Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

The Deal with Delayed Cord Cutting or “Hey! Doctor! Leave that Cord Alone!” May 17, 2009

Recently I have received a few emails/comments asking me about the pros/cons of delayed cord cutting.  Delayed cord clamping/cutting is the process of waiting until the umbilical cord stops pulsating (approximately 5 minutes) and/or waiting until the placenta is delivered (approximately 30 minutes) before the cord is cut after the baby is born.  In today’s hospitals, obstetricians typically wait no longer than 30 seconds after the shoulders are delivered before they clamp the cord.  Why such a short time?  Author Tina Cassidy in her book Birth: The Surprising History of How We Are Born sheds some light on the subject:

 

“Throughout history, the immediate postpartum period has been as much a victim of fashion and misconception as has labor and birth.  And standard practice still varies among countries, hospitals, doctors, and midwives. 

 

The first act that usually occurs after the slippery baby emerges is the cutting of the umbilical cord.  …The act also forces the newborn to breathe air through its lungs for the first time.  Perhaps because of the symbolism of that moment, cord cutting has been a magnet for drama, ceremony, and superstition.

 

In most hospitals today, cutting the cord is such an uneventful routine that it can pass unnoticed by the overwhelmed mother.  Doctors generally wait about thirty seconds a time period long enough, they believe, for the baby to receive all the blood it needs from the placenta.  …They then apply two clamps, break out the scissors, and often ask the father if he wants to cut between the ligatures.  Doing all of this quickly also allows for the baby to be suctioned, weighed, and swaddled, before it gets cold.  

 

Some childbirth experts argue that, rather than being guided by a clock, it’s best to wait until the cord stops pulsing before cutting, allowing the baby to receive all the blood it was meant to receive from the placenta.  They say it helps the mother as well, because the placenta shrinks as it pumps out extra blood, making it easier to deliver.”

 

Penny Simkin, author of the book The Birth Partner, also writes about this subject:

 

“The cord is often cut immediately, but a recent scientific analysis has found benefit to waiting for at least two minutes or until it stops pulsating—in five minutes or so.  Less likelihood of anemia for as much as six months exists in babies whose cords are cut late.  Until the cord is clamped or stops pulsating, blood passes back and forth between the baby and the placenta.  It goes from placenta to baby when ever the uterus contracts, squeezing blood from the placenta through the umbilical cord to the baby.  Between these contractions, with each beat of the baby’s heart, blood is pumped from the baby through the umbilical cord and back to the placenta.  This transfer stops when the cord is clamped or stops pulsating, which occurs when the blood vessels close down.  The best way to make sure that the baby has the right amount may be to place the baby on the mother’s belly and wait for the cord to stop pulsating.  Exceptions to this are when the baby needs immediate medical attention, when the cord is tightly wrapped around the baby’s neck, preventing delivery, and when you have decided on cord blood removal and storage.”

 

So what can we take from these quotes?  I believe we can take the following two things:

 

#1  Immediate cord cutting is very convenient for today’s hospital staff and birth attendants.  It allows for the birth attendant to begin inspection of the mother’s perineum and stitching up of any episiotomy or tear that may have occurred (or was cut) during delivery.  It also provides an opportunity to use a sponge stick to provide traction on the placenta (a.k.a. slight tugging) to “assist” the placenta in detaching (Note: The majority of obstetricians do this as it is part of “active management of the third stage” which is predominately and widely taught in medical schools and residency programs across the U.S.)  When the cord is cut soon after delivery, it also allows for the nurses/pediatrician to take the baby away from the mother (either in or outside of the room) and weigh it, tag it, footprint it, give it medications like vitamin K shot and erythromycin eye ointment, and swaddle it. (Note: If you think that sounds assembly line-ish, your right!  These practices are based on a desire for modern maternity hospital wards to increase their efficiency!)  Typically mothers are told “Oh this won’t take very long!  You’ll have the next 18 years to spend with your baby!  It’s too hard to hold the baby and get stitched up anyways!  We’ll give her right back…promise.”  I would like to add that it is my personal philosophy that any practice that is done solely or mainly for obstetrical convenience and not for the safety or wellbeing of the mother or baby is a practice that should be re-thought or abandoned!

 

#2  The placenta does not stop working when the baby is born.  In addition, blood continues to flow from the baby to the placenta and back again making the claim that the baby will get “too much blood” a physiological fallacy especially if the baby is placed on the mother’s abdomen skin-to-skin above the level of the placenta which assures that blood will continue to flow, but not to excess.  (Unless, of course, the cord is milked, and by that I mean the practitioner puts the cord between his thumb and forefinger and pushes all the blood in the cord into the baby and then clamps it, a practice which is both outdated and harmful in the fact that it will most surely lead to neonatal jaundice.  This old-school practice of “milking” the cord is probably where delayed cord clamping inaccurately got its bad reputation!) 

 

In my quest for more knowledge on this topic I stumbled upon a YouTube video entitled Better Birth VA – We Can Be Much Kinder” produced by L. Janel Martin. 

 

 

This video was created in part for the Birth Matters Virginia Video ContestIt is a fascinating video that interviews a variety of midwives/obstetricians including:

 

 

This list of birth attendants, both obstetricians and midwives, are practitioners who are in support of delayed cord cutting.  More research into their backgrounds and practice revealed to me that they all believe in, work within, and support a midwifery model of maternity care, a woman-centered model that has been proven to reduce the incidence of birth injury, trauma, and cesarean section and promote empowering, positive birth experiences for childbearing families. 

 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Let’s take a moment to learn a little bit more about the research that SUPPORTS delayed cord clamping/cutting:

 

  • Delayed Umbilical Cord Clamping Boosts Iron In Infants (2006): A report of a study conducted by UC Davis nutrition professor Kathryn Dewey that revealed a two-minute delay in cord clamping at birth significantly increases a child’s iron status at 6 months of age.  This study documented for the first time that the beneficial effects of delayed cord clamping last beyond the age of 3 months.

 

  • Early versus delayed umbilical cord clamping in preterm infants (2004): A Cochrane review (considered the “gold standard” of research and evidenced based practice) of studies on babies born prematurely which revealed that delaying cord clamping for greater than 30 to 120 seconds, rather than early clamping as is the current obstetrical practice, seems to be associated with less need for transfusion, less intraventricular haemorrhage, and helped the babies adjust to their new surroundings better.

 

  • Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes (2008): A Cochrane review that showed no significant difference in postpartum hemorrhage rates when early and late cord clamping were compared. The review also reported growing evidence that delayed cord clamping confers improved iron status in infants up to six months after birth, with a possible additional risk of jaundice that requires phototherapy.  (It is important to note however that the act of placing the baby on the mother’s abdomen skin-to-skin above the level of the placenta assures that blood will continue to flow, but not to excess.)

 

 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

So let’s break it down shall we?!

 

The PROS of Delayed Cord Clamping/Cutting

(This list was written by Marie Berwald, a certified HypnoBirthing practitioner and Yoga instructor from Canada, for a post entitled “Late vs Early Clamping of the Umbilical Cord in Newborn Babies” on her blog Birth Bliss.  Marie supports each one of these points with research so please check her blog out!)

 

1) The blood in the placenta rightfully belongs to the baby, and babies not receiving this blood have the deal with the equivalent of a major blood loss or hemorrhage at birth.  It is estimated that early clamping deprives the baby of 54 to 160 ml of blood, which represents up to half of a baby’s total blood volume at birth.

 

2) There is a significant amount of iron in the cord blood which the baby needs for optimal health and for the prevention of anemia.

 

3) Babies benefit from the increased oxygen available to them from the cord-blood when the taking these first few breathes.  The earlier the cord is clamped, the more likely the incidents of respiratory distress.

 

4) The blood that babies receives through the cord after birth acts as a source of nourishment that protects infants against the breakdown of body protein.

 

5) As an added bonus, delayed cord clamping keeps babies in their mother’s arms, the ideal place to regulate their temperature and initiate bonding and breastfeeding.

 

The CONS of Delayed Cord Clamping/Cutting

 

1)     May increase the baby’s risk for jaundice, a condition that many newborns develop related to the baby’s immature liver that cannot process bilirubin, a yellow byproduct of the breakdown of old red blood cells.

 

It seemed to me that the PROS of delayed cord clamping outweigh the CONS however I feel that it is important to explore the subject of newborn jaundice more…that is, Is it something that parents should be worried about?  Is it serious enough to trump all of the research supported benefits of delayed cord clamping? 

 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

 

The answer to my question came from one of the obstetricians featured in the YouTube video featured above, Dr. Sarah J. Buckley.  In an article entitled, Leaving well alone: A natural approach to the third stage of labour  Dr. Buckley writes,

 

“Early clamping has been widely adopted in Western obstetrics as part of the package known as active management of the third stage. This comprises the use of an oxytocic agent- a drug that, like oxytocin, causes the uterus to contract strongly- given usually by injection into the mothers thigh as the baby is born, as well as early cord clamping, and ‘controlled cord traction’- that is, pulling on the cord to deliver the placenta as quickly as possible.

 

While the aim of active management is to reduce the risk of haemorrhage for the mother, ‘its widespread acceptance was not preceded by studies evaluating the effects of depriving neonates [newborn babies] of a significant volume of blood.’

 

Some studies have shown an increased risk of polycythemia (more red blood cells in the blood) and jaundice when the cord is clamped later. Polycythemia may be beneficial, in that more red cells means more oxygen being delivered to the tissues. The risk that polycythemia will cause the blood to become too thick (hyperviscosity syndrome), which is often used as an argument against delayed cord clamping, seems to be negligible in healthy babies.

 

Jaundice is almost certain when a baby gets his or her full quota of blood, and is caused by the breakdown of the normal excess of blood to produce bilirubin, the pigment that causes the yellow appearance of a jaundiced baby. There is, however, no evidence of adverse effects from this mild jaundice.  In fact, jaundice, which is present in almost all human infants to some extent, and which is often prolonged by breastfeeding, may be beneficial because of its powerful anti-oxidant properties.

 

Early cord clamping carries the further disadvantage of depriving the baby of the oxygen-rich placental blood that Mother Nature provides to tide the baby over until breathing is well established. In situations of extreme distress- for example, if the baby takes several minutes to breathe-this reservoir of oxygenated blood can be life saving, but, ironically, standard practice is to cut the cord immediately if resuscitation is needed.”

 

I encourage you to read the full text of Dr. Buckley’s article on her website as she not only talks more about the benefits of delayed cord clamping, but she also supports all of her arguments with research.

 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

 

Are you interested in delaying cord clamping during the birth of your baby?  If you are, know that the research supports you!  If your birth attendant states that she/he does not usually practice delayed cord clamping/cutting but doesn’t automatically shoot the idea down, as her/him if she would be willing to learn more about it.  On the other hand be weary of any birth attendant that discourages this practice, tries to talk you out of it, or outright refuses to participate.  This could be a red flag that she/he will not be wiling to support any other desires in your birth plan.  A regular visitor to my blog recently wrote me this email:

 

Dear NursingBirth,

 

I belong to an online birth club and a fellow mom wrote this post the other day:

 

“I met with my obstetrician yesterday for my 32 week appointment and brought my birth plan with me.  She looked over it and proceeded to tell me all these issues with it…  I want to have a natural/med-free childbirth and mentioned if the labor wasn’t progressing I would like to try nipple stimulation or breaking my water first. She told me no, this it is bad for the baby, and that pitocin is less bad for the baby.  I want to let the baby’s cord finish pulsating before cutting it… she said absolutely not, because it increases the risk for jaundice. Then at the end of the appointment she walked out and I over heard her talking to a nurse about all the issues with my birth plan and how I must have just copied and pasted stuff from the internet.  Maybe I’m being overly sensitive, but it just seemed a little harsh and awkward.  What would you guys do?”

 

Everyone has been writing back to her that she needs to consider finding another doctor but she seems reluctant because she is already 32 weeks along and has had this doctor for her entire pregnancy.  What do you think?

 

Sincerely, 

Concerned Friend

 

My thoughts….this is a RED FLAG to walk right out of that doctor’s office and never look back.  This doctor CLEARLY does NOT practice evidenced based medicine.  Is switching birth attendants during the last few weeks of pregnancy a hassle and nuisance that a mother should not have to go through on top of all the other stresses she is probably experiencing?….ABSOLUTELY!  But is it absolutely imperative that she still switch practices even though it sucks big time….YOU BET IT IS!  I hope that any mother that finds herself in a similar situation truly understands the risk of staying with a birth attendant that does not support her birth plan just because she don’t want to a) hurt anyone’s feelings, b) think she can still have the birth you want without her/his support, c) go through the hassle of finding a new attendant (trust me, I know it is a huge hassle). 

 

The bottom line for me is this:

 

IT’S YOUR BIRTH!!  YOU ARE ONLY GOING TO BE GIVING BIRTH TO THAT CHILD/CHILDREN ONCE IN YOUR WHOLE LIFE!!  YOU, NOT YOUR BIRTH ATTENDANT, ARE THE PERSON THAT IS GOING TO HAVE TO LIVE WITH THE CONSEQUENCES OF A BIRTH THAT IS CONTROLLED BY SOMEONE ELSE!!  YOU HAVE THE RIGHT TO HAVE THE POSTIVE, EMPOWERING, SAFE, AND HEALTHY BIRTH THAT YOU DESIRE!!

 

For help writing a birth plan please check out:

 

About these ads
 

67 Responses to “The Deal with Delayed Cord Cutting or “Hey! Doctor! Leave that Cord Alone!””

  1. Mama Kalila Says:

    This was in my birth plan… it also was one of the many things ignored in it. They immediately cut her cord and then pulled the placenta out of me… I was too out of it at the time to argue… and my husband (rightly so since they took her off to the side away from us) was w/ the baby. Pulling led to bleeding led to them freaking out and worrying us… Of course, my dr that went over the birth plan (lol) was no where around and the dr was a med student… who I have no idea if she ever saw the bp (the nurses did… but they joked about how they hadn’t followed any of it).

    • nursingbirth Says:

      Mama Kalila, that is so frustrating, especially for everyone to joke about how they “didn’t follow your birth plan.” I mean, when I go over a mom’s birth plan with her I always talk about how I will advocate for her and her birth plan but that sometimes things arise in labor and birth that require a reassessment of the situation and perhaps a diversion from a birth plan. Unless Kalila came out really in distress (which it doesnt sound like she did) there is no reason your wishes should not have been followed! Also for some docs, its just too ingrained in their practice to do things their own way that even if they go over your birth plan, old habits die hard and they end up doing thing their way anyways. The good news is that you are such a super savy mama now that I am sure you are doing your research for the next time!! You deserve it!

    • Melissa Says:

      WOW! So much confusing information. I am a New Doula who had worked with a New Mom and went over all of her personal options and choices. She and Dad had decided to leave cord for at least 5 minutes, and put it on the birth plan. When Dr. was delivering Baby she told Mom she could potentially bleed if she left it attached????? Ant the Nurse sad that she would lose nutrients that the baby needs back into the Placenta???? Wow what is correct? And why do we not have something so important known in our Hospitals?

  2. I respect mom’s desires for delayed cord clamping. The best way to recover a healthy newborn is on mom’s chest, cord attached if she wishes. There is no controversy there. However, because my specialty is neonatal care, and I teach neonatal resuscitation, I am going to have to disagree with some of the points presented:

    ” The earlier the cord is clamped, the more likely the incidents of respiratory distress syndrome.”
    Respiratory distress syndrome is caused by a lack of surfactant in an infant’s alveoli (the small breathing units of the lungs). It is almost always a condition of prematurity. You may sometimes see it in term babies who were extremely compromised in utero, or in infants of diabetic mothers. Sorry, but it has nothing to do with the clamping of the cord.

    “In fact, jaundice, which is present in almost all human infants to some extent, and which is often prolonged by breastfeeding, may be beneficial because of its powerful anti-oxidant properties”.
    I agree with this. It should be stressed she is talking about mild jaundice. Jaundice we do not think twice about. But hyperbilirubinemia should not be taken lightly. I would advise not to delay the cord clamping for a family that is high risk for jaundice: previous infant treated with phototherapy, east asian descent, prematurity less than 35 weeks, certain blood group incompatibilities. (BTW, an interesting side note is that Pitocin can increase bilirubin levels also).

    “Early cord clamping carries the further disadvantage of depriving the baby of the oxygen-rich placental blood that Mother Nature provides to tide the baby over until breathing is well established. In situations of extreme distress- for example, if the baby takes several minutes to breathe-this reservoir of oxygenated blood can be life saving, but, ironically, standard practice is to cut the cord immediately if resuscitation is needed.”
    I have major issues with this cavalier statement. Babies in extreme distress and who are in secondary apnea (meaning not breathing at birth, and will not improve with tactile stimulation) should NEVER have delayed cord clamping! Why? Because for an infant to be in secondary apnea they would have to have suffered from oxygen deprivation in utero for a prolonged period of time. Placental blood is not always oxygen rich, thus the compromised baby. Babies like these need positive pressure ventilation with 100% oxygen without delay. The longer the infant remains hypoxic, the harder it will be to resuscitate them.
    Nursing Birth, I want to stress that I have no issue with delayed cord clamping in a healthy newborn. Sorry if I can across as more clinical than compassionate. I would be happy to explain any of my points further if you or any of your readers are interested in the neonatal perspective.

    • nursingbirth Says:

      realityrounds, Thank you for your comment. I appreciate your knowledge on neonatal resuscitation. I would like to comment myself on a few points you brought up.

      1) You write, “I respect mom’s desires for delayed cord clamping. The best way to recover a healthy newborn is on mom’s chest, cord attached if she wishes. There is no controversy there.” I disagree with you because if there was no controversy surrounding this issue, then the vast majority of healthy newborns would be recovered on mom’s chest with cord attached, which rarely happens in this country unless moms and dads fight for it. The fact of the matter is that even though nurses like you and me understand that delayed cord clamping can be beneficial for the healthy newborn, the current obstetrical philosophy and teaching of active management of the third stage of labor teaches new doctors to cut the cord 10-30 seconds after the shoulders are delivered. My argument is that this is at least unnecessary and at most detrimental to the newborn.

      2) You write, “Respiratory distress syndrome is caused by a lack of surfactant in an infant’s alveoli (the small breathing units of the lungs). It is almost always a condition of prematurity.” Here I absolutely agree with you. I think the author of that statement meant to say “respiratory distress” which can be caused by a variety of factors including but not limited to cesarean birth without the benefit of labor, pitocin induced hyperstimulation of the uterus, narcotic drugs given to the mother for pain relief too close to delivery, and as some research is showing, early cord clamping. Instead the author wrote “respiratory distress syndrome” which is a very specific disease which you well summarized in your comment. Thank you for bringing that point up and I will be sure to remedy it so that my readers do not get confused.
      3) You write, “Babies in extreme distress and who are in secondary apnea (meaning not breathing at birth, and will not improve with tactile stimulation) should NEVER have delayed cord clamping! Why? Because for an infant to be in secondary apnea they would have to have suffered from oxygen deprivation in utero for a prolonged period of time. Placental blood is not always oxygen rich, thus the compromised baby. Babies like these need positive pressure ventilation with 100% oxygen without delay.” I agree with you here as well. However you are assuming a few things here including a) that neonatal resuscitation including positive pressure ventilation and 100% oxygen cannot be done with the cord still attached, which it is done in some home birth situations where neonatal resuscitation is required, and b) all babies that don’t cry immediately after birth or all premature babies are automatically born in secondary apnea, which is not true. Now I agree that more advanced techniques like placement of an umbilical line or intubation cannot be done with the cord still attached as it requires the infant to be placed on a warmer high enough for a team to work on him. However these advanced techniques are rarely if ever required for full term, healthy, newborns that have had a safe and healthy birth without the use of unnecessary interventions. And generally speaking it is much easier for a NICU team to work on a infant in general if they are on the warmer and I understand that is a reality. But what I am advocating for ESPECIALLY for the healthy term newborn without signs of respiratory distress and perhaps even some premature babies that are generally “healthy” with prematurely being their only immediate issue at birth is that delayed cord clamping is safe and has appropriate and well researched evidence support its use.

      Something to think about…

  3. Wow, that was terrific! Thanks so much for posting! I’m going to put that video on my blog.

    And to the mom mentioned above, RUN, DON’T WALK out of that OB’s office! Trouble looking for a place to happen.

    You have an awesome blog – thanks!!

  4. Joy Says:

    I hope that expecting mother is able to read this post and know that the only way her wishes will be respected is if she has a respectful doctor. It’s never too late to find another doctor, even a different one in the same practice.

    I haven’t talked over my birth plan with my doctor yet. Right now I’m on the course to meeting each OB in the practice, so I suppose I need to talk to ALL the OBs in the practice about my plan in the event that they are on-call when I go into labor, right?

    I’m REALLY glad you touched on this subject right now. I’ve been too fatigued and forgetful to remember to do research on early cord-clamping. But I have been wondering about it. THANK YOU!

    I’m more worried about anemia than jaundice (my other children were never jaundiced).

    Now I’m interested to know about the Vitamin K/eyedrops they give baby right after birth. It’d be neat to hear some information on exactly what goes on to BABY right after birth. I want them to wait to do all that junk. I’ve been tested for STDs every pregnancy and I’ve always come back perfect and without STDs. So I just wonder why they do all that if the mother has none?

    P.S. I HATE that doctors yank on the cord to pull the placenta out. I’m definitely going to yell a big, “What the H are you doing?” if it happens to me this time.

    With my firstborn they did this and my recovery time was WORSE. I bled more and it was a lot more clotty. With my second I had a diff. doctor deliver and they let me birth placenta myself and the bleeding was minimal and I healed a LOT FASTER!

  5. Joy Says:

    realityrounds- there are always special circumstances in which cutting the cord quickly is very necessary. Many times NursingBirth mentioned that UNLESS there is an emergent situation doctors should wait to clamp and cut the cord until it stops pulsing. So I think we’re all on the same page.

    My firstborn had her first BM in utero so she had to be clamped and cut quickly and whisked away to ensure she didn’t aspirate/drink the meconium-filled amniotic fluid. In that instance I’m grateful they did what they could to keep her safe. And she was safe. I don’t think she even had a fever.

    So again, definitely understandable in emergent situations such as the ones you stated!

  6. pinky Says:

    Have you spoken to any neonatologist? I have spoken to them at length. If the baby is on the mother’s belly, then the baby could be losing blood since the baby would be higher than the placenta. When the Neonatologist have really preterm babies they have the OB keep the baby below the level of the placenta and wait 1-2 minutes if possible.

    So it matters where the baby is in relation to where the placenta is when the placenta cord clamp issue arises.

    Also having too much blood can be just as bad. It won’t just be jaundice. Being overloaded with rbc can cause a bunch of other problems with the newborn.

  7. Hi Nursing Birth,
    I meant there is no controversy in recovering babies on mom’s chest, in my view! Sorry, my bad :). I realize a lot of birth attendants find that controversial. Secondary apnea is a definitive condition. If you stimulate a baby and they refuse to breathe after a few seconds, preemie or not, they are in secondary apnea. No assumptions there. You can certainly keep the cord attached during resuscitation, but to what benefit? A compromised neonate at delivery did not have enough oxygen supplied via the placenta to keep their organs perfused. So perfusing a neonate with hypoxic cord blood renders no benefit. I want your readers to know that this is a RARE occurrence. Only about 1% of babies need full on resuscitation at birth. I do not want to come across as a fear monger.

  8. Joy- I just read your comment. I think I can answer some of your questions. You wrote: ” Now I’m interested to know about the Vitamin K/eyedrops they give baby right after birth. It’d be neat to hear some information on exactly what goes on to BABY right after birth. I want them to wait to do all that junk. I’ve been tested for STDs every pregnancy and I’ve always come back perfect and without STDs. So I just wonder why they do all that if the mother has none?

    P.S. I HATE that doctors yank on the cord to pull the placenta out. I’m definitely going to yell a big, “What the H are you doing?” if it happens to me this time.”

    I feel the need to apologize that parents have no idea as to what we are doing to their newborns when they deliver. This is a wake up call for sure! Generally, if the baby is brought to the warming table instead of mom’s chest, we dry the baby off, assess them for stability, assign APGAR scores, give the Vit K and erythro, put on their ID bands and abduction alarms, weigh, measure, assess them some more, make foot prints, etc. You can refuse the Vit K and erythromyicin. Vit K is used to prevent hemorrhagic diseases of the newborn, and erythromycin is used to prevent eye infections. Both are rare, but tragic if they occur.
    As far as the OB pulling on the cord, that is old school. This can cause the cord to detach from the placenta, and then your in for a world of hurt. Do birth attendants still do this?

  9. Mama Kalila Says:

    No she was perfectly healthy, no problems at all. No need for any of that to occur. And yes, definately resesarching and making plans for next time. We’re using a birth center next time, and I’ve already interviewed the midwife (far in advance). I’m pretty confident things will be better..

    Realitysounds, yes they do still do it lol. I’m proof. And from everyone I’ve talked too… its a pretty common occurance!

  10. sarah Says:

    I didn’t know that cord traction was so widely practiced, I thought that caused a much higher risk of retained placenta (by ripping it apart). My first was born in a birth center and so we waited until the cord stopped pulsing and then my mom cut the cord, DH and I thought is was to weird.

  11. Joanna Says:

    “In fact, jaundice, which is present in almost all human infants to some extent, and which is often prolonged by breastfeeding, may be beneficial because of its powerful anti-oxidant properties”.
    I agree with this. It should be stressed she is talking about mild jaundice. Jaundice we do not think twice about. But hyperbilirubinemia should not be taken lightly. I would advise not to delay the cord clamping for a family that is high risk for jaundice: previous infant treated with phototherapy, east asian descent, prematurity less than 35 weeks, certain blood group incompatibilities. (BTW, an interesting side note is that Pitocin can increase bilirubin levels also).”

    This is very interesting to me. My first was an induction with Pitocin. He had meconium and was not breathing at birth. He had Jaundice with a high level of 21. He was in the hospital an extra 3 days and had phototherapy at home for at least a week.

    My second labor was totally drug free, no Pitocin. He did not have meconium and was screaming at birth. We did delay cord cutting with him, as I never saw anything about it possible causing Jaundice. He had a very mild case of jaundice which was treated under the lights at the hospital for 2 days and then cleared up in its own. The Ped at the hospital also was aggressive about treating this quickly based on my other son’s record. I don’t know if the aggressive early treatment was what prevented it from getting out of control or if he was better about getting rid of the excess bilirubin quicker.

    I should add the both my boys have a more rare blood type, AB Negative, RH Negative. They were both tested for blood incompatibilities and none were found. If I have a third should we not delay cord cutting? It’s interesting to me that my older sons levels were so high and we did not delay, while my younger son’s, whose cord cutting we did delay, case was mild. Any thoughts?

    • nursingbirth Says:

      Joanna, that is a great question and unfortunately I am not an expert on jaundice. Perhaps for your next baby you could present some research to your OB about delayed cord cutting and together come up with a plan :)

      • Laura N Says:

        Jaundice is also associated with the use of Pitocin (childbirthsolutions.com). The website it was probably due to the IV though.

  12. Amanda Says:

    I have had both experiences. My first was in a hospital and they immediately cut the cord and pulled my placenta out. My second was in a birth center and they waited a little while to cut the cord there. It was a weird experience to have my baby in my arms and to have him still attached to me, but cool at the same time. It was also great to focus on my baby in my arms while my stitches were being done. My husband and friends got to poke around my placenta after it came out. They thought that was cool.

    Thanks for doing all this research! I can tell you put a lot of work into your post.

    • nursingbirth Says:

      Amanda, thanks so much!! And thanks for sharing your two very different experiences! Those first few moments together for mom and baby are so important and so special!!

  13. Janel Says:

    Hello,
    Thank you so much for sharing my short for the film contest. It is part of my film that is coming out in parts, beginning in June. http://www.theothersideoftheglass.com. Also on Face Book.

    Could I add something to your “bottom line”? I am an advocate for baby-centered (soul centered) care.

    It is the BABY’S BIRTH. It IS the BABY who will not get his or her cord blood. It IS the BABY whose brain, body, and soul will not get the experience she or he NEEDS to have the attachment and body with the mother — that will determine THEIR relationship and that BABY’s relationship with EVERY OTHER person.

    Mother-centered also allows for planned cesareans and epidural and all of the other interventions medical has conjured up to “help” woman and then made “normal”. When one begins to consider the profound, deep, life-long consequences to the BABY of whatever it is done, people will do differently. A society that honors the soul coming into a human body will create a different kind of human and planet. A woman will do things differently, including conscious aware conception and she will make her choices regarding her AND her BABY’S LIFELONG needs, not just in that moment (ie, drugs to avoid pain and to avoid dealing with her own fear with the belief that if it’s ok for her it’s ok for her baby.) That’s my humble opinion.

    And, then there’s the father … whether there or not … he is 1/2 of the baby … and to deny that is to deny part of the baby, to deny part of the self. Time to heal the masculine so we can heal the feminine and the planet.

    Thanks for the opportunity to chime in … I really, really appreciate this article and research you’ve done. Thank you and bless you.

    I

    • nursingbirth Says:

      Janel, thanks for adding to my bottom line!! Sometimes I feel like women are scared into so many things (like unecessary testing, interventions, or cesareans) for the sake of the “baby”(the old “You don’t want to harm your BABY do you you bad mother!?” kind of scenario) that I tend to focus more on “mother centered care.” But you are totally right! It is really the mother-baby-father unit that is truly a WHOLE and not just individual parts that we need to be focusing on. I appreciate your take on it! I can’t wait until your film comes out!

  14. Joy Says:

    realityrounds- with my firstborn they did pull on the cord and placenta. I remember one nurse practically got on top of me and was pushing on my stomach as the doctor pulled. The doc was on her way to a c-section and was in a hurry. Didn’t happen with my 2nd and I’ll fall over dead before they do it this time around (having #3 in October). I was really young and not as knowledgeable then and too tired to speak up. Now it makes me angry to think about.

    • nursingbirth Says:

      Joy that is CRAZY but unfortunately you are not alone in your experience. As reality rounds put it “fundal pressure is a big no no” and it IS! It can cause uterine prolapse, uterine rupture, and injury to mom & baby, among a host of other complications. Just another example of a doctor that a) does not practice evidenced based medicine and b) cares more about obstetrical convenience and over mother/baby safety! I am so glad you kicked him/her to the curb my friend!!

  15. Joy, OMG that sounds horrible. Correct me if I’m wrong Nursing Birth, but I thought fundal pressure was also a big no no. That sounds like a horrible experience Joy. No wonder you were angry. I sure baby #3 will be a good experience just like baby #2 :)

  16. BCB Says:

    Nursing Birth, I have a student nurse question. In nursing school we were taught that clamping/cutting the cord stimulates respirations. This comes from our textbook, Maternity, Newborn, and Women’s Health Nursing by Susan Orshan, specifically this quote “…clamping of the umbilical cord affects chemoreceptors sensitive to changes in arterial oxygen and carbon dioxide content, contributing to the onset of respirations.” This sentiment was echoed by our faculty to the tone of *this is why cords are clamped and cut immediately after the birth*
    I guess my question is this: Is the above quote enough to justify swift cord-clamping? Or not?
    Thanks so much for this post. I’m enjoying the research you’ve done!

  17. Aisha Says:

    I was hoping to donate the cord blood when my baby is born. I am still planning on doing so, because its free and it could help someone in need or for research. I don’t know if I will be able to donate it because of collection issues at my hospital.

    However, I can see the advantages of delayed cord cutting, but I also understand that as far as interventions go, immediate cord cutting is not as risky to the baby and mother as other birth interventions like drugs or pitocin.

    I do believe that the vitamin K shot is not harmful to the baby and can prevent complications same as the eye ointment. I think that the PKU testing is necessary. I do have some issues with the Hep B vaccine given the day or day after birth.

    But I agree I think that all parents must be informed of the procedure done to the baby and woman right after birth, I know that there’s a million forms that you have to sign but I’d love to know what they are all about….before I give birth, I’m 29 weeks.

    • nursingbirth Says:

      Aisha, CONGRATS on your pregnancy :) What is most important to me is that moms & dads are truly informed about any procedure done to them or their baby so it looks like you have done your research, your decisions are yours, and you are on the right track! That is most important!

    • newmom Says:

      Just a reminder that delayed cord cutting and cord blood donation are NOT compatible. If your hospital won’t collect the cord blood, you can register with http://www.cryo-intl.com/ to donate it. I plan to delay cord cutting, and would like to donate the placenta if possible, but I have not been able to find a place to donate the placenta to. (I am having a home birth) If I cannot donate it, I will encapsulate it, as I am at risk for postpartum depression. I would hate to see it go to waste by throwing it out or burying it.

  18. janel Says:

    BCB — thank you for posting this resource.

    The doctors I’ve interviewed have told me, as they say in the short film, that there was never any research done prior to doing this routinely until it became the norm. In fact, Dr. Allemann talks about how this is a way of the system. For example, as a resident she saw how it is so easy to start a drug, many drugs, or any intervention, and then is nearly impossible to get a drug stopped “for fear it ….”. As a resident, she took on a challenge to get people off drugs. She also shares how it is, and it is a common understanding of history, that cord clamping became the norm during the “twilight” and ether drug era. It was necessary to get the baby separated from the mother to stop the intake of the drugs and because the baby was floppy and needed to be supported or forced to breath. Instead of reconsidering drug use or following the obstetric text books in the early forties that said it was dangerous, they just developed rituals around this monumental separation of mother and baby — rituals that allowed them to be in control. During the ether days of drugging mothers Virgina Apgar developed her own little format for evaluating the condition of the mother and baby – because she observed such differences and such life-threatening situations. Rather than suggest not using ether, she developed her system so she’d know the seriousness. Others asked her to show them and you know the rest of the story. It was never developed, tested, researched, or normed based on healthy, normal mother-baby’s. Drugging was just continued.

    NOW, in 2005 there are such studies done that divide babies into “immediate” and 1, and 3 minutes “delayed cord” clamping to learn that the babies who got 3 minutes do better on physiological measures. Amazing. And, so what of the immediate and one minute babies. Oh, well? Too bad? “You’re fine”?

    One midwife in my film never clamps a cord. She cuts it further from the naval than normal and the mother will squeeze the cord. Yes, it is left open. No, they don’t get germs because they are in their own environment and the flow is out of the cord at that point and says it drains some. She demonstrates how all other mammals most likely chew it off and it stimulates that motion and action. She says in the fifteen years since she’s been doing this she has had ZERO jaundiced babies. Dr. Marshall Klaus also spoke of the needs of the baby to nurse within the timeframe we know the “self-attachment” “breast crawl” to happen SO that they have that first, huge, MAJOR, green BM. They don’t get jaundiced either. If the baby is separated from the mother for any reason, and even in midwifery births when they aren’t left alone, the baby’s crawl to the breast is disrupted, and that first feeding doesn’t happen the way it was intended.

    I think it would be interesting to find out how many people born at home in the 20-40’s with physicians also had their cords clamped. It is sort of a male, mechanistic, “have-to-do-something” mentality. My mother was a twin born at home in 1930 in January in Iowa and a doctor was there. We are pretty sure her mother had morphine or something. And, as the first twin, I betcha her cord was clamped fast. You know, the way humans are treated at birth in this society is a real testament to how resilient we are … how little it takes for us to “survive” but what we know in my field of pre and perinatal psychology is that it is all imprinted in the brain as the “survival” mechanism, or theme, I call it. It is how one will live their life, starting with the first moment and adding perception after perception to the original wiring. Layers of experience — what we experience fires the brain and what fires wires. What most people keep wiring is the information that comes from the same situation — separation, needs not met, no one sees me that is the main experience in hospital and some midwifery births. Ok, that’s for another time. I could, and do, go on and on.

    I think what you’ve shared with us is a typical, acceptable form of “scientific education” that shows us WHY nurses and doctors are so hell bent on doing what they know is right. I went through ob residency with my ex and I am still amazed and appalled at the info he was told and that he didn’t get. I have given much thought to how can we find this middle ground — when people realize their wounding at the hands of medically trained, caring, people who didn’t know? The person has a right to be outraged but how do we come into awareness and consciousness healing our own wounds without creating chaos and anger towards those who ignorantly did what they were trained to do? Imagine being trained this way and then learning it was wrong and realizing all the damage you’d done to other human beings. I think it’s the main reason, dynamic, that keeps the cycle going. This is good info for my own research and works. Thanks so much.

  19. janel Says:

    Aisha … if I may, please consider that the placenta is the baby’s organ. It is the baby’s blood. Blood is our Life Force. Blood and oxygen … must have for life .. for QUALITY of life. Blood and oxygen — body and spirit. We are connected to our place of origin, the Creator, Heaven, God… whoever and whatever … every human seems to be connected or seeks to be connected.

    Birth is only a physiological matter in medicine. … birth IS a sacred, spiritual event. A soul is coming into your lives … made by the union of your egg and your partner’s sperm. YOU are forever connected to this being. Everything you do matters.

    Medicine has given ZERO thought to the full needs of the placenta, cord, and the blood on a physiological level and has NO CLUE about the needs of the mother and baby’s bonding and attachment. You and your baby will be defined by how you separate and reconnect. Of course, we know now there is much that can be healed. And, importantly, as prevention, we know what can create the best start physiologically, psychologically, emotionally, and spiritually. IMHO, there is no place for early cord clamping in a civilized nation. Our culture is driven by consumerism — in the 50-60’s women were convinced that artificial, man-made formula was Better for their babies. BETTER!! NOW, we know the importance of the baby to crawl to and attach to the breast and we know that colostrum is a miracle substance. Every day now more research about the benefits of breastfeeding — documented by the fact that mammals have been surviving that way for 1000’s of years. WHAT ELSE? And, WHAT do we NOT know about the PLACENTA and the baby’s blood?

    Finally, babies are souls … they are fully conscious from before conception. In the womb, they hear, feel, taste, and they LEARN. They know their native language by last trimester. Mothers are in relationship from the beginning, forming the foundation for every other relationship, programming the body and brain to live optimally in exactly the same environment – nutrition, stress, relationship wise. It IS the baby’s life and birth. Babies will participate fully when acknowledged and when a practice of communication is established with them. SO, with a practice established, a connection formed, and trust in getting messages from and to your baby, you can ask your baby is s/he wants to donate his/her blood. Perhaps, your wish to do so is a message from your unborn baby. Perhaps, it is yours. This relationship and communication is vital during labor and birth. A mother who trusts her communication and relationship with the baby will be in connection and will know when baby is or is not in distress for example.

    What I do know is the greatest thing you can give your baby is the acknowledgment of his awareness and his role in this. HIS or HER Birth … more than a passenger, more than a co-pilot. S/he is the purpose. Women need to trust their body AND their connection with their baby.

    And, then in the end, regardless of what you want and decide, caregivers will likely do what they wish … people you’ve never met before you don’t know you or your baby, like in the film with the hospital birth. Just doing their job based on textbook information, not listening to mother crying, “noooooooo” when the doctor pushes her hand away to stop the cord clamping. MOTHER’s body KNOWS what baby needs. HER BODY MADE THE BABY and knows. Trust birth. Trust Babies.

    You will make the right choice for you and your baby …. but in these times you need to be very educated and very prepared. All of these interventions have double side. They are all invasive to the newborn — he only wants to be on his mother’s chest, touched gently, and to gaze in his mother’s eyes. That’s his biological impulse … every mammal does this. ANYTHING done in the first three hours disrupts critical brain development and attachment/bonding. BUT THE GOOD NEWS is we can MEDIATE it by being aware IN THE MOMENT .. talking to the baby .. having baby in mother’s arms. MOTHER lettting us know, ok, we are ready for shot, after she’s told baby what it is for — IF YOU REALLY MUST DO IT during bonding time — and that it will hurt, the ointment will blur baby’s vision so he can’t focus in on mother’s eyes and trigger the brain. Caregivers CAN BE SO MUCH KINDER and do it CONSCIOUSLY … in the mother’s arms … talking to the baby … why you have to do it. ASK, watch for signs of baby responding, do it slowly so baby has time to integrate the experience. EVEN ADULTS need this from medical people, why not newborns? Tell the baby, mother preferably, “You won’t be able to see me, but I am right here.” Protect the environment as then the sense of HEARING becomes heightened — ask people to be quiet.
    Even babies in the NIC, especially babies in the NICU need this
    kind of care — respectful, communicative, slower pace when possible, and someone communicating what is happening.

    You can donate you baby’s cord blood (a huge gift to do) by doing so consciously, slowly, with your baby’s involvement — with your own ritual around doing so. Not just strangers cutting him off and taking it. With honor and respect for the gift it is.

    And, one last thing …. before I get back on the road this morning … my film will question the impact of the father cutting the cord — in a system that “allowed” him in but doesn’t respect him or really include him, that drugs and cuts babies off from mothers, and I wonder IF it is, and I believe it is, very damaging to clamp the cord before the MOTHER via her body and psyche and connection to the baby, says it’s ok, it’s time … what is the personal, familial, and social impact of that? What is the impact of that on the baby/father relationship and the mother/father relationship? What does she FEEL, unnamed, unspoken in their relationship? How does this manifest in their lives, in our society?

    Thanks for the post. As long as you connect with your baby in utero and develop your attachment and bonding you’ll make the right choices. ANd, whatever happens can be processed, integrated, and healed. That’s what’s important to know. Mother’s guilt is a social wounding that woman carry.

  20. Aisha Says:

    Janel, no offense but you totally lost me there. In all respect, I am not a religious and perhaps not much spiritual either, so in all honesty I don’t understand what you are saying.

    However I have had family members die from Leukemia and other Lymphomas or cancers as well as other illnesses that could have been treated with bone marrow transfusion or better yet, cord blood. This is my way of giving back to people that may need it. I will not bank my baby’s cord blood because it is very expensive and I don’t know if we will ever have a need to use it, however, there are many people right now that may have an use to the cord blood that I donate. I don’t understand what the oposition is to donating the cord blood and placenta is, when I am giving life not only to my son, but maybe also to someone else that has an absolute need for preserving their life.

    I am giving birth in a hospital setting with the care of a midwife not an OBGYN, I lean more towards the midwifery model of care, mostly because I don’t believe in unnecessary interventions, this may be contradicting, but, if necessary and recommended by my midwife, I will follow her best advice on how to proceed if there are complications during birth. I am getting informed on what my options are during birth so I can pick and choose which way I want to follow. I would preffer a natural birth, no medications or inductions, I would like to have my baby with me at all times after delivery, which is an option at my hospital. My husband will also be there at all times and I plan on nursing right away after delivery. But I am deffinitely a middle ground person on everything, if there are logical and safety reasons to intervene then by all means, I would like my safety and the baby’s safety to be the most important thing of all even if it goes against my birth plan.

    My husband, will be my birth partner, he will be active throughout labor and he will be my coach during labor and my partner in my entire life with our child, whether he decides to cut the cord or not, that is his choice. I don’t know how this will impact any of our souls or our life there after, but I know that we are both very excited and looking forward to raising our child together.

  21. khalilaann Says:

    I belong to that same birth board too, and I believe I responded to that post. As an update, I do think the mother is going to get a new doctor. It’s what we all told her she should do. I just hope my doctor doesn’t do that when I bring up my opinions at the next appointment! It’ll be a pain to switch this late in the game, but it’s a much better idea to switch doctors then have a doctor do something ((say inject the pit into your leg for placental birth without even saying anything)) that you specifically stated you did not want. That would tarnish the whole experience! And probably make me go on some sort of rage induced rant to the hospital….

  22. khalilaann Says:

    Wow! I just read through the other comments and I am AMAZED at the amount of people who had the umbilical cord pulled on to make the placenta come out! I’ve only been in the “research beyond ‘Your Pregnancy Week by Week’ and the spiral bound the hospital gave me” mode for a week and I already know all of the problems that can occur ((or occur more frequently)) when it’s pulled on as opposed to a natural delivery, or even delivery from a pit injection! What if hemorrhaging occurred as a result of that? Shouldn’t the doctors be more concerned about something that could cause a big law suit for their hospital?

    • nursingbirth Says:

      Khalilaann, I am so glad to hear that that mother is possibly going to switch birth attendants!! Also, in my opinion, birth attendants that do NOT practice evidenced based care have a “I’ve already made my mind up, this has been ‘working for me’, don’t confuse me with the facts” kind of attitude. So sad!

  23. […] Today’s Super Comment is in response to May 17th’s post entitled The Deal with Delayed Cord Cutting or “Hey! Doctor! Leave that Cord Alone!” […]

  24. Kim Says:

    I recently attended a birth where there was light meconium during transition. As a result, they cut the cord and took the baby to the warmer within seconds, even though she had good muscle tone and was crying heartily.

    In situations where the baby ‘may’ be compromised or need assistance breathing, I would assume that the extra oxygenated blood from the placenta would be even more beneficial until regular breathing is established. I also would think (although I have no formal training to say one way or the other) that by FORCING the baby to breathe by cutting the cord, the risk of aspiration would be higher than if left to breathe gently on their own time, while still getting oxygen from the placenta.

    I feel very strongly that if my baby were to be born needing help I’d prefer to have the natural assistance from my body as long as possible, while they worked on him or her. (I’m due in October.)

    Is there anything that can/should be done to get the baby the help right there with the cord still attached? What can they do across the room that they can’t do on the bed with mom? (Keeping in mind precautions to keep baby warm of course.)

    • nursingbirth Says:

      Kim that is a great question. For discussion purposes I am going to assume we are talking about a healthy term baby and a healthy mom. Current NRP guidelines (that is, Neonatal Recusitation Program) state that if a baby is born with light meconium and is vigorious at birth (i.e. good muscle tone, strong respiratory effort/crying, heart rate >100) then they should be treated as if there was no meconium there. They do not need to be rushed to the warmer just because of meconium. Vital signs, bulb suction (if necessary), tactile stimulation, and assessment of skin color, blow by oxygen, etc can all be done skin to skin with mom with cord still attached. Also as I am sure you know, the BEST place to stabilze a baby’s vitals and especially TEMP is skin to skin on mom’s chest. Are you a doula or were you a labor companion for a friend/family? Thank for commenting!

  25. Kim Says:

    Thanks for the input. I love that you answer all the comments. I probably really wouldn’t have had to ask if I had read all the previous comments before hand (what a discussion! your comment section is a wonderful learning tool too!), but I wanted to get it out while I was on my mind.

    I’m a (very new) doula. I’m almost done certifying with Dona as soon as I take a breastfeeding class and get my paperwork sent in and approved. I’ll be having baby number one in October, after which I hope to pursue a career in midwifery, although I’m unsure whether to go the direct entry or nurse midwifery route….also unsure where to get the money for training! LOL

    • nursingbirth Says:

      Kim, I love the comments section on this blog too!! So many things to learn from other health care professionals and moms! Congrats on almost being done certifying as a doula!!! We need more doulas like you! And I hear you on the money for midwifery training. My dream is to go to midwifery school but I’d like a few more years of nursing under my belt first (and for my husband to finish his degree!) and even though we have “tuition reimbursement” at my hospital, it should really be called “tuition drop in the bucket” because it doesnt even come close to covering the cost of a midwifery program! *sigh* Keep up the good work!

  26. Dana Says:

    Thanks for the very comprehensive post on delayed cord cutting! I linked to your post from my blog. I had come to most of the same conclusions through my own research but really appreciate having it all there in one place for me to refer to and to refer my caregivers to. I’m planning to leave the cord intact until the placenta is out when my third child is born in September.

  27. […] have to write it at all (or do the extensive research required for such a post), because Nursing Birth has written it. Since it’s very long, I won’t write any more about it, except to say GO […]

  28. pinky Says:

    Curious? What is your education level? The reason I ask is that you have named every woomeister in the universe. I am surprised you have not mentioned Ghadi, Ina May and Santa Clause.

    Tina Cassidy is a writer. She is not a authority on birth. I liked her book but I would get myself down to the medical library if you want to print up pros and cons of delayed cord clamping. You may start with the BMJ, they have done a few decent studies.

  29. I am starting to feel uncomfortable with some of the comments regarding neonatal conditions and delayed cord clamping. For the record, I have 16 years NICU experience, a Masters of Science in Pediatric/Genetic Health Nursing, RNC certification in NICU nursing, and I have been a Neonatal Resuscitation educator for 10 years, and have certified over 1000 nurses, doctors, respiratory therapist, neonatologists, med students etc. I feel the need to break down some of these comments:

    “I recently attended a birth where there was light meconium during transition. As a result, they cut the cord and took the baby to the warmer within seconds, even though she had good muscle tone and was crying heartily”. There is no such thing as light mec, thin mec, particulate mec, etc when it comes to neonatal resuscitation. Mec is Mec, is Mec. If the baby comes out vigourous (strong cry, good tone, good heart rate), the baby will not be INTUBATED to suction out the trachea. This baby should still be looked at more carefully than a baby without mec. Please note that meconium is passed in utero due to an acute or chronic hypoxic event. This hypoxic event dilates the infant’s anal sphincter, and the mec is subsequently passed. Just because a mec baby is vigorous at birth, does not mean he may have not aspirated meconium in utero. These babies deserve more surveillance. This could be done theoretically on mom’s chest, but it would be done awkwardly.

    “In situations where the baby ‘may’ be compromised or need assistance breathing, I would assume that the extra oxygenated blood from the placenta would be even more beneficial until regular breathing is established. I also would think (although I have no formal training to say one way or the other) that by FORCING the baby to breathe by cutting the cord, the risk of aspiration would be higher than if left to breathe gently on their own time, while still getting oxygen from the placenta.” Kim, these are some dangerous assumptions. Please remember that a baby who refuses to breathe at birth suffered some hypoxic event in utero that made him apnic. Most likely the placental blood is hypoxemic. Delayed clamping in these situations is dangerous. Period. If a mec baby comes out lethargic and apnic, that infant must be intubated to suction out that mec from the upper airways. You do not want an infant gasping and aspirating mec, which causes a chemical pneumonia in the infant. If it is an apnic baby who does not have mec, prolonging respiration will have tragic and deadly consequences. Make no mistake about this, please.

    “Is there anything that can/should be done to get the baby the help right there with the cord still attached? What can they do across the room that they can’t do on the bed with mom? (Keeping in mind precautions to keep baby warm of course.)”
    This is what we can not due on the bed with mom” Give positive pressure ventilation, intubate, give chest compressions, insert intravenous or umbilical lines, give medications and fluids. It would also be hard to monitor and keep warm an infant who needed assistance on the mom’s bed.

    “Current NRP guidelines (that is, Neonatal Recusitation Program) state that if a baby is born with light meconium and is vigorious at birth (i.e. good muscle tone, strong respiratory effort/crying, heart rate >100) then they should be treated as if there was no meconium there.” Current NRP guidelines do not differentiate between different types of meconium, as previously stated. It does NOT state that these babies should be treated as if no meconium is there. It states that these babies do not need to be intubated for tracheal suctioning. I personally would be comfortable recovering a vigorous mec baby right on mom’s chest. But I also have the years of education and experience to quickly tell when a baby is going south. Just like the jaundice issue, any type of meconium is not to be take lightly.

  30. Nursing Birth, I addressed some of the comments on your site regarding delayed cord clamping with babies that present with meconium or need to be resuscitated. This happens to be my area of expertise. I presented detailed information supported by the American Academy of Pediatrics, yet my comment was deleted. If you do not agree with the comments, answer them with evidence.

    • nursingbirth Says:

      Dear realityrounds, last night at 7:11pm you posted a comment in regards to my delayed cord clamping post. I read the comment when after returning from work around 9:30pm. I thought your comment was very thought provoking, well written, and deserved some more research on my part before I was to respond. I was absolutely exhausted and did not feel like staying up late to answer your comment but I really wanted to be the first person to comment on it (this may be a bit selfish but after all, this is my personal blog, so I feel I have the right) so I asked my husband the following question, “Hun, there is this comment that was posted by a NICU nurse that I really want to respond to first but I’m too tired to stay up. The people who read my blog often comment a lot in the morning so I know they will comment on her post before I get a chance to tommorow. What do you think I should do?” He replied, “Why don’t you just archive the comment for tonight and then when you get a chance in the morning you can answer it. It’s late tonight anyways and I don’t think anyone will even notice.” I replied, “What a great idea!” and went to be at 10:00pm. So I just got back from some errands and checked my blog and was very disheartened to read your comment reality rounds. Apparently you recheck my blog often (which I appreciate) and commented that I removed your post only about 42 minutes after I archived it. WOW! I just want you to know that I did not delete it. I am mearly doing some research of my own before I repost it and reply to it. Now, you may not agree with that and that is cool, but again, this is a personal blog and after all, you too have a blog (which I read and enjoy) so I hope that you realize you too could post on delayed cord clamping at any time. In fact, your stellar credentials lend themselves to perhaps posting about neonatal recusitation on your OWN blog!! How cool would that be! I’d read it for sure!

      (For those of you who are not aware realityrounds has 16 years NICU experience, a Masters of Science in Pediatric/Genetic Health Nursing, RNC certification in NICU nursing, and has been a Neonatal Resuscitation educator for 10 years. Certainly she is a great resource and I am truly honored that someone with her credentials is even ready my blog!! I find that I learn so much from all of my readers that comment on my posts which happen to include moms, childbirth educators, doulas, OBs, midwives, nurses etc etc etc.)

      I hope you will continue to post comments to my blog. In fact you often post comments to my blogs….long ones at that that often have parts where they disagree with me or other commentors. I have never deleted one single comment and I have even commented myself how I WELCOME hearty debate on my blog. I am deeply saddened that you are accusing me of deleting your comment now.

      Patience! realityrounds….Patience my friend :)

  31. Nicole Says:

    i read this and did some follow-up research. i really like the idea of delayed cord clamping, it made so much sense to me. i brought this up with my ob-gyn at my 20 week appt, just to clarify and ask if she was in support of this. i said i would like to have my baby as soon as he comes out and put on my chest. i aslo stated that i would like to delay the cord cutting/clamping until it stops pulsating, i backed it up with all the information i had on why this is a good thing. she went on to completely disagree with me. she said that because of gravity, once the baby is on my chest the blood will flow back into the placenta making that more difficult to deliver, and also draining blood that was on its way to the baby. so now i’m all confused.

    • nursingbirth Says:

      Nicole, is there any way to get a second opinion from another midwife or OB either in that practice or in that community? I am worried for you because it sounds like you were very well prepared and she just shot you down despite all of that. I wonder if she will be willing to work with anything you write in your birth plan that contradicts her everyday practice. Hmmmm…

  32. Hi nursing birth,
    Thanks for responding. Of course I will keep reading and commenting. I am slightly computer illiterate and did not know you could even archive comments. My bad! It is your blog and you have the right to moderate comments as you wish. I have deleted a comment on my site once, but it was truly disgusting and mean spirited. There are some nutters out in the blogosphere, unfortunately. I understand you exhaustion. We are currently laboring mom’s in the hallway, waiting for beds. What happened 9 months ago?

    • nursingbirth Says:

      realityrounds,

      Oh man I know! We are SO busy right now! I am so happy you are not offended. I’ve got the day off tommorow so stay tuned. Heading to work now for 3-11.

  33. Chris Says:

    This is such a great post! Comprehensive too. I’ve been researching this a lot lately. We’ve had four home births with “delayed” cord cutting, and clamping only on the baby’s side. We’ve had, of course, no problems with it.

    When this subject came up just recently in my nursing school, because the instructors acknowledged that there’s no real need to cut early except to whisk the baby away to the warming bed and examine it. One even mentioned that we don’t clamp early with any animal species (i.e. on farms or zoos).

    When my textbook dealt with it, it only cited polycythemia as a result of late cord clamping. Uh, polycythemia compared to what? Oh yeah, babies who were cut early. :P

    I think given how long iron stores last in the infant body (around six months!), we should be letting these babies have all the blood they are supposed to get.

    Thanks for a great post!

    • nursingbirth Says:

      Chris, you write “When my textbook dealt with it, it only cited polycythemia as a result of late cord clamping. Uh, polycythemia compared to what? Oh yeah, babies who were cut early.” I LOVE IT! Its like when they tell moms that their breastfed babies arent growing fast enough…compared to what? ….oh yeah, bottle fed babies! UGH!

  34. […] cord clamping … Nursing Birth, one of my favorite blogs, wrote a fabulous piece on early versus delayed cord clamping.  This is such an awesome post and I am glad to have it as a resource. Not only does she make some […]

  35. Sugarbear Says:

    Dear Nursing Birth,

    First, since this is the first time I have written a comment on your blog, I wanted to thank you for such a real, personal, insightful and honest blog about issues that I am passionate over. I was made aware of your blog by a friend that I know from the website babyfit.com. I keep up with your current posts and try to go back and read a few old ones each week. I find it to be a breath of fresh air to hear the kind of things you say coming from someone in the medical community. I wish I had found you and had known what I know now before my son was born, but that is another story for another time.

    I have been feeling conflicted about the issue of cord clamping. I have been reading information here and from other sources about the benefits of delayed clamping and I find it amazing. My best friend has a daughter who is three weeks younger than my son. After we shared all those months of pregnancy together and encouraged each other through returning to work and pumping breast milk, and helping each other through all the questions, concerns, and joys of first time motherhood, I was devastated when her child was given a diagnosis of MPS1, aka Hurler’s Disease. Praise be to God, her life was saved by a stem cell transplant. The stem cells she received were from a cord blood donation. So, you can understand how passionate I have become about stem cell donation in general, and cord blood donation in particular. We understand that research is indicating that cord blood is the best and most effective option for Hurlers children.

    My question is, does delayed cord clamping mean that there will not be enough cord blood left for donation purposes? I have not been able to find any information that addresses this question, but I am admittedly not very adept at research. I was hoping you could shed some light on this for me. Thanks in advance.

    • nursingbirth Says:

      Sugarbear, the answer is yes and no. You can still do delayed cord clamping and cord blood banking if you delay the cord clamping for a very short period of time, say 30 sec to at most 1 min max. (I’m just going by my experience here so if anyone has any websites or resources for Sugarbear on this topic please let us know!) As far as extended delayed cord clamping like greater than 1 minutes and especially if you wait until the placenta detaches before you clamp, cord blood banking is not an option. Therefore the risks and benefits for each individual family must be weighed in. For example, as of now the American Academy of Pediatrics does not recommend private cord blood banking. On their website FAQ about cord blood banking it reads:

      “I’ve been approached by a self-storage program to store my child’s cord blood. Isn’t it better to be safe than sorry? Should I store it or donate it?

      Parents should consult their physician to help them make an informed decision.

      Cord blood donation should be encouraged with the cord blood is stored in a bank for public use.
      Private cord blood banking should be encouraged when there is knowledge of a full sibling in the family with a medical condition (malignant or genetic) that could potentially benefit from cord blood transplantation.
      If banking for future personal or family use, parents should know that most conditions that might be helped by cord blood stem cells already exist in the infant’s cord blood and would not be used (ie, premalignant changes in stem cells).
      Storing cord blood as “biological insurance” should be discouraged because there currently is no scientific data to support (self) autologous transplantation.. “
      website: http://www.aap.org/advocacy/releases/jan07cordbloodfaq.htm

      So yes, I believe that public cord blood banking is a noble endeavor however the cord blood you are donating is indeed your baby’s blood and therefore I can see the positives to both sides, that is, delayed cord clamping for the benefit of your child or public cord blood banking for the possible benefit of other children. In your situation you have a personal experience with a child who has benefited from donated cord blood so perhaps donating your next baby’s cord blood is something that is more right for your family.

      Thanks for sharing your personal story and thanks for reading!!!

  36. Emily Jones Says:

    “…Unless the baby needs immediate resuscitation, there is almost never a need to cut the cord immediately.

    **ETA** See Nursing Birth for a great discussion on this myth…”

  37. janel Says:

    My video was banned twice by YOutube for “objectionable content” but back up at http://www.metacafe.com/watch/2870183/we_can_be_much_kinder_birth_matters_video_contest/

  38. Kathy Says:

    I just recently read an article about stem cells, and it said that there are stem cells in the placenta as well, so I’m wondering if it would be possible to keep the placenta to use for stem cell banking (that’s what I’m assuming they’re basically using cord blood for — the stem cells in it), and then the baby can get the full complement of blood s/he needs, and the parents can store or be generous and donate stem cells from the placenta which is not going to be used.

    • nursingbirth Says:

      Kathy, I have never heard of anything like that but HOW COOL are those possibilities!! Hopefully they will be possible (if they are not already possible) one day :)

  39. […] is a great post by a L&D nurse about Delayed Cord Clamping, with great resources to check […]

  40. hodgkins Says:

    Having overcome non-hodgkins, this was good to see. Thanks for this.

  41. Mama Kalila Says:

    Ok I don’t see her comment on here, but it was emailed to me… From NewMom.. My midwife actually told me that we could delay clamping and still bank or donate cord blood. So yes it does seem that it is possible. Personally we’re only going to delay clamping since banking is too expensive and donating requires delivering in a hospital (and the worst one here no less).

  42. […] was important to us that her cord not be clamped or cut until it was done passing blood between my body and hers. first of all, it doesn’t seem right […]

  43. This blog is great. There’s continually all of the right details in the hints of my fingers. Thank you and maintain up the excellent work!

  44. Looking for research regarding early cord clamping and retained placenta. This is the only reference I can find – are there any more out there? http://www.whale.to/a/butler7.html


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

 
Follow

Get every new post delivered to your Inbox.

Join 94 other followers