loading page

Preventing Postpartum Hemorrhage Using Expedient Judy’s 3,4,5 Protocol: Retrospective Cohort Study
  • Judy Cohain
Judy Cohain
Hebrew University

Corresponding Author:[email protected]

Author Profile


Background: Postpartum hemorrhage (PPH) was deadly prior to blood transfusions, and therefore either never existed or was eliminated by evolution millions of years ago. No animals hemorrhage. Human PPH appears to be a relatively recent occurrence, perhaps coinciding with the decrease in the use of squatting. The first documented case of human postpartum hemorrhage appears around 1400 AD. Regardless of which third stage protocol is used, 95% of low risk women do not hemorrhage, but about 5% do. A protocol called Judy’s 3,4,5 calls for squatting out the placenta between 3 and 5 minutes postpartum in order to lower the 5% PPH rate to the same rate as experienced by other mammals, i.e. zero. Methodology: A retrospective cohort study of 1,027 planned, attended low risk vaginal births in Israel using Judy’s 3,4,5 minute third stage protocol compared to 2,691 attended low risk vaginal births in British Columbia using various forms of active or expectant management of the third stage of labor. Results: Among similar groups of low risk births, active management, or expectant management resulted in 4% PPH over 1000 cc, whereas Judy’s 3,4,5 minute protocol resulted in 0% PPH over 500 cc. Conclusion: Judy’s 3,4,5 minute protocol is logical, using gravity to deliver the placenta expediently. It results in 0% postpartum hemorrhage over 500 cc and an average blood loss of 100 cc in the first hour after the birth of the newborn, which compares favorably to any other third stage protocol.