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On a quiet day, I can hear her breathing." :: Arundhati Roy ::

"The most common way people give up their power is by thinking they don't have any." :: Alice Walker ::
Sunday, November 26, 2006  

Why do we clamp or cut the cord at birth?

If you are a medical student, resident, doctor or L and D nurse, have you ever wondered why we are so quick to cut the cord? Is there evidence or proof or a serious reason or any thinking at all behind this nationwide medical tradition?

I was told during medical school that we cut the cord to prevent the baby from getting too much blood and being iron overloaded... Made perfect sense at the time and I never questioned it again until about two years ago when it dawned on me that there might actually be benefits to NOT CUTTING the cord immediately at birth. I'm not particularly thoughtful or insightful, I just hang out with midwives and doulas and one is bound to get some common sense knocked into your head if you are quiet long enough to hear a thought outside of your own narrow training.

Is there any evidence that not cutting is harmful? Not that i've ever seen and i've asked alot of experts as well. There is a new research article out that demonstrates delayed clamping of the cord (3 minutes instead of 15 seconds) can prevent neonatal anemia and only raises the hematocrit within normal range. No dangers at 3 minutes. According to the article, this is a highly controversial topic. What amazed me is not that it is controversial, but that no doctors seem to even talk about it. It's not controversial, it's another medical taboo. These guys probably did a lit search and they also say there is no research stating that it is dangerous to delay cord clamping. (http://www.pediatrics.org/cgi/content/full/117/4/e779)

I challenge medical students and residents to push the envelope on this one and question your teachers. You will learn alot about how medical opinion is formed and protected. First elicit your teachers expert opinions. "Why do we cut the cord right away? Is it harmful if we don't? What benefit is there? Is there a situation when it might not be necessary?" Then ask them to share with you the research evidence that supports this practice. And then report back here what you find.

Now take a moment, trust nature, and think about the physiology of birth. Isn't the cord how the baby "breathes" in the womb? If the baby is blue and not breathing right away (assuming the mom was relatively healthy and the cord isn't falling apart in your hands from infection or IUGR or mec staining) and there is a strong pulse in the cord, wouldn't the baby be better served being placed on mom's belly with the cord attached, receiving warmth and oxygen for a few minutes while it acclimates to the physics of it's new surroundings?

And for normal healthy babies that come out screaming, what harm is there in letting the kid transition for a few minutes while the physiology of the placenta and cord figure out it's own end moment? Why do we need to put a human touch tainted by an aggressive relationship with time into the birthing matrix?

I'm so curious why we intervene in a normal process and more curious what a comparison trial would show for blue babies who are whisked away in the first 10 seconds to intubation or blowby O2 compared to blue babies with a healthy cord pulse given a few minutes to acclimate while still attached to it's natural O2 source.

Fear will probably never let that trial happen, with the assumption that we would be placing the baby in harm's way... I'm not sure. I think it's worth a serious conversation between MD's, midwives and birth assistants. We might even have to invite the opinions of doctors, midwives and birth assistants from countries that aren't completely dependent on technology to get a more grounded and physiological perspective.

andru

posted by andru | 11/26/2006 09:09:00 PM | |


Comments:

I'm so happy to see others talking about this topic! I learned in Nutrition this year how beneficial waiting to cut the cord can be, especially in situations where malnourishment or anemia is pervasive. I hope this is soon adopted everywhere.

# posted by Blogger Kathryn : 12/27/2006 6:18 PM  

There has been some actual research on the subject. In fact, I blogged on the subject of delayed cord clamping in preemies a while back.

Here are my comments:
http://tiggersdontjump.blogspot.com/2005/06/delayed-cord-clamping-benefits-for.html

Here are a couple of articles:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=13679933&query_hl=4

and

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15495045&query_hl=4


The neonatologists at my hospital have discussed this with the OB docs and delayed cord clamping is actually being practiced on a somewhat limited basis with our preemies.

The first time you see someone do this when you're not used to it is rather disconcerting. When you see the results -- and they look the same to me as in those articles -- it's pretty convincing.

# posted by Blogger Judy : 12/28/2006 11:10 PM  

There is nothing more annoying in th middle of a normal delivery than your resident rushing you to cut the cord. It just makes everything so much more stressful and panicky then it should be. PLus, sometimes we don't let dad cut the cord because it "takes too long" It doesn't seem right.

# posted by Blogger Irishdoc : 1/02/2007 12:42 PM  

Hi,
I'm just curious - I'm taking a first aid course right now. Under childbirth in the manual, we are told to wait until the umbilical cord stops pulsating before we tie and cut it. Presumably it takes some amount of time for the cord to stop pulsing. We are not told why we should wait until the pulsing stops, but when I first read the directions, I assumed that there was still blood flow going on while the cord pulsed. My questions, then, are:

How long does this pulsing usually last?

Is the cord cut earlier (while still pulsing) in hospitals?

Thanks!

# posted by Blogger Laura : 1/03/2007 3:02 PM  

Laura,

when the cord is pulsing there is blood flow to the baby. it can pulse for a minute up to 5-10 minutes. i'm sure midwives would have a more accurate answer. i like your first aid book. it proves once again that the more you study and the higher your degree, the less you really know.

andru

# posted by Blogger andru : 1/04/2007 9:34 AM  

I just happened upon this blog, but wanted to comment. I am a student midwife, doula, and lactation consultant. The research regarding iron stores and transfer of blood after birth is convincing. And as an LC, knowing how babies are often given supplemental iron in the first six months due to inadequate iron stores, it's clear that early clamping has undesirable effects. (Supplemental iron when no warranted has risks and problems associated with it, so prophylactic supplementation is not a good protocol.)

Laura, the cord will usually pulsate for 20-60 minutes after birth. The studies regarding iron stores recommend delaying clamping for 1-3 or 3-5 minutes (depending on the study), so even this "delayed" clamping is done well before pulsation stops. I find 3 minutes is a good compromise for my hospital doula clients to negotiate with their doctors.

As a homebirth attendant, we do not clamp until pulsation has stopped. We have lower rates of jaundice (the cited worry about delayed clamping, which is not well-supported by research) than the hospital population BY FAR, but that is probably also because breastfeeding is more often established well, whereas hospital deliveries often have complicating factors (meds, etc.) that discourage early and effective breastfeeding.

I think you're on the right track to question protocols that are simply not evidence-based.

# posted by Blogger Gina : 4/09/2009 8:50 AM  

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