minutes avoiding damaging long-term consequences. At hospital birth, it is estimated to take a minimum of two minutes to turn the woman onto all fours from the usual position in a hospital bed while connected to a monitor, IV and epidural. An epidural anesthetizes the woman making it impossible to push optimally. Epidural also anesthetizes the baby, making spontaneous breathing less likely and making resuscitation more challenging. Suprapubic pressure is difficult at the height of the hospital bed, so time is lost while the bed is lowered. Vacuum and forceps vaginal deliveries, which are not used at home-birth but accompany about 8% of hospital births, are independent risk factors for true shoulder dystocia.

Prenatal ultrasound does not improve perinatal outcomes.

Based on accurate randomized controlled studies, the correct evidence-based recommendation would be for women not to undergo prenatal ultrasound except to assist with turning a breech baby to head down, evaluating ectopic pregnancy and directing the needle during amniocentesis and fetal blood transfusions. First and second trimester organ scans, biophysical profile (BPP), amniotic fluid index (AFI), placental grading 0-III and Doppler umbilical, uterine and fetal artery velocity testing have been tested in randomized controlled studies on tens of thousands of women. They are used to attempt to predict suspected fetal growth restriction (FGR or IUGR), suspected placental insufficiency and suspected postdate pregnancy. They are unable to predict those with sufficient accuracy to direct management that will reduce the number of stillbirths or improve perinatal mortality rates and in most settings result in increased cesarean rates as a result of failed induction.