The most common cause of hemorrhage is said to be Uterine Atony, but the reason the uterus does not contract is because the placenta is preventing it from doing so.

The longer the placenta remains in the uterus, the higher the risk of excess bleeding.  Despite a routine shot of 10 units of pitocin, after 10 minutes the risk of PPH doubles. After 20 minutes 4X, and after 30 minutes 6 times as common. 

MINUTES COUNT!

To completely prevent all PPH  > 1000 cc, the placenta has to be delivered at 5 minutes postpartum.

The best way to do so, is using gravity and the womans stomach muscles. When the woman delivers the placenta in squatting,  the placenta delivers completely.  To deliver by 5 minutes, the woman gets into a full squat at 4 minutes and pushes out the placenta without waiting for a contractions.

Squatting uses gravity to deliver the whole placenta, without some remaining inside.

Judy’s 3-4-5 PROTOCOL: At the 36-week prenatal visit, the midwife squats in front of the client to demonstrate how she will deliver her placenta 5 minutes after the birth. Client’s consent is obtained.  At the birth,support immediate continuous skin-to-skin contact with the baby for the first 3 1 ⁄ 2 minutes postpartum. If the mother gives permission, the cord is cut at 3 1/2 minutes postpartum while the baby is in her mother’s arms. It is not necessary to cut the cord but it makes it easier for the woman to get into squatting and the more expediently she squats, the less blood she loses.  

The midwife keeps hands off the fundus and the cord. At 4 minutes: The midwife verbally directs the mother into a squatting position on the floor with both feet flat on the floor or if she gave birth in the bathtub, then squatting on the floor of the empty bathtub. If the cord is cut, the baby is handed to someone or waits for one minute near the mother, kept warm by covering the baby well. The midwife verbally encourages the woman to push out the placenta without a contraction.  It is helpful to say things like: “the placenta is right there, ready to deliver! Just give a push”

The woman pushes and births the placenta. The time of delivery is noted. Immediately after delivery of the placenta, the mother is dressed with a pad or diaper, 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 i.e. 200 to 300 cc is lost in 5 minutes, a shot of either 10 u Pitocin, 0.2 mg methergine intramuscularly, or  PO Methergine 0.125mg, depending on the amount of bleeding, 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.

YouTube example

https://www.youtube.com/edit?o=U&video_id=LOp6Z4mahvA