Already did it. I published all my protocols, in a clear reproducible fashion repeatedly. These protocols resulted in perfect outcomes among 900 consecutive homebirths. You or anyone else can reproduce those protocols and get the same outcomes if you do births at home- ie. no cesareans, no tears and no PPH. I am not sure if they can be reproduced in hospital but they should be tested in hospital. i have tried extensively to do so. Dr Inbar Ben Shachar the head of L&D in Ziv Hospital in Tzfat said in front of his entire dept. that he wants to test them, but that was one year ago and he never followed up on it, despite my constant requests to do so. It may be that a woman in hospital has added fear that effects her outcome negatively. I dont know. But here is what i guarantee. Send me any term woman, with a live fetus, with a head down baby, and I can deliver her without a cesarean, without a tear and without a PPH, and with a healthy baby.

Article Prolonged second stage: Three cases 14, 17 and 24 hours long...

Article Minimalizing bleeding and tearing at vaginal birth: One prac...

Article To what extent do English language RCT meta-analysis justify...

https://midwiferytoday.com/mt-articles/lessons-from-a-homebirth-practice/

I am not the first to claim excellent homebirth protocols although I may be one of the first to publish my outcomes as well as how I accomplished them in a way that they can be reproduced. Dr Agnes Gereb and I use very similar protocols. At the above website, Dr Stevenson’s protocols are provided. I agree with his protocols with the following differences and improvements.

- I remind the mother that the fetus is dependent on her for their oxygen, so she must not hyperventilate, or hold her breath except during a push, but rather breath normally throughout all the stages of labor. This prevents some of the low apgars that occur in some settings.I have never had a woman who could not follow this direction.

- I agree that sometimes only the face is purple after birth from the pressure of birth, but the body is pink and that should be pointed out to the parents. It resolves within 2 hours.

-I dont count heart rate at birth, but do resuscitation whenever the baby is flacid.

- I also ignore cords 1x, 2x, 3x, 4x around the neck and true knots except to chart it in the file

- I do calculate APGAR scores

- I dont get any tears by giving the perineum time to stretch at crowning- an additional half a minute during which the mother pants instead of pushes, up to 1.5 hours of crowning with a thick muscular ring in one case. (that did not tear, given time)

- I also usually do one check of the fetal heart on arrival, except among the vbacs which I check more often.

- Like him, I rarely do a vaginal exam- about half of my births have no vaginal exams during labor.

- ‘obstruction because baby’s head doesn’t enter the pelvis’ I have never had a head that did not enter the pelvis and am not sure what he experienced. I have only had cases of ‘obstruction’ that needed manual interference in the case of Mentum Posterior Face Presentation which i moved to OA with my hand. Dr Stevenson mentions stair walking and him lifting the head off the pubic bone maneuver, neither of which i have needed, used or found helpful. Long second stages such as 5 to 22 hours to push the baby out , was because the head had to change shape to fit thru the pelvis. i.e. cone or mould. I had one case of an arm that came out first and was unable to reposition it to OA and the woman had a cesarean.

-I agree :If blood pressure has been within normal limits during pregnancy, I do not measure it during labour. I also never use suction after birth, although sometimes an hour after birth, i have needed it to clear the mucus. But I do something else. As much as possible after the head is out, i try to get the woman to delay delivery of the shoulders for a minute or two. During that time, i watch the mucusy fluids (and thick meconium if there is thick meconium) drain out of the nose of the baby. Using this method i have not had a baby with TTN. I am not sure but I think mucus in the lungs is the reason for TTN.

When i get to the birth and contractions have stopped I dont go to the kitchen. I bring my pillow, find a corner and go to sleep, expecting possible long labor once it starts. I sleep anywhere.

He wrote”Normally there is no hurry to deliver the placenta” Research shows expectant delivery of the placenta results in 5% PPH over 500 cc and Dr Stevenson makes no mention of his PPH > 500 cc rate. i know he had at least 1% or 2% PPH because i ask lots of midwives. Research is very clear that expectant delivery is not ideal. There is a definite hurry to deliver the placenta to avoid all PPH. Avoiding PPH, avoids some infections and nursing problems. I deliver all placentas by 5 minutes and have not had a PPH over 500 cc except one woman, there is always an exception, who delivered the placenta and screamed for 45 minutes that she wants to die because her brother had just been murdered. She lost 800 cc. Measured in a measuring cup.

-“All my clients were very strong-minded, warm-hearted, highly motivated people into healthy living” Many of my clients are but certainly many are not. Some are severely obese. Two are chain smokers. 12 of them never leave their home. Some have severe lisps, are deaf, are needlephobes, white coat syndrome, have broken legs, grandmultiparity > 10 and postdates. The only thing they have in common is they were all frightened at the time of birth and they wanted a good outcome. There are no athiests in the fox hole and so far, i have yet to meet a woman who didnt say she would have taken an epidural at the end if one were offered. They were all scared as the baby came out, overwhelmed by the pain. Many of my clients take me because i offer successful vbacs, a vaginal birth after third and fourth degree tears, because they have had a crisis at hospital and dont want to go back even though they have no fondless for homebirth and are not particularly strong or motivated.

https://midwiferytoday.com/mt-articles/lessons-from-a-homebirth-practice/