It appears on ResearchGate projects: Citizen Science Judy's 3,4,5 to eliminate PPH.
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***** Judy’s 3-4-5 PROTOCOL: At the 36-week prenatal visit, the midwife squats on the floor in front of the client to teach and demonstrate to client 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 Ministry of Health in Israel last year made it impossible for midwives or doctors to buy Pitocin or IM Methergine, so I have been using Methergine PO 0.125 mg for past year with success. Doesnt need refigeration like the IM, but takes 5 minutes to kick in, unlike the IM Methergine which is immediate.
THIS IS A WONDERFUL INNOVATION. BUT I WANT ASK : HOW DOES THIS PROTOCOL COMPARE TO THE ALREADY ESTABILISHED PROTOCOL OF ACTIVE MANAGEMENT OF 3RD STAGE OF LABOUR WHICH INVOLVE CONTROLLED CORD TRACTION. SECONDLY, WHAT BENEFITS OR ADDED ADVANTAGES DOES THIS PROTOCOL HAVE OVER THE OTHER?
No controlled cord traction. Cut the cord at 3 minutes. Get the woman into squatting on the floor. She pushes the placenta out at 5 minutes. No need to pull on the cord. The placenta is separated and sitting at the opening waiting to be delivered.
The benefit of this protocol is active management results in a minimum of 5% PPH, whereas this protocol results in 0% PPH.
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