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Studies on cord clamping!

Posted by on Apr. 25, 2011 at 8:51 PM
  • 11 Replies

I need help ladies.

I had my meeting with my doula client today. All went well. And she let me attend her appointment with her OB. He is an awesome OB. He's totally cool with letting her birth her way and supports her and has been her doctor for a long time. ...the problem? He feels very strongly against delayed cord clamping. Not really a *big* issue, considering.

However, as a doula it's my job to stay well informed and provide accurate information for my clients, so I asked him to provide studies and resources that I could review that are in support of his view. Tomorrow I'll be going back to his office to pick up whatever he has printed out and I'd like to have the opposite view to hand to him.

I have a few articles and know of a couple studies on delayed cord clamping. But i'd really like to have the best of the best. If you ladies could help me find studies to support the benefits of delayed cord clamping that would be fabulous! :) Thanks.

by on Apr. 25, 2011 at 8:51 PM
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Replies (1-10):
jcmomma
by on Apr. 25, 2011 at 8:57 PM
Check out leaving a baby's umbilical to stop pulsating on Facebook. I have found them to be fill of good info. Good luck
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truealaskanmom
by on Apr. 25, 2011 at 9:15 PM

there is a post on here that early cutting can cause brain damage

doulala
by on Apr. 26, 2011 at 1:43 AM

I think this is a considerable issue.  
And it may be a BIG deal to some -or- nothing to others...    Depends on how the Mother feels, really....

What does your client prefer?
Is she looking to you to become educated, preferring to stick with her OB's recommendations, or going her own way anyhow?
Regardless of how anyone feels about it, the end decision is the Mother's.   It is HER body & baby.   If she hires a care provider to attend her delivery then that provider is providing.   A service.   For a lot of money.  

Quoting outstandingLove:
 He feels very strongly against delayed cord clamping. Not really a *big* issue, considering.
  



We do have posts on this here somewhere...    I can try to locate those.

;-)





"If you don't know your options you don't have any"          ~Korte & Scaer

"If you choose not to decide you still have made a choice."    
           ~Rush

doulala
by on Apr. 26, 2011 at 2:09 AM

 

 

Why is clamping significant? Because, in the majority of medically managed births, the umbilical cord clamp violently separates a newborn infant from a portion of their vital blood supply, possibly causing damage to the brain, heart and or lungs of the child before it even takes its first breath. Many Western OBs routinely clamp the umbilical cord before the child has been fully birthed. "So what? They're doctors, they know what they're doing." According to the majority of the research they don't. Here are several reasons why you might want to tell your doctor to delay clamping the cord and some of the research available to back you up when you do.

"The placental blood normally belongs to the infant, and his/her failure to get this blood is equivalent to submitting the newborn to a severe hemorrhage at birth." (from study 1, cited below)

When a human baby is born it needs to begin breathing air into its lungs in order to survive. However, it would be a mistake to imagine that a baby's first breath contains their body’s first experience of life-giving oxygen. Oxygen is provided for the fetus throughout the entire pregnancy by the mother, through the placenta. Following birth the placenta continues to provide oxygen for approximately 5 minutes while blood pumps, to and fro, through the umbilical cord. This is part of an ingenious plan of God’s (or nature’s) to allow the newborn time to "unfold" his/her lungs and to gently make the switch from living underwater to breathing air through the lungs. Remember, the infant is not receiving "placental" blood or even the mother's blood through the umbilical cord. The baby is retrieving its own blood supply from one of its own functioning organs that just happens to be inside its mother's body.

When the transfer of blood is given time to complete itself, the placenta and umbilical cord shut down, essentially dying. The blood vessels in the baby's cord close, the placenta separates from the uterine wall and is soon expelled, its function completed. With a simple cord tie and sterile cutting tools, the umbilical cord can be safely severed at this point. The baby is typically breathing well, pinked up and perhaps even nursing away contentedly in a reasonably calm mood. Of course, baby’s first surgical procedure doesn’t really need to be done immediately following birth or, even, at all. In times past when infections were more common and sterile tools were less common, our ancestors would frequently wrap the placenta in a diaper and swaddle it in with the baby until the cord dried out and the placenta fell off by itself, a few days after the birth.

But that’s probably not what happened to your baby, if s/he was born at a typical Westernized hospital. Most OBs and even CNMs are trained to clamp the cord during or immediately following birth. If you suggest the idea of waiting until the cord has stopped pulsing you will probably be confronted with at least one of two prevailing medical attitudes:

#1 ~ It's far too dangerous for me to allow the cord to pulse. You would be putting your baby at risk of : (pick one or more of the following choices) jaundice, plethora, hyperviscosity, or polycythemia.

and/or

#2 ~ What is all this touchy-feely stuff about the umbilical cord? Early clamping does no harm.

Let's look at the research and see if either of these statements hold water, shall we?

In 1993, a study by "Kinmond et al...found no increased jaundice, plethora, hyperviscosity, or polycythemia using this method. Yet fear of late clamping persists because physicians have been conditioned to believe that these complications are caused by placental over-transfusion. Cord stripping (allowing the baby to retrieve its own blood supply) has become tantamount to malpractice."

I found the above quote in an article (cited below, note 2) but haven't yet tracked down the Kinmond study itself. It truly makes sense to me though, nature's plan to ensure our survival of birth would not, by and of itself, cause such dire consequences. I would need to see an extremely convincing study proving that such things were happening to otherwise healthy infants of healthy mothers before I would believe it.

Mothering Magazine has this to say about jaundice. "Among other drugs, Pitocin inductions and epidurals have been conclusively linked with nonphysiological neonatal jaundice (this is not normal, breastfed jaundice). Any drug administered to mother or baby must be viewed with a 'jaundiced' eye, for it is likely to compete with bilirubin sites on blood protein, causing more bilirubin to be free to contribute to jaundice.

"In an all-out effort to prevent the possibility of jaundice, obstetric practitioners have reasoned against delayed cord clamping, since it increases the volume of red blood cells , which, in breaking down, will produce increased levels of bilirubin. True, hyperbilirubinemia may be prevented in premature and "medicated" infants by early clamping; however, in a normal delivery of a full-term, unmedicated infant, there are untold advantages to delaying cord clamping until after the placenta has delivered itself." (emphasis mine)

In fact, it seems that the practice of early cord clamping began during the days of heavily medicated births. Doctors deliberately stopped the blood flow to keep the newborns from retaining too much of the anesthesia their mothers were under. It's enough to make me think that being able to dole out drugs to laboring women is more important to doctors than preventing the various problems related to early cord clamping in newborn babies. A rather scary modern sign of the times, I fear.

When I published the first draft of this article, I got a comment from a mama who was told her doctor needed to clamp the cord early because she was diabetic and her baby was at risk of developing polycythemia (a thick blood disease) if the cord was not clamped early enough. I poked around and decided this was another obstetric myth. There are babies who do develop polycythemia and some of them are born to diabetic mothers. Late cord clamping does not appear to be a deciding factor for transmission of this condition.

On to argument #2, cord preservation is “touchy-feely, pseudo-science.” Early cord clamping has been shown to cause: newborn anemia, respiratory distress leading to brain damage and/or death (rare, yes, but it happens), inadequate blood supply resulting in a need for transfusion, possible heart defects resulting from problems closing off the hole in the heart valves following birth. There are a few doctors now theorizing that the rise in autism is due to brain damage caused by early cord clamping. The mother may suffer an increase in the length of the 3rd stage as well as increasing her blood loss following birth when her baby’s umbilical cord is clamped early.

More medical studies are needed with large control groups of babies who are not separated from their blood flow prematurely, but there is already ample evidence that early clamping is a violent, uncontrolled experiment that’s failing families.

Some more medical quotes:

"Deprivation of placental blood results in a relatively large loss of iron to the infant." (1)

"The time of cord clamping may be involved in the pathogenesis of idiopathic respiratory distress syndrome (the earlier clamped, the more respiratory distress)." (3)

"Placental blood acts as a source of nourishment that protects infants against the breakdown of body protein." (1)

"Studies have shown that immediate cord clamping prolongs the average duration of the third stage and greatly increases maternal blood loss." (4)

"In order to give the newborn the blood that it need(s), physiologically cord clamping should be performed not immediately after birth. One should wait ... until the umbilical vein has been empty and is collapsed." (5)

"Normal blood volume is not produced by a cord clamp ... Many neonatal morbidities such as the hyperviscosity syndrome, infant respiratory distress syndrome, anemia, and hypovolemia correlate with early clamping. To avoid injury in all deliveries, especially those of neonates at risk, the cord should not be clamped until placental transfusion is complete." (2)

Early cord clamping may also be at least partly responsible for many of the cases of blood sensitization in Rh factor negative mothers, considering the blood is clamped off with enough force to create a brief “backflow” of the infant’s blood into the mother’s placental “wound.” Dr. Robert S Mendelsohn, M.D., in his book "How to Raise a Healthy Child. . . In Spite of Your Doctor" blames the entire Rh negative issue on early clamping of the cord. (This book is high on my recommended reading list for anyone with kids)

Recently, it has become widely known that umbilical cord blood is rich in stem cells and that they can be harvested and used to restore bone marrow in deficient children. It’s a lot cheaper and easier to just slow down birth and allow the child to absorb those rich, healthy stem cells while they’re fresh and available, immediately after birth. Any healthy mother and child should be encouraged to remain attached to each other for as long as it is comfortable, following a low risk birth.

Of course, there are some cases where the newborn is severely compromised at birth. In most of these cases, the cord is instantly severed so the birth attendants can whisk the baby off to the warmer. These are the very babies who need their blood the most! The premature, the distressed and those babies born by Cesarean sections may suffer needless interventions due to the practice of early cord clamping. Make sure that your birth attendant is made aware that you do not authorize early cord clamping long before you give birth. It isn’t time to argue the point once you are already in labor.

If your attendant does not indicate willingness to wait for the cord to stop pulsing, especially in an emergency, it may be time to consider firing them and having your baby in a safer environment. The first rule of medicine is supposed to be, "Do no harm." I, and many others, including many doctors and midwives of every stripe, believe that routine early cord clamping violates that oath. If your birth attendant doesn’t recognize this, find one who does. Delaying cord clamping is not nonsense. It is the very serious matter of your baby's health and well being.

1) De Marsh, QB, et al "The Effect of Depriving the Infant of its Placental Blood", JOUR AMA ? 7 June 1941

2) George M. Morley, MB., CH. B "Cord Closure: Can Hasty Clamping Injure the Newborn?", OBG Management - July 1998

3) Saigat, Saroj, et al. "Placental Transfusion and Hyperbilirubinemia in the Premature" PEDS 49:3 – March 1972

4) Walsh, S. Zoe "Maternal Effects of Early and Late Clamping of the Umbilical Cord" LANCET – 11 May 1968

5) Z Geburtshilfe "Cord clamping at birth - considerations for choosing the right time" Perinatol 1982 Apr-May;186(2):59-64

The Midwives Archives page on cord care is full of good information too.

doulala
by on Apr. 26, 2011 at 2:10 AM

Do We Clamp the Umbilical Cord Too Soon? Early Clamping May Interrupt Humankind's First 'Natural Stem Cell Transplant'

ScienceDaily (June 7, 2010) — The timing of umbilical cord clamping at birth should be delayed just a few minutes longer, suggest researchers at the University of South Florida's Center of Excellence for Aging and Brain Repair.


Delaying clamping the umbilical cord for a slightly longer period of time allows more umbilical cord blood volume to transfer from mother to infant and, with that critical period extended, many good physiological "gifts" are transferred through 'nature's first stem cell transplant' occurring at birth.

The USF review is published in a recent issue of the Journal of Cellular and Molecular Medicine (14:3).

"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'."

At birth, the placenta and umbilical cord start contracting and pumping blood toward the newborn. After the blood equilibrates, the cord's pulse ceases and blood flow from mother to newborn stops. In recent Western medical practice, early clamping -- from 30 seconds to one minute after birth -- remains the most common practice among obstetricians and midwives, perhaps because the benefits of delaying clamping have not been clear. However, waiting for more than a minute, or until the cord stops pulsating, may be beneficial, the authors said.

Birthing methods have also changed over the last century. Throughout human history and currently in cultures and areas where delivering mothers squat to deliver, gravity helps speed the stem cell transfer. Today, the cord may be clamped early for a number of reasons, including the medical resuscitation and stabilizing of infants or the notion that delaying clamping might lead to adverse effects or, more recently, to quickly facilitate umbilical cord banking.

According to study co-author Dr. Dong-Hyuk Park, the relationship between cord clamping time and the transfer of stem cells needs to be understood through the early weeks of the perinatal period and the process of 'hematopoiesis,' the formation of blood cells that begins as early as two weeks into pregnancy. A transfer of pluripotent stems cells continues throughout pregnancy, however, and for a time through the umbilical cord following delivery.

"Several randomized, controlled trials, systematic reviews and meta-analyses have compared the effects of late versus early cord clamping," said Dr. Park. "In pre-term infants, delaying clamping the cord for at least 30 seconds reduced incidences of intraventricular hemorrhage, late on-set sepsis, anemia, and decreased the need for blood transfusions."

Another potential benefit of delayed cord clamping is to ensure that the baby can receive the complete retinue of clotting factors.

Yet, there is debate and disagreement on early versus later clamping. The side favoring delayed clamping, the authors noted, cite the value of the infant's receiving umbilical cord blood (UCB)-derived stem cells, known to be pluripotent.

"The virtue of the unique and immature features of cord blood, including their ability to differentiate, are well known," added Dr. Sanberg.

The researchers concluded that many common disorders in newborns related to the immaturity of organ systems may receive benefits from delayed clamping. These may include: respiratory distress; anemia; sepsis; intraventricular haemorrhage; and periventricular leukomalacia. They also speculate that other health problems, such as chronic lung disease, prematurity apneas and retinopathy of prematurity, may also be affected by a delay in cord blood clamping.

"There remains no consensus among scientists and clinicians on cord clamping and proper cord blood collection," concluded co-author and obstetrician Dr. Stephen Klasko, senior vice president of USF Health and dean of the USF College of Medicine. "The most important thing is to avoid losing valuable stems cells during and just after delivery."

The authors agreed that delaying cord clamping should appropriately be delayed for pre-term babies and babies born where there is no effort to bank umbilical cords, and for babies born where there is limited access to health care and where nutrition may be poor.

doulala
by on Apr. 26, 2011 at 2:13 AM
 


http://www.givingbirthnaturally.com/restricted-umbilical-cord-problems.html

Restricted Umbilical Cord Problems

The most common source of restricted umbilical cord problems in childbirth is completely preventable and due to a procedure documented as harmful to the baby - early cord clamping.  (see references at conclusion of article for further information)


What is Early Cord Clamping?

Early cord clamping (ECC) is defined as any method by which the cord is manipulated to stop the flow of blood to the baby while it is still pulsating.  This includes clamping, cutting, hand squeezing, tying or holding the baby too high or too low.


In a natural vaginal birth with no medications, the cord pulsates on average for 7 minutes.  In a medicated birth, including c-sections or babies with a compressed cord, the cord will pulsate for as long as 20 minutes.  Good practice is to leave the cord alone for 12 minutes or until it turns white/silver in color.


Serious Risks Associated with Early Cord Clamping

Whenever a pulsating umbilical cord is clamped,  20-60% of the baby's total blood volume is trapped inside the placenta.  A 9 pound baby manufactures only 10 ounces of blood during gestation.  It will take over 6 months for the baby to replenish the volume of blood lost by early cord clamping.


In essence, newborns become involuntary blood donors.  HALF their blood volume is lost when their cords are early clamped. 


This decrease in necessary blood volume causes the babies to become anemic.   In most cases, the anemia is not diagnosed and the infant is sent home in a weakened state, more susceptible to a host of complications, including SIDS.


Restricted umbilical cord problems associated with anemia are Autism, heart perforations, thyroid disorders, brain tumors, leukemia, hormonal imbalances and liver/kidney disease.


Male infants will suffer more than females.  They have higher metabolisms that require 10% more blood.  This trend is also seen in that males represent a greater proportion of children receiving special education services in schools and higher incidences of disabilities such as ADD, behavioral issues, and Autism.


Currently, 1 in 16 babies are revived after birth.  For how many is this due to low blood volume, an inflicted condition?  In effect, medical personnel must undo the wrong they're created.  Another critical correlation is the fact that the United States has the 2nd highest infant mortality rate and practices early cord clamping as a routine procedure. 


Any baby whose cord has been early clamped is weakened.  Weaker babies become more susceptible to infection, especially at the site of the cut cord.  There are 25 known infectious strains resistant to all antibiotics and they are primarily found in hospitals.  This mix is just asking for trouble. 


Another of the restricted umbilical cord problems is  engorged placenta, a direct threat to the mother and future pregnancies.  When the blood flow is restricted by clamping, the blood can pool in the placenta, causing it to rupture or backflow the baby's blood into the mother's.  This cause lead to serious side effects, such as maternal hemorrhage and can even prohibit future pregnancies due to the blood mixing.


Why are Cords Early Clamped?

Restricted umbilical cord problems caused by early cord clamping occur for many reasons, none of them acceptable or in the best interest of the child.  The first is ignorance.  Many doctors are unaware of the risks of early cord clamping.  This is in part due to poor training.  Some commonly used medical texts still detail the use of early cord clamping.  However, this represents a serious concern in that ACOG guidelines now refute the use of early cord clamping.  Early cord clamping was first documented as harmful in 1801 and again in 1957.  It wasn't until after 1923 that it began to be mainstreamed.


The second is convenience and time management.  Doctors want to be in and out of the birthing room.  Waiting an extra 20 minutes for the cord pulsation to stop naturally and the placenta to detach on its own may not fit into their agenda.  They put your child at risk of developing restricted umbilical cord problems for their own convenience.  Someone should remind them of that oath they took to do no harm.


If those two reasons weren't enough, the third will blow your mind.  It represents an unforgivable injustice.  Many doctors early cord clamp so the placenta and its cord blood can then be sold to the highest bidder.  Yes, that's correct.  When you sign papers allowing the hospital to "dispose" of the placenta and other remnants of birthing, when you think they are being burned or safely disposed, they're actually selling them to medical research for as much as $30,000 each!  This figure was reported by the Children's Hospital in Randwick, Australia.  This was confirmed in the 10th edition of the Principles of Anatomy and Physiology, 2003 page 1076.   They're placing the baby at risk of these restricted umbilical cord problems to make money.


For each mother who allowed the hospital to dispose of her placenta (the vast majority), medical testing could currently be performed on your baby's stem cells, including cloning.  This misuse of the placental blood represents a violation of informed consent.  You did not consent to medical experimentation, only to disposal. 


False Reasons for Clamping

Short cord, maternal hemorrhage, c-section, respiratory distress are just a few of the worthless reasons to clamp a cord.  Even a baby in distress can be revived with the cord intact.  It also allows better access to the umbilical vein as it remains uninjured.  All of the restricted umbilical cord problems are usually the result of drugs given during labor, including oxytocin, pitocin, iv fluids, and pain medications, not a result of leaving the cord intact.


The cold truth is that hospital operate under the assumption that something will go wrong.  This subconscious message is transmitted to every mother birthing in a hospital - from the sterile, cold environment to the brisk pace of the nurses.  What they don't want you to know is that the interventions cause the complications.  93-95% of all births proceed normally with no complications whatsoever.  If this information became widespread, they'd be out of business, fast.


When Should a Cord be Early Clamped?

The only situations in which a cord should be early clamped is when the cord has torn or with a placenta previa.  Babies born via c-section can be delivered with their cord and placenta intact.   Multiples can also be delivered without risk of restricted umbilical cord problems.


Prevention of Restricted Umbilical Cord Problems

  • Birth in a warm room or warm water - cold temperatures cause blood flow to slow
  • Wrap the baby immediately head to toe in warm blankets or allow skin-to-skin contact with the mother with blankets covering both.
  • Do not manipulate the baby to breathe.  While the cord is pulsating, the baby is receiving oxygenated blood, thus not triggering the need to take an additional breath.  As the blood travels into the baby's expanding lungs, once they become filled, the baby will feel its own signal to breathe and will do so with fully expanded lungs.
  • If the cord is wrapped around the baby's neck, have the birth attendant insert a finger between the neck and the cord, allowing the birth to proceed normally.
  • If you choose a hospital birth, request your placenta.  Take it home and plant it under a new tree that will grow as your baby does.


To stop the atrocity of restricted umbilical cord problems due to early cord clamping,  sign this petition http://www.thepetitionsite.com/takeaction/102580814 to protect the health and welfare of babies and mothers.

 

Cord Clamping

The next and perhaps most critical newborn baby care decision to be made for your baby's welfare is cord clamping - immediate or delayed. The benefits of delayed cord clamping, which is defined as waiting until the cord has stopped pulsating until clamping or cutting it, are well-documented.  Once the baby is born, its entire circulatory system undergoes an amazing transformation to allow the baby to receive oxygen via its lungs rather than through the umbilical cord - a valve in the heart closes, the lungs perfuse with blood and eventually a first breath is taken.  When this delicate balance is interrupted by prematurely severing the child's lifeline, its umbilical cord, numerous undesirable side effects can occur. 

doulala
by on Apr. 26, 2011 at 2:14 AM

 

http://www.bellybelly.com.au/articles/birth/cord-clamping-delaying-cord-clamping

Umbilical cord blood is a baby’s life blood until birth. It contains many wonderfully precious cells, like stem cells, red blood cells, and more recently scientists have discovered that umbilical cord blood contains cancer-fighting T-cells.

 

Yet common practice is to cut this source of valuable cells off from the baby at the moment of birth, due to unsubstantiated claims that it can cause complications. Not only that, a new line of business has been set up to store this precious cord blood for you, which all sounds great in theory, but why deprive a baby of those super cells at birth and then give them back on the very small chance that a problem has appeared later in life? Could there be a link to not having those super cells at birth and those illnesses? Storing cord blood is not only extremely expensive but it is also worth finding out exactly what they have been successful on helping and how common those conditions really are.

How likely is it that my baby will need stored stem cells?

According to Dr Sarah Buckley, in her well researched book ‘Gentle Birth, Gentle Mothering’ (2005):

  • The likelihood of low-risk children needing their own stored cells has been estimated at 1 in 20,000
  • Cord blood donations are likely to be ineffective for the treatment of adults, because the number of stem cells are too small
  • Cord blood may contain pre-leukemic changes and may increase the risk of relapse
  • Autologous cord blood is only suitable for children who develop solid tumours, lymphomas or auto-immune disorders
  • All other uses are speculative

And this from the Choice website:

“The most common reason for transplantation in childhood is for leukemia, but a donor’s own cord blood is unlikely to be used. The most appropriate source of stem cells is another person, either a family member or an anonymous stem cell donor.”

Collection is also very lucrative for the collector (midwives get offered training in this too, some decline but some do it). Collectors get paid hundreds for doing the procedure.

Timing of cord clamping

There have been an increasing number of studies published with regards to the timing of cord clamping, including a recent 16-month study which was published in 2006 which you can read more about here. It was conducted at Hospital de Gineco Obstetrica in Mexico City, where over 350 mother/baby pairs were part of the study.

This study, as well as several others, have provided 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

A two-minute delay in cord clamping increased the child’s iron reserve by 27-47 mg of iron, which is equivalent to 1-2 months of an infants iron requirements. This could help to prevent iron deficiency from developing before 6 months of age.

Another study has been released in 2007 from the University of Granada which has similar findings, you can read it here.

While delayed clamping is beneficial for babies across the board, the studies found that the impact of delayed clamping is particularly significant for infants who have low birth weights, are born to iron-deficient mothers, are premature, or those who do not receive baby formula or iron-fortified milk. Given that mother nature provided breastmilk for babies and not formulas, you would think she also supplied that valuable source of iron for a reason too. You may have noticed that formula companies promote iron deficiency rates to sell their products.

The 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. Some couples choose to leave the cord unclamped until it has stopped pulsating, which could take a few minutes or it could take around twenty – either way, the baby is able to have his or her supply of placental blood.

Delayed Cord Clamping & Donating/Storing Cord Blood

Delayed cord clamping is not compatible with cord blood donation. The reason being is that in order for them to collect that blood, they need to cut the cord so that blood can be used for storage or donation. So if you would like your baby to have it’s full supply of cord blood, you may need to reconsider you plans to donate or store cord blood.

Delayed Cord Clamping & Jaundice

You may be told that delayed clamping causes jaundice in babies by your carer or hospital. 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)”

Delayed Cord Clamping & Blood Volume

You may also hear of concerns over the increase in blood volume and red blood cell volumes, overloading the heart and causing respiratory difficulties, as a result of delayed clamping. Again, this is not substantiated.

According to an article from the World Health Organisation, they state: “These effects have not, however, been demonstrated. In fact, there is probably a self-regulatory mechanism in the infant which limits the extent of placental transfusion. Moreover, there is evidence that the circulatory system of the newborn is capable of rapid adjustment to an increase in blood volume and viscosity by increased fluid extravasation and dilation of blood vessels.”

Delayed Cord Clamping & Maternal Haemorrhage

Again, another unsubstantiated claim. As per the earlier studies, there was no significant maternal postpartum blood-loss volume which is echoed in the World Health Organisation article:

“Although there was some evidence that early clamping reduces the duration of the third stage of labour, there was no significant effect on the incidence of postpartum haemorrhage”.

Something important to note

Just after you have given birth, the last thing you are paying attention to is the umbilical cord! So if after reading this article you have decided not to have the cord clamped immediately, make sure you make it well known with your caregiver and at the hospital that you want to delay clamping of the cord, so your baby can have it’s full store of blood.

There are some circumstances where the cord will need to be clamped immediately, including if you choose to have the third stage injection of syntocinon to expel the placenta faster – obviously the cord will need to be cut right away in this managed form of third stage. You can chose a normal physiological third stage if you haven’t had syntocinon during your labour (for inductions, augmentations or third stage).

Finally…

All this leaves one question. Why isn’t delayed cord clamping standard practice if it means healthier babies and has no adverse effects? The answer is very clear – most obstetricians are reluctant to take up this practice.

According to THIS survey on the ‘Attitude of obstetricians towards delayed cord clamping’ as published in the Journal of Obstetrics and Gynaecology (sent out to obstetricians all over the world), the results came back glaringly stating that the reason the obstetricians who haven’t changed over to delayed cord clamping is ‘difficulty implementing it into practice’, which I find to be a big cop out really. Why are many obstetricians REALLY so reluctant to implement a simple process which benefits mother and baby? Why can’t the midwife clamp the cord later if the obstetrician is too busy? It’s yet another sensible and very healthy process that was practiced decades ago, before obstetrics even began and took over with a surgical approach.

The Royal College of Obstetricians and Gynaecologists MUST and SHOULD produce guidelines for delayed cord clamping in obstetric practice for healthier mothers and babies.

Summary

Don’t be embarrassed or afraid to speak up if you feel your baby could benefit from delayed cord clamping. Print off this article as well as these studies and present them to your carer if you would like to discuss delayed cord clamping with them.

Useful Websites and References:

Dr. Stuart Fischbein: Delayed Cord Clamping (GREAT YouTube clip) Third Stage of Labour: A Natural Approach
Don’t Cut The Cord
Five Good Reasons To Delay Cord Clamping
Birth Injuries Related To Umbilical Cord Clamping
Early or Late Clamping?
Early Clamping of the Umbilical Cord
Risks of Premature Cutting of the Umbilical Cord

mom2ellasophia
by on Apr. 26, 2011 at 2:16 AM
Bump for later!
Posted on CafeMom Mobile
outstandingLove
by on Apr. 26, 2011 at 3:33 AM


Quoting doulala:

I think this is a considerable issue.  
And it may be a BIG deal to some -or- nothing to others...    Depends on how the Mother feels, really....

What does your client prefer?
Is she looking to you to become educated, preferring to stick with her OB's recommendations, or going her own way anyhow?
Regardless of how anyone feels about it, the end decision is the Mother's.   It is HER body & baby.   If she hires a care provider to attend her delivery then that provider is providing.   A service.   For a lot of money.  

Quoting outstandingLove:
 He feels very strongly against delayed cord clamping. Not really a *big* issue, considering.
  

I believe that delayed cord clamping is very important. But I don't think it's *as* important as the mother being able to experience the birth the way she wants/needs it. That's all I meant by saying it was not a "big" issue. All the other major stuff doesn't seem to be a problem for this doc.

My client is unsure. She does want to be educated, but she also wants the support of her OB. I think that ultimately she will follow her OB's advice. He said that he would allow a 30 second delay on the cord, but any more than that is dangerous.

I would like to keep an open communication with this doctor as much as possible. He is one of the only "natural" doctors we have in town (and we only have 2 midwifes).

outstandingLove
by on Apr. 26, 2011 at 3:33 AM

Thanks for all the info!

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