Confused now: cord clamping and polycythemia

[texasfarmom]

I had my OB read my birth plan at my last visit. It seemed his main concern was my request to delay clamping the cord until it quit pulsing. I didn't do a very good job defending my position on this when he asked why I wanted this either. I have read several things and talked to my doula (who is also a mw) about it, but couldn't get my reasoning out.

So, he said I should also look into polycythemia, or the baby getting too much blood. Honestly, I'd never even heard that could happen. Well, there are risks accosiated with that as well...

Any insight? WWYD? My doula said it was not the most important thing...should I just drop it from my birth plan?

[*MamaJen*]

I would not consent to early cord clamping, and would insist on delayed clamping (and you can argue the use of that term -- I don't know of any other mammals that chew through their cord in the first ten seconds after birth. I think premature cord cutting is a more accurate term). Delayed clamping is associated with lower risks of anemia, and also, it prevents the OBs from immediately grabbing the baby away to do unnecessary things, and keeps the baby skin to skin on your chest, where a newborn belongs.
Here's what Henci Goer says on it: "Placental transfer of oxygenated blood, nutrients and stem cells continues for several minutes after birth. Physiologic principles suggest that the optimal transition to life outside the womb depends on this transfer. By emptying the engorged placenta, blood volume transfer to the newborn may also facilitate normal placental detachment."
http://www.lamaze.org/LinkClick.aspx...id=120&mid=566
Data is really mixed on the Polycythemia issue and I think the benefits of delaying cord clamping clearly outweigh minimal risks. One thing I've heard about Polycythemia is that the HCT levels are actually skewed because they were developed based on babies who had their cords prematurely cut.
http://www.medscape.com/viewarticle/708616_4
http://www.lamaze.org/OnlineCommunit...c/Default.aspx

[queenofchaos]

I am not so sure that when a cord is clamped is such a huge issue. I really don't believe that the child is missing out on anything. So long as there wasn't some issue with the cord before or during the birth, the blood volume should be the same before, during and after the birth. I have not seen anything where I am convinced that there is some transfer of anything that wasn't already present when the baby first emerged from the birth canal. Out of 6 births, I have had 2 that had really early cord clamping (one baby the cord actually ripped apart due to it being wrapped around his body and neck and being really short, had to be clamped right away). I never noticed a difference. The idea of baby getting too much blood sounds pretty hokey to me.
The thing that I would be concerned about is the dr listening to you and respecting what you prefer. If the doula/MW seems to think it a small thing, then the dr shouldn't have a problem agreeing to it. Makes me a little leery of possible issues you might have with him down the road.

[mediumcrunch]

Polycythemia is why I am ambivalent about delayed cord clamping. My second child had polycythemia but not due to delayed cord clamping but probably due to my oligohydramnios. He ended up with a bottle because he needed the hydration (this was a looooong time ago and I knew nothing of syringe/tube or cup feeding), a lot of his first 24 hours in the nursery and a gazillion heel sticks and we paid the price in our nursing relationship. I understand all the reasoning behind delayed cord clamping and am not pro-early cord clamping or anything. Like I said, I am ambivalent about it. I think the number of babies that have delayed cord clamping that end up with polycythemia due to the delay is extraordinarily small but....well, my personal experience has colored my opinion of the whole thing.

[SunChild]

Thanks for bringing this up ~ My birth plan includes delayed cord clamping. I know in my mind why, intuitively and through thorough research why, but I am not always a quick talker, and I am not ready to respond with thoughtful reasonable response for my midwife if they ask, so THANKYOU, I will have in my mind a ready answer, and a thoughtful answer if I ever get questioned on my choices. I am usually not a good speaker, and I'm shy and I really avoid the hard questions. Although my research still continues.

[JessieBird]

We "delayed" cutting DS's cord and he developed mild polycythemia. His symptoms included pretty severe jaundice and rapid breathing. Thankfully, my midwives didn't panic but rather watched him very closely at home and reassured me that it was resolving on its own. His breathing normalized within 36 hours, the jaundice was gone within 4 days and his levels had normalized by then. We have a very sunny house so we cranked the heat and kept him naked for his first three days to avoid going under the lights for the jaundice. He nursed well and nearly constantly in those early days so we were reassured that he was getting lots of fluids. No transfusion or IV fluids or any other treatments were required. I wasn't able to do any research at the time so it wasn't till several months later that I made the connection to having waited to cut the cord. I was recounting my birth story to an OB friend and he mentioned it as a possible cause.

I'm not quite sure what we will do with this baby. I feel very fortunate that with DS, I had one of the most experienced midwives in my province looking over him and she knew that his condition would resolve. If I hadn't been in such good hands we might have ended up in the hospital going through all sorts of alarming procedures. Or if his condition had been any worse, perhaps we would have missed the signs and not gotten help in time to avoid the more serious complications of polycythemia. This time we have a different midwife who is less experienced although I will be more informed.

Sorry this isn't very helpful. I have to do a lot more research myself before #2arrives in October.

[Pinoikoi]

Well referenced article:

http://www.childbirthwithlove.com/controversy.html

My midwife recommends cutting the cord well AFTER pulsing has stopped.

[fresh_veggie]

I just took an advanced first-aid course, and according to the major medical places that put the course together (it was a semester long one - wowzers) you are supposed to cut the cord when it stops pulsating, but you have to keep the baby on level with the placenta, or the blood volume can go up or down depending on where the baby is in relation to it.

I also think baby should immediately be on momma's chest, not sure how this works out with what I heard above. I wish every medical association would agree, because it seems if a doctor hears one opinion first, that's the one they go with and everyone else is stupid and demanding. Not to say they don't have experience and all...

[CallMeMommy]

Originally Posted by fresh_veggie

but you have to keep the baby on level with the placenta, or the blood volume can go up or down depending on where the baby is in relation to it.

Which doesn't make any sense, because it implies the cord is a hollow tube that allows the fluid to slosh back and forth, when in reality is has valves to regulate the flow of blood.