Wait to clamp that cord....

Amy - posted on 04/12/2011 ( 36 moms have responded )

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"Delaying clamping for an extra minute or two may help prevent anemia in full-term infants, according to a study cited by the researchers. Studies on preterm infants have found delaying clamping the cord for 30 seconds or more reduced the incidence of anemia, intraventricular hemorrhage (brain bleeding), late-onset sepsis (a complication of infection in the days after birth), and decreased the need for blood transfusions, according to the study."

http://www.womenshealth.gov/news/english...


I'm wondering just how much that short extra time really helps. I was told it's best to wait until placenta stops pulsing. But..have to be honest. I have no idea what happened after my son was born. I just don't recall.

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Mary - posted on 04/13/2011

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Just need to add that what Laura is describing is NOT reflective of all US hospitals. It is certainly not an accurate description of the greater Baltimore area. In fact, the Mid-Atlantic region in general is so saturated with midwives that finding a job or practice with an opening is beyond competitive. Inductions are highly regulated and the reasons for them scrutinized - they are not done "just for the hell of it" (i.e. a woman is sick of being pregnant, or for provider scheduling convenience).

Mary - posted on 04/13/2011

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There's a reason baby's face comes out towards the mother's bum.



God, it would be GREAT if that statement were always true! But as any woman who has delivered a baby direct OP (aka "sunny side up") can attest after a prolonged 2nd stage, this is not always true. I'm also a little confused about the "swabbing" of the perineal area comment; that's certainly not common practice where I worked. It's a bit pointless, since there is nothing sterile about a vaginal birth. I do think this was common practice - oh - more than 20 years ago



.If the mother wasn't anemic during pregnancy delayed cord clamping usually ensures a full iron supply for the baby for at least nine months.



Again - a great theory, but, sadly, a large number of women ARE anemic to varying degrees when they deliver. Although there are no current or exact numbers on the percentage of women who are considered anemic, a CDC study in 1993 put it at 37% in low-income women. The study also suggested that this number was probably similar in ALL socio-economic groups based on the prevalence of anemia among women of child-bearing age across the board.



I was one of those women. Despite religiously taking my PNV with iron, and adding an additional iron supplement in the 3rd trimester, my hematocrit was atrocious on the day I delivered (25).

I'm unusual too - many pregnant woman cannot tolerate the additional iron due to issues with ungodly constipation

Charlie - posted on 04/13/2011

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well it's a little hard to take my baby over to the table to resuc immeadiatly when he is black , limp and silent when he is attached to my placenta that hasnt passed yet , they can hardly just reef that thing out of there or wait , given my choice between waiting another half hour / twenty minutes for my placenta to pass and saving my childs life I take saving my childs life and early clamping Time is of essence when my child is dying , I didnt have time to fuck around hoping for him to have fluffy recovery , believe it or not my hospital is really against using intervention unless it is ABSOLUTELY needed they are one of the most progressive hospitals when it comes to natural birth and attachment .



If it had been a smooth birth like my last one I would have had him delayed clamped too .

Charlie - posted on 04/12/2011

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Also another study just published last year tells us that early clamping may interfere with nature’s first stem cell transplant.

"Several clinical studies have shown that delaying clamping the umbilical cord not only allows more blood to be transferred but helps prevent anemia as well," said the paper's lead author Dr. Paul Sanberg, director of the Center. "Cord blood also contains many valuable stem cells, making this transfer of stem cells a process that might be considered 'the original stem cell transplant'."

http://www.medicalnewstoday.com/articles...

Charlie - posted on 04/12/2011

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I specifically asked for the chord to be clamped AFTER the placenta have stopped pulsating after a lot of research , I was happy to find that the hospital actually did this as common practice throwing the old idea of early clamping out the window .


Benifits of delayed clamping are significant especially in little boys who lose iron stores much quicker .

solid evidence of the benefits of delayed clamping. The main benefits being:

Increased levels of iron
Lower risk of anaemia
Less transfusions and
Less incidence of intraventricular haemorrhage

As for Jaundice , you may be told that delayed clamping causes jaundice in babies. This is NOT true.

Babies are no more likely to become jaundiced by delaying cord clamping and there is no relation to jaundice and the time of the cord being clamped. In the studies, the bilirubin levels were within normal range no matter when the cord was clamped. (Excess bilirubin levels are what is associated with jaundice).
Here are some statements from recent studies to back this claim:

“There were no significant differences for other secondary outcome measures: plasma bilirubin levels at 24 to 48 hours, neonatal morbidity (respiratory distress, tachypnea, grunting, jaundice, seizures, sepsis, necrotizing enterocolitis), mortality (none), neonatal intensive care unit admission, length of hospital stay, disease up to 1 month of age, weight or rate of breast-feeding at 1 month, maternal postpartum blood-loss volume, and maternal hematocrit level at 24 hours postpartum.”

AND

“Plasma bilirubin values as well as hyperbilirubinemia rates were similar in the 3 groups, which goes along with other authors’ observations.”

AND

from the recent study at the University of Granada

”...the clamping of the umbilical cord of newborns from full-term pregnancies, two minutes after the infant is expelled from the womb, makes no difference to hematocrit or hemoglobin levels of the umbilical cord vein compared to clamping the cord within 20 seconds. Thus, the study shows that early clamping (which is widely performed) is not justified.”

Further to this, Dr. Sarah Buckley’s well-researched article, A Natural Approach to the Third Stage of Labour’ states:

“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. (Morley 1998)

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. (Morley 1998). One author has proposed that jaundice, which is present in almost all human infants to some extent, and which is often prolonged by breastfeeding, may actually be beneficial because of the anti-oxidant properties of bilirubin. (Gartner 1998)”


Studies have suggested that delayed clamping, for as little as two minutes, should be implemented as standard practice, however this is yet to happen at many hospitals I am thankful the hospital I birthed in was quiet progressive in birth and after birth care .

36 Comments

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Merry - posted on 04/13/2011

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Definitely true Mary, it's very different state to state, even farther north here in Wisconsin is much much better. It's just the Milwaukee area that is sort of sucky in the hospitals. I know in west bend my friend has a great midwife who delivers in a hospital that is more like a birthing center then a hospital! I'm mostly speaking of the down town Milwaukee hospitals.

Dana - posted on 04/13/2011

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I just read this thread, I don't have much to add but, I have to echo Mary's post. What Laura is describing is not reflective of my area also.

Merry - posted on 04/13/2011

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Lol loureen, my hospitals aren't even filled with incompetent midwives! There are no midwives in the area at all! Just obgyns. And yes they do push drugs, they push inductions, they push c sections if you don't dilate a cm an hour. They usually use scare tactics to get moms to agree with their policies. My obgyn told me if i didnt let her clamp the cord immediately that the cord would pull blood from baby back into me!. Many drs in my area, Wisconsin, are surgeons who specialize in obstetrics. So they prefer c sections to vaginal births. They like birth to be very schedules and quick. I was very very lucky to have an ob who let me labor for 20 hours before staring to say I needed a c section. Thankfully I delivered a few hours later. But so many drs in the area will push c sections at every little heart deceleration.

There's really nothing 'natural minded' about the hospitals around here, sure they paint them nice and allow rooming in, but it's still very structured and rigid about policies etc. Not very warm and welcoming even for the low risk women.

Stifler's - posted on 04/13/2011

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I think it's different countries Loureen. Australian midwives seem to be more into pushing natural and minimal interference and in some of the posts I've read by people from the USA it's common to have the OBGYN there pushing epidurals and doing cervix dilation monitoring every hour, etc.

Charlie - posted on 04/13/2011

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Thats what I am saying , The hospital I birthed in firmly believes in delayed clamping , they know the benefits and do it as common practice , in our situation he had to be cut , he needed more intervention than just oxygen .

I am not sure how hospitals work where you are from but the two I birthed encourage mothers to go as natural as possible unless the baby is at serious risk they do not intervene , unless the mother asks they do not offer and then even then they make the mother fully aware of all possible aspects , I just get the feeling from a few posts both in this thread a few others that hospitals are full of thoughtless , ignorant midwives who are more interested in shuffelling people in and then out of birthing suits then giving them the best care possible armed with up to date information .

Merry - posted on 04/13/2011

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Loureen, I don't think anyone is suggesting not to resuscitate a baby until the placenta passes, just that the baby can be resuscitated while laying on moms chest instead of taken away to the incubator. Obviously in some situations it might be needed to just cut and run with a baby, but the benefit of leaving the cord intact is often overlooked by medical staff.

Stifler's - posted on 04/13/2011

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Ooh I remember now. They cut the cord before I even passed the placenta. They cut it and took Logan away because he had the cord wrapped around his neck and he was blue and making gurgling screamy noises and the fire alarm was going off. I took AGES to pass it and the fire alarm went off again while I the midwife was trying to massage it out of me.

Minnie - posted on 04/13/2011

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I imagine that vitamin k producing bacteria would be in a bit higher number in baby's gut if they wouldn't swab the heck out of mom's perineal area/thighs/anus. There's a reason baby's face comes out towards the mother's bum.

April - posted on 04/13/2011

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we will be doing delayed cord clamping here too. with our son, i had a c-section, so of course it it was clamped immediately.

Merry - posted on 04/13/2011

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And also helps with vitamin k to wait to clamp it.
I too think it's odd that in situations where baby isn't breathing they rush to clamp cut and take it to the warmer. I know it's probably easier to work on the baby when it's in the nice height incubator, but honestly the baby gets oxygen through the cord until it's clamped, and the moms body warmth has been shown to be much better for helping babies breathe then incubators and oxygen.
I'd prefer they leave cord intact, put baby on moms chest, and then use oxygen mask if necessary etc. It just wouldn't be as easy for the dr or nurses to do since mom would be 'in the way' and baby would be lower and less accessible.

Minnie - posted on 04/13/2011

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It's the baby's blood, after all. If the mother wasn't anemic during pregnancy delayed cord clamping usually ensures a full iron supply for the baby for at least nine months.

Bonnie - posted on 04/13/2011

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I didn't even know there was a potential benefit to waiting to cut the cord. I have never seen anyone wait to cut it.

Caitlin - posted on 04/13/2011

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hmmm.. I know my firts was done quickly, but that's because they weren't sure if i needed to be ruched into the OR because I was bleeding pretty darned bad after the delivery (luckily i didn't need to be) but she was fine,a nd stayed on my chest the whole time - the only difference was a nurse was there holding the baby also (i'm assuming that was just in case i passed out). I honestly had no idea what was going on at the time, I was so amazed by my little girl, I only found out after they worried about me. My doc still laughs about it because I ruined his new shoes by spraying him with blood and placenta, lol.



My second one I believe they clamped later - i don't think they waited the fulla moutn of time, but remember them waiting a bit before putting on the clamps, so maybe it had stopped pulsing - i'm not sure.

Minnie - posted on 04/13/2011

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See, I wonder about cord clamping due to need for resuscitation- homebirth midwives will typically leave the baby still attached to the cord because the baby is still receiving oxygen and resuscitate the baby on the mother's chest. It seems more of a procedural thing in a hospital for the cord to be cut for resuscitation.

Stifler's - posted on 04/13/2011

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Hmm I'll have to ask the midwives about this one. I can't even remember what they did with Logan, and didn't care at the time. Never heard of this until recently lol.

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For me they had to wait for my babys cords to stop pulsing.As the had to take a blood sample.I was rhesus neg.
My girls were fine.There insulin levels were not affected.

Kate CP - posted on 04/12/2011

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Yea, I was really hoping for delayed cord clamping this time around but because of my GD the doc said no. I decided to look into it and come to find out it can mess with the baby's insulin levels if you don't clamp right away. :/

Charlie - posted on 04/12/2011

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There are a couple of medical reasons why delayed clamping may not be optimal or available GD being one of them I was unable to delay clamping with my first due to his agpar score being 3 and him needing immediate resuc due to be born to quick ( shock ) , some things can't be helped .

Kate CP - posted on 04/12/2011

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It's actually contraindicated to clamp the cord late if you have GD.

Amber - posted on 04/12/2011

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I honestly have no idea. I was so worried about his breathing that I didn't think of anything else. (He was fine but it was a concern.)
I'm going to have to ask Chad because now I'm really curious...hmm.

You guys distract me from my studying by giving me interesting subjects to research :)

April - posted on 04/12/2011

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My son was clamped after the placenta stopped pulsing, my midwife said it would be better for him and i trust her. My daughter was clamped early though, i had given birth to her at the hospital and she was my first so i didn't know anything about that then. I'm glad that i listened to my midwife, now that i've read the facts. :)

Jocelyn - posted on 04/12/2011

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My first baby's cord was clamped right away.
My second baby's cord (after a lot of research) was clamped after it stopped pulsing.

Merry - posted on 04/12/2011

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She clamped it the instant he was born, before he took a breath. This time I want to wait until I deliver the placenta before clamping.

Charlie - posted on 04/12/2011

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Laura are you saying they actually cut the chord BEFORE it has even passed ?

Merry - posted on 04/12/2011

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We are waiting until at minimum it stops pulsing, but I'd prefer to wait to clamp and cut until I deliver the placenta. Feels natural to me to not separate baby from my uterus until my body decides baby is ready to be apart. Idk, ve read the jaundice issue, and I don't feel it's a problem.
Delaying the cord cutting makes so much more sense, I mean my obgyn clamped and cut erics sord before he even breathed, no wonder he was so blue and they wanted to watch himo for a few hours. He was cut off from my oxygen before he was ready to breathe his own!
Darn hind sight.

Minnie - posted on 04/12/2011

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There are some things that are commonly deemed a problem, like jaundice in newborns, low vit k levels at birth and low iron in breastmilk, but I would venture to say that they aren't a problem because they are the norm. I also have read about the antioxidant properties of bilirubin.



With my first birth my OB was all too eager to cut the cord immediately and pulled on my cord with gusto.



With my second I made sure to watch my own cord and let my midwife know when it was ready to be cut.

Ez - posted on 04/12/2011

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The jaundice issue is a common reason given as to why delayed cord clamping is not desirable. As Loureen explained, it is not true.

I honestly can't remember when my daughter's cord was cut, but it certainly wasn't delayed and I didn't know enough at that time to request it. Any future babies will keep their cords until they stop pulsing.

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I asked my OB about this. She said if you wait for the placenta to stop pulsing you're more likely to create high billirubin levels in the blood (that's what causes jaundice).

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With my youngest the doctor waited to have hubby cut it (or even clamp it) until after I had passed the placenta and they had cleaned everything up down there to determine if they were going to give stitches or not (thankfully not... lol). The whole time that was going on I was holding our daughter on my chest with my hubby's hand gently rubbing her back (making an "Ellie sandwich" between us. lol). Then, after the doc was done with everything else, she gently rolled our daughter over, clamped the cord and hubby cut it (all while our daughter was laying on me). The only reason they took her off me for the first 3 hours after she was born was to weight and measure her. Everything else was done while she was on me (even washing - they had a warm damp rag and they just wiped her down). I don't know if there was a specific reason for waiting to clamp the cord (and I honestly can't remember what they did with my other daughter), but I wouldn't be suprised if it was for the reason in the article. My doc was more of a midwife than a doc in mentality when it came to birth though (she refuses to do c-sections except for the most extreme emergency situations and she does not like giving women any drugs to help with the pain), so that may have had something to do with it...

Lady Heather - posted on 04/12/2011

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I have no idea either. Ha. But this is cool. It gives me a question for my midwife. She always says I don't ask enough questions.

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