MIDIRS Digest: Expedient squatting third-stage technique to prevent excessive bleeding at birth

By Judy Slome Cohain

Thirty years ago, when I began attending home births, I attended the birth of a very educated, as well as instinctive, woman. She delivered her baby in a squatting position, and as is normal, immediately sat down to hold her baby. However, a few minutes later, she got into the squatting position again, to deliver her placenta.

I was a young Certified Nurse Midwife and my training recommended that women lay down to deliver the placenta, so I recommended that she sit down. She listened to me obediently. Many placentas will deliver in sitting but hers did not. Home midwives are taught that if the placenta does not deliver after 30 minutes of trying, it is time to transfer to hospital.

After 25 minutes, I told her to try whatever she wanted to get the placenta out, since in five minutes we would have to transfer to hospital. She got into a squat and in 30 seconds, to my great relief, the placenta came out complete with very little blood. A lightbulb lit in my head. I now know that delivering the placenta in squatting by five minutes postpartum results in the least postpartum bleeding and eliminates postpartum haemorrhage of over 500 cc.

I searched the literature and retrieved an elegant study in Obstetrics and Gynecology which found: ‘For third stages of labor more than 10 minutes compared with third stages less than 10 minutes there was twice the risk of postpartum hemorrhage. For a third stage of labor more than 20 minutes compared with less than 20 minutes there was four times the risk of postpartum hemorrhage, and for third stages over 30 minutes compared to those less than 30 minutes there was 6 times the risk of PPH.’ (Magann et al 2005:290-3.) This means that, in addition to the squatting position, it is also important to deliver the placenta expediently. Seconds count. The faster the placenta delivers, the less chance of haemorrhage. This makes sense because after the placenta is delivered, the uterus can completely contract. Contraction of the uterus stops the bleeding by closing off the blood vessels that previously sustained the placenta. The placenta detaches from the wall of the uterus within 60 seconds after the birth of the baby. If you get into a squatting position it begins to fall down towards the opening.

Read the full article, featured in MIDIRS Midwifery Digest, December 2020 here.

A short video of a placenta delivered in the squatting position can be viewed on YouTube here.

© MIDIRS 2020