Delayed cord clamping - baby has to be lower than placenta???

[nia82]

The midwife I saw for my first prenatal appointment said that they do that in their practice routinely as otherwise the blood wouldn't flow from the placenta back into baby. It is a CNM/obgyn practice out of a hospital. I have never heard this and find it a little fishy. Is there any research supporting that baby has lie between my legs for all the time the cord is pulsating??? I doubt it, I mean how else does our blood make it back from the legs into the heart (I'm aware of vein clamps or whatever they are called in English in the veins to pump up blood, but would think the umbilical cord would be totally able to push up blood two inches or so to baby on my chest)....
If you have studies, please link so I can print it out and take along!

[Romana]

:eyeroll: No, the baby does not have to be lower than the placenta. The baby will get more blood faster if the baby is below the level of the placenta. However, it is by no means a requirement. The baby may receive a little less blood, and not quite as fast, if the baby is on your tummy/chest and the placenta is lower, but it's still more than the baby would get if clamping occurred immediately. The blood from the baby will not flow back into the placenta if the baby is above the placenta.

I don't have citations, but I did research it at one point.

[womenswisdom]

No, not going to hurt the baby if s/he is on your chest while they wait for the cord to stop pulsating. I mean, babies with mamas with placenta previa, where the placenta is at the bottom of the uterus, still receive blood from the placenta and they are above it. It's just silliness. If you are unable to convince them, though, you could always do a side-lying position with the baby in front of your chest, so that the baby is at the same level as the placenta. That way you can still to skin-to-skin, etc.

[kltroy]

Well, gravity is at work here. Baby will get more blood faster if he is below the placenta, but if he is laying on your chest and you're laying down, this is pretty close to the same level as the placenta. I've actually heard arguments for NOT having baby below the placenta because then baby would get more blood than he was "supposed to" (the only concern being increased bilirubin/jaundice, which seems to be slightly valid, judging from the literature). FWIW, if the baby is *much* higher than the placenta and the cord is left unclamped then blood can actually run back out again, which is counterporductive. Within about 5-10 minutes or so of the birth, the blood vessel from the cord actually begins to close off, so delaying clamping much beyond that doesn't get the baby any additional blood.

The other option, which one of my OB/GYN friends does for her births, is to "milk" the cord - basically, she pushes all of the cord blood towards the baby by squeezing the cord and running her hands along it, so that she can go ahead and clamp it but still get the blood to the baby. I guess this is what the "newer" OB/GYNs are being taught to do? Seems to me a reasonable thing if you're impatient or if baby needs to be resuscitated and you can't simply wait.

[terra-pip]

That's just ridiculous. With my first his cord stopped pulsing before I had even delivered my placenta. And he was given to me right away...actually putting the babe to the breast will help start some after contractions to deliver the placenta. The only thing I've ever heard about it is not to wait too long even if it still is pulsating because you could overload a baby's system with too much iron. Most baby's will stop pulsing at about 5 minutes or so. If anything I would think keeping him low would allow too much blood volume. <shrug> Just tell them that you want the baby put on your chest right away and the cord clamped after pulsing. She should respect that wish.

The "milking" thing would make me feel a little nervous actually.

[CrunchyChristianMama]

Originally Posted by kltroy

The other option, which one of my OB/GYN friends does for her births, is to "milk" the cord - basically, she pushes all of the cord blood towards the baby by squeezing the cord and running her hands along it, so that she can go ahead and clamp it but still get the blood to the baby. I guess this is what the "newer" OB/GYNs are being taught to do? Seems to me a reasonable thing if you're impatient or if baby needs to be resuscitated and you can't simply wait.

Milking the cord has actually been found to be quite dangerous I believe. I would have to find the study to quote, but I would not recommend doing so at all.

Let nature take it's course. The cord is perfectly designed to pump the necessary blood to the baby and clamp itself off on it's own when it's ready and baby has the correct amount of blood. There's no need to do anything special. It's not natural to not hold your baby after it's born, so I truly can't see any benefit from leaving a baby to lie on a bed after it's born.

[CherryBomb]

No, that's not true, and I'd be wary of a practice that's that ignorant, personally.

[nia82]

Thank you for your answers.. It seemed not right to me and wasn't done to my sisters in Europe. I will discuss it with the obgyn who I will meet at my next appointment (you see both since you might end up with either one for delivery). I also wanted to discuss their stance on having to deliver on my back in case of pre-E with which I'm not okay.
I cannot see any obgyn in my town, they are all anti-natural birth and have a horrible reputation - the only midwife is nice, but her hands are tied and she might not be on call. The practice that I'm seeing right now is 1 hour South of home in Fort Collins and they are by far the crunchiest available. I can go to a Birthing Center in Denver which is awesome, but I shy away from a 2 hour drive, especially since baby is due in late Jan / early Feb - our interstates get closed and then I'm stuck anyways with horrible obs... Homebirth is out of question, it just got legalized here but no rules have yet been formed so no CPM from Colorado can come up here. No CNMs do homebirths around here, it is rather tricky, but in the end I might switch to Denver and just drive there every month.

[womenswisdom]

Originally Posted by nia82

I also wanted to discuss their stance on having to deliver on my back in case of pre-E with which I'm not okay.

Do you mean in case of shoulder dystocia? This sounds like a BAD practice to be at if you want a non-interventive birth. They are not practicing evidence-based medicine, or even coming close. Have you talked to them about when they recommend/"require" induction? Or if they do late u/s to determine fetal weight?

[nia82]

Oh no, they were talking about preeclampsia. But I know that obgyns will call you preeclamptic just for having elevated blood pressure throughout contrax - which is normal for being in pain. I had that happen with DS - my readings were fine in between contrax but spiked a little during brutal back labor contrax. I thought I was dieing, pushing was painless compared. So they did not allow me to be in an upright pushing position despite my begging and crying. It was horrible. That doctor was in California amd I don't want that ever ever again!

[terra-pip]

Originally Posted by nia82

Oh no, they were talking about preeclampsia. But I know that obgyns will call you preeclamptic just for having elevated blood pressure throughout contrax - which is normal for being in pain. I had that happen with DS - my readings were fine in between contrax but spiked a little during brutal back labor contrax. I thought I was dieing, pushing was painless compared. So they did not allow me to be in an upright pushing position despite my begging and crying. It was horrible. That doctor was in California amd I don't want that ever ever again!

I'm not familiar with pre eclampsia...but I would do a lot of reasearch before I would let someone say you had to push while on your back. It's okay for your BP to spike high or low in labor I think...you're doing hard work. Mine always got low near transition and I felt nausea and shaky.....but no one ever refused me to move around how I felt. I naturally want to lay down on my side and rest and breathe when I felt that way and then it spiked up again and I was up and doing the work of pushing. I'm not even sure if anyone was really checking my BP...just I could feel it myself. I had BP checks after birth and when I was first admitted though. And my second was with an OB. And I had back labor with my first...breaking your waters feels good for it, walking and sitting on a birth ball feels good, pushing on your hands and knees feels good while someone puts counterpressure against your perineum area.

[mwherbs]

I looked into this a bit earlier this year here is a copy of my post- it may help

so I tried to trace down the roots of this belief well atleast to a degree- Alice Yao a Dr of Peds, for over 50 years now, published in 1968-69 in the Lancet a paper on the effects of infant position and placental transfusion - now here is what she says in regards to relative position - I would also like to point out that in recent years she has co-authored/published studies on benefits of delayed cord clamping for premies and there is an open clinical trial on laying a baby on mom's tummy. any case the info on position is if the baby is held 50 to 60 cm above the placenta no benefit- a baby on a mom's tummy is at the level of the placenta- her chest-if the cord will reach that far is not 50 cm above that--
here is a nice quote from a presentation given discussing changing common practice of quick clamp and cut-to delayed in 3rd world countries because the difference to those infants is profound- and can make or break survival in the long "In addition to the timing of cord clamping, three other birth-related factors might influence the amount of placental transfusion at birth:
(1)the position of the baby in relation to the placenta;
(2)the method of delivery (vaginal vs caesarean section); and
(3) uterine contractions during the third stage
The rate of placental transfusion is markedly influenced by the position of the
delivered infant. An infant held 50-60 cm above the placenta will not receive
any blood from the placenta. At 10 cm above or 10 cm below the level of the
placenta, infants receive the maximum possible amount within 3 minutes of
birth."

[Earthy Birthy]

I happened upon this thread because I did a search for "Fort Collins" for a totally unrelated topic. I just wanted to let you know that there are a couple of great CNMs in Greeley, which is also an hour south of Cheyenne. I lived in Fort Collins when my first baby was born, and I drove all the way to Greeley for prenatal care. Here's the website: Women's Wellness Center of the Rockies. I absolutely loved Tammy Brunk (Carleen was nice too, but I bonded with Tammy), and she ended up being the one on call when I had my baby. I didn't get the waterbirth that I wanted to have because of pre-e, but I was on hands and knees and then in a supported squat while I pushed, and I made it through a 20+ hour induction without an epidural.

Anyway, you have options. Explore all of them before choosing a care provider. Oh, and as everyone else said, the thing about the baby having to be lower than the placenta is nonsense.

[nia82]

Wow thank you Txmidwife. I actually live in Cheyenne, going to Greeley isn't that much further. Where do they deliver? The Greeley hospital is NOT in my insurance network, but I think they consider giving birth an emergency, so it might be covered (Carleen and Tammy are in network CNMS with my insurance).

[Earthy Birthy]

I had my baby at the hospital in Greeley, but you might just call their office and tell them your situation.

[LaydieBugs]

I had a similar situation - not caring for the OBs, and finding one midwife but she might not be on call ...

So we went for home birth, though it wasn't my first choice. Have you looked into that? Insurance often doesn't cover, but it turned out to cost less for us anyway, and was well worth it.

[fruitfulmomma]

No, she is not right. As pp said there are doctors who say the opposite about baby getting too much blood with delayed clamping also. Really wish they'd get their stories straight.

NCMC in Greeley is a good place. I don't know their stance on delayed clamping but I've had two unplanned hospital births with them and everything went really nicely.

If you are interested in a homebirth do call the midwives in the Fort Collins area. I know mine has clients come in from Wyoming to birth in friends homes or whatever. Maybe one of them has an idea of something that could work for you.

[nia82]

Thank you ladies for all your help! After deliberating forever, at least it seems, I decided to go for the birthing center in Denver. It's a 2 hour ride, but I think I won't regret it. They are cool with whatever I feel is right and allow waterbirth. Plus, it's 100% covered by my insurance....

Homebirth is not really covered with my insurance unless I use a CNM, and then they reimburse $1500 maximum. I can't justify a 2K bill if I can have a good birth at the birthing center for "free". Plus, I don't want to be stuck in Cheyenne for a potential transfer... The hospital and the obgyns are scary.

There are wonderful CPMs in Fort Collins, but they cannot legally practice here. CPMs just got legalized in March in WY, but no laws and regulations have been set yet, it's gonna take a while, so technically if they get caught attending a homebirth up here, they are in big trouble.

The whole cord clamping thing opened my eyes that a hospital birth will always be a hospital birth; it might be advertised as baby-friendly, natural or whatever, but it will always be the technocratic-clinical model of birth that I don't want to experience again!