Expedient Standing Or Squatting Placental Delivery And Postpartum Hemorrhage: A Retrospective Cohort Study

Objective: To compare expedient delivery of the placenta in standing or squatting by 3 minutes postpartum to current third stage management.Design, Setting, Sample and Methods: A retrospective cohort study comparing 2 practices with identical inclusion criteria differing in third stage management: 2,154 planned, attended low risk vaginal births using expedient squatting to 2,691 planned, attended low risk vaginal births using various forms of active or expectant management. Main Outcome measures: PPH≥1000 cc and manual removal of placenta. Results: Among comparable populations, combinations of active and expectant management resulted in 4.1% PPH≥1000 cc, whereas expedient delivery of the placenta in standing or squatting by 3 minutes postpartum resulted in 0% PPH≥500 cc. Conclusion: Less postpartum bleeding and postpartum hemorrhage occurs when women push out the placenta with the assistance of gravity and expedience, in standing or squatting by 3 minutes after birth. “The mind of the beginner is empty, open to all possibilities, free of the habits of the expert.”