Sunday, July 8, 2012

Delay Cord Clamping - Your Baby Deserves Their Blood!

The techno-medical management of birth is pervasive. I struggle to understand the origination of some obstetrical interventions, such as the immediate (or quick) clamping and cutting of the umbilical cord.

The umbilical cord develops between 3.5 and 8 gestational weeks and sustains the baby throughout the pregnancy and even in the minutes after birth by transferring nutrients and oxygen to the fetus from the placenta and carrying fetal waste away.

The transfer of nutrient rich and oxygenated blood continues after birth and is important for all babies to receive, but particularly important for babies that are slow to start breathing on their own.

I recently watched a youtube video of a Grand Rounds lecture from M.D. Nicholas Fogelson (AcademicOB/GYN) about delayed cord clamping and the importance of this as a standard of practice in medicine. He gives an excellent presentation and discusses several large well-executed research studies in which the evidence for delayed cord clamping is strong.

I was also intrigued by his slides and remarks about other mammals and what they do with the cord after birth, obviously they are very unconcerned with the cords and often leave them alone until after the placenta is birthed. In humans, some practice a "Lotus Birth" where the cord is not cut and the baby/placenta are left connected until the cord naturally falls off of the baby.

Some of the important points I took out of Dr. Fogelson's lecture include:
  • Delayed cord clamping results in about a 25-40% greater blood volume in the newborn that persists for about 2 weeks
    • If an adult had 40% less of their blood volume they would go into shock
  • Hematocrit levels are significantly higher in babies with delayed cord clamping (65% compared to 45%), however they stay below levels for polycythemia if the cord is left alone (ie. not stripped or "squeezed out"
  • Increased volume of red blood cells
    • There appears to be no greater incidence of jaundice noted in any of the studies (some believe this would occur because of the "higher"volume of red blood cells) and bilirubin levels often do not exceed the "pre-determined limit"
  • 50% of the placental transfusion occurs in the first minute (60 seconds) after birth, the remaining 50% occurs over the next 3-5 minutes

... what is SO complicated about leaving the mother and baby skin to skin for the first 5 or so minutes after birth, with the baby laying on the mother's abdomen before cutting the cord? We already know that laying on the mother's abdomen has many other benefits such as keeping the baby warm, increasing oxytocin release in the mother to help facilitate the birth of the placenta and decreasing maternal bleeding, and helps establish breastfeeding.


It needs to be standard practice that cord clamping and cutting is delayed for at least the first few minutes after birth.

As for cord blood collection, although the uses of cord blood appear to be growing, the benefits of babies receiving their own personal supply of embryonic and fetal stem cells, as well as stores of Iron and other nutrients, seems to be the most simple example of "do no harm" as there is no evidence to support that babies are BETTER without the cord and placental blood.

Also, as with all things we do with newborns and young children, our movements and intentions need to be gentle and respectful of their more sensitive needs; cord clamping and cutting can occur on the mother's warm and comforting body and the procedure and be done in a peaceful manner. This is the cutting of the mother and child's physical connection, something that could be very sacred and profound to some :)

Enjoy the moment and leave the cord alone!
~Wisdom and Birth 

2 comments:

  1. I hope you've seen this! :)

    Penny Simkin demonstrates why the baby's umbilical cord should not be routinely clamped and cut immediately following birthhttp://www.youtube.com/watch?v=W3RywNup2CM

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    1. I have seen it, but I watched it again anyway! I like how she gives the water bottle visual. So many babies have been robbed of about 1/3 their blood volume, crazy! I also like that she addresses if there is an "issue" like meconium and suction is needed, then it should be done on the mother with the cord still attached. :)

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