Delayed cord clamping, dangerous?

[m0xxie]

I'm 26 weeks along with my first, I met with my doctor last week and asked if there would be any problem with my desire to let the umbilical cord stop pulsing before it is clamped & cut. She seemed surprised that I would want to do such a thing, and said that contrary to what I might think, the baby can actually experience blood loss this way, and most delivering doctors would have a problem with my request.

If what she says is true, then by all means clamp away, but I haven't heard anything like that before, and lots to the contrary, that delayed clamping gives the baby the benefit of those wonderful stem cells hanging out in the cord blood.

It's this sort of thing that makes me really nervous about a hospital birth, because it feels like if I don't remember to ask every question and research every option beforehand, I may not be prepared enough to argue my point successfully at the time when it matters most. Add to that the problem that my insurance system (Kaiser) will not let me have the doctor of my choice attending my birth, but just assigns whomever happens to be on call at the time, most likely someone I've never even seen before.

I told my doctor that , in a perfect world I would have my baby at home, and she responded that it was such a miracle that I even achieved a natural pregnancy at my advanced age (43) that I shouldn't press my luck, that my risk of complications at birth goes up with my age (which was also news to me).

Anyway, sorry for the novel, just needed to get the whole story out... any info on the cord issue, or any generally supportive comments very much appreciated!

[WifeofAnt]

Maybe if you hold them up in the air and purposely drain all the blood back before clamping it... I just have a few little smart aleck remarks, lol.

1. Why isn't this a problem in other countries? In many cultures the cord isn't severed until hours after the placenta is delivered.
2. Why isn't this a problem for other animals? No other placental mammal severs the cord before the wharton's jelly stops blood flow to and from the placenta.
3. Just google 'delayed cord clamping risks'. The only proven risk that comes up is a slight increase in jaundice. Jaundice is totally treatable with lots of breastfeeding (colostrum is a natural laxative and helps move the bilirubin out) and bili lights or sunlight.

There's also a facebook page with more resources:
http://www.facebook.com/delayedcordclamping

[MamaMonica]

Moved to B & B

[starbyfar7]

when i first heard about delayed cord clamping, i decided to research it to see if it was right for us and i never heard of anything like that. some doctors don't believe that it has medical benefits for baby, but ive never heard of one saying that it was dangerous.
my partner and i were debating whether or not to bank the cord blood or delay the clamp because our midwife said we cant do both she's all for delayed clamping, and in fact.. said that if baby was struggling for whatever reason, she wouldn't clamp because that blood is so important to the baby. she told us this during our initial interview.. just in case we had decided to bank the cord blood already.. but we had already decided to delay the cord clamping until it stops pulsing.. so no biggie.

your doc is interesting.. you should ask him for sources/references on that info and see what he says lol

[elanorh]

My OB and my Ped both were fine with us delaying clamping for dd2. Neither had any concerns; the only caveat that the OB had was that if I were hemorrhaging then he'd have to clamp and deal with the hemorrhage, so he wanted me to know that was a remote possibility.

Incidentally, dd2 had less jaundice than dd1 (who was clamped at birth).

My OB told me that it is an unusual request for him, but that he doesn't have any concerns about it.

Personally I'd be checking with your insurance company and looking for a different OB (or a MW). Find someone whose practice meshes more with what you want. The fact that your OB told you that delayed cord clamping is dangerous (well, seriously, does she understand human physiology if she thinks that the blood can pump back INTO the placenta/Mom?) -- and additionally that she's starting to wave the "Oh, you are an older mother and therefore at higher risk" flag both make me wonder how many medical interventions she would want to push on you - early induction, EFM, etc.??

Sorry - I've had a few friends pushed into very medicalized, c/s births lately as a result of the cascades of interventions, and your description worries me.

[MsBlack]

Originally Posted by WifeofAnt

Maybe if you hold them up in the air and purposely drain all the blood back before clamping it... I just have a few little smart aleck remarks, lol.

1. Why isn't this a problem in other countries? In many cultures the cord isn't severed until hours after the placenta is delivered.
2. Why isn't this a problem for other animals? No other placental mammal severs the cord before the wharton's jelly stops blood flow to and from the placenta.
3. Just google 'delayed cord clamping risks'. The only proven risk that comes up is a slight increase in jaundice. Jaundice is totally treatable with lots of breastfeeding (colostrum is a natural laxative and helps move the bilirubin out) and bili lights or sunlight.

There's also a facebook page with more resources:
http://www.facebook.com/delayedcordclamping

Um, WifeofAnt....sorry, have to mention:
In most mammals, the cord actually rips away from placenta during birth, before wharton's jelly has had time to form at all. Babies are born unattached, most often (and I've seen many a puppy, kitten, foal and goat-kid get born). However, that is physiologically normal for them, and only rarely causes problems (of dozens of kittens I've seen get born, for instance, only ONE bled-out through cord stump within few min of birth...surely there was some other underlying problem for the kitten).

It's true that jaundice is not a problem, though, most often. It's actually normal for newborns when it occurs, and only rarely a cause of problems. Far more babies are treated for jaundice than actually need any treatment, mainly because the med world does not seem to understand how it is normal in neonates.

By the way--in my practice, I don't call it 'delayed cord clamping', I call it 'normal cord clamping'. We just aren't thinking about the cord, except 'by the way' (by the way, mama, mind the cord when you move baby to your other breast...), until a pretty long time after birth. Only rarely do cords get cut sooner than 15 min--and more often it's 30-60 min, depending on when the placenta comes out mostly.

What they do in hospitals is PREMATURE cord clamping. Docs have decided that their way of cutting cords immediately is 'normal', and that waiting is a 'delay'. They are wrong, of course. As wifeofant points out, traditionally cords have not been cut instantly upon birth--and are rarely cut immediately at any homebirth now. We are not 'delaying' the cord clamping--the Docs are HASTENING it, clamping prematurely.

The doc who told you this is simply ignorant. Sadly, she does not even know she is ignorant on this topic...sadly, most docs are fairly ignorant on the subject of Normal Birth, and they do not know it. Most often their clients don't know it, either--but you are someone who can help educate her!

[Mommal]

Ah, those amazing vampire placentas- they faithfully nourish the baby for 9 months, but the instant the baby is born, they suck the blood right out of him.

A very quick look at Google Scholar shows that your doc is full of... Here are some references to show her:

Current best evidence: a review of the literature on umbilical cord clamping. Mercer, J. Journal of Midwifery & Women's Health Volume 46, Issue 6, Pages 402-414 (November 2001)

The Effect of Timing of Cord Clamping on Neonatal Venous Hematocrit Values and Clinical Outcome at Term: A Randomized, Controlled Trial. Ceriani Cernadas, J.M. et al. Published online March 27, 2006 PEDIATRICS Vol. 117 No. 4 April 2006, pp. e779-e786 (doi:10.1542/peds.2005-1156)

A Systematic Review and Meta-Analysis of a Brief Delay in Clamping the Umbilical Cord of Preterm Infants. Rabea, H., Reynolds, G., Diaz-Rossello, J. Neonatology Vol. 93, No. 2, 2008

I'd at least look at your other options, as far as providers go. Someone who already views your pregnancy as a miracle and you as a ticking time bomb SOLELY BECAUSE OF YOUR AGE is not likely to be a provider who is willing to support your birth as a natural, normal process. She's much more likely to want to step in and save your miracle baby from you and your vampire placenta.

[WifeofAnt]

Originally Posted by MsBlack

Um, WifeofAnt....sorry, have to mention:
In most mammals, the cord actually rips away from placenta during birth, before wharton's jelly has had time to form at all. Babies are born unattached, most often (and I've seen many a puppy, kitten, foal and goat-kid get born). However, that is physiologically normal for them, and only rarely causes problems (of dozens of kittens I've seen get born, for instance, only ONE bled-out through cord stump within few min of birth...surely there was some other underlying problem for the kitten).

Eh, I've only seen kittens born and they all came out in pretty much the same pattern. Kitten first, placenta about a minute or two later (still attached to the cord), repeat until all kittens are born. Then once they were all out she started eating the placenta and severing the cord. Maybe my cat was just odd but all 8 kittens followed the same pattern.

(picture of the first 3 with attached placentas, one placenta is hiding.. Hopefully that works.)


My original point is that across the animal kingdom reproduction, pregnancy, and birth are almost surely idiot-proof. Most everyone is going to have to figure out how to do it if the species is to continue. Nature wouldn't hand us a widespread situation that has the capacity to destroy the species such as the baby 'bleeding back' and expect us to last very long.

[nia82]

Hm time to educate that obgyn. If she refuses to learn, time to find a new one.
Delayed cord clamping should be normal and is highly beneficial, premature cord clamping is only warranted when baby is in severe distress and needs to be whisked to the NICU asap. In all other cases, no way!
A lot of obgyns prefer premature cord clamping and then active delivery of the placenta to get it over with instead of waiting around. Unfortunately.
All my friends and family back home (Germany) had their cords clamped until after the cord stopped pulsating while baby was on their chests hanging out or nursing. They all had hospital births with obgyns and midwives, but the obgyns managed the actual 2nd and 3rd stages... And for your ob to know, there is a way better maternal and fetal outcome over there! So hm no, delayed cord clamping (which should be called normal cord clamping) is totally harmless and highly beneficial.
Don't let them tell you that if you do delayed that baby has to be lower than the placenta. Studies showed that any position within a few inches below or above the placenta is fine, of course best is on mom's chest. And if nursing can be initiated asap it will help with the 3rd stage without any active management.
If you are interested in changing obgyns, my SIL had a great experience with a natural minded obgyn at Sequoia Hospital in RWC.

@ WifeofAnt: How cute, I just love cats. I once witnessed the exact same thing with our cat back home back in 1990! She bit the cord only once the placenta was delivered...

[pugmomma]

I don't have any advice about delayed clamping, but I do have experience with Kaiser. I also have Kaiser and had to switch OBs three times before I found one that really listened to me. I know I may have a stranger deliver my baby, but I am hoping that I can at least get my birth plan the way I want prior to that.

[rparker]

I'm not sure what counts as "delayed" cord clamping currently, but our family practice doctor was perfectly fine with our request to wait 3-5 minutes/until the cord stopped pulsing to clamp the cord. The research we did indicated that after 5 minutes the increased risk of jaundice outweighed the benefits (in our opinion).

The cord had stopped pulsing when he did clamp it and he asked my permission before doing it... the only "risk" in his opinion was jaundice, NOT blood loss, and I think he would have waited longer if I had insisted but we were still in the bathroom where I had delivered and at that point I wanted the baby to be detached

FWIW my husband is a pediatrician and had zero reservations about his child's cord clamping being "delayed" other than jaundice... which was mostly a hassle we didn't want to have to deal with having a breastfed baby in a hospital. (Our older daughter's cord was clamped right away and she had mild jaundice... this baby had none.)

[fruitfulmomma]

And some moms have heard the opposite from their OBs - that the baby will get too much blood. Well, which is it???

"Delayed" cord clamping is normal, it is what has occurred in cultures around the world for thousands of years. Clamping at birth is for the benefit of the doctor and the hospital methods which whished the baby away from mom at the moment of birth in order to clean them from all the mommy germs and such.

Here is an interesting article on a study done by pediatricians on the need for delaying with regards to the change in breathing - http://www.time.com/time/magazine/ar...830142,00.html

[Maprilynne]

Originally Posted by fruitfulmomma

And some moms have heard the opposite from their OBs - that the baby will get too much blood. Well, which is it???

"Delayed" cord clamping is normal, it is what has occurred in cultures around the world for thousands of years. Clamping at birth is for the benefit of the doctor and the hospital methods which whished the baby away from mom at the moment of birth in order to clean them from all the mommy germs and such.

Here is an interesting article on a study done by pediatricians on the need for delaying with regards to the change in breathing - http://www.time.com/time/magazine/ar...830142,00.html

Wow! That's a great mainstream article! (Cuz so many people will listen to TIME magazine over a midwife with 1000+ births.)

[nashvillemidwife]

Originally Posted by MsBlack

In most mammals, the cord actually rips away from placenta during birth, before wharton's jelly has had time to form at all.

Wharton's jelly forms early in pregnancy. It holds the vessels together and protects them from compression while in utero. What are you talking about?

[m0xxie]

Originally Posted by fruitfulmomma

Here is an interesting article on a study done by pediatricians on the need for delaying with regards to the change in breathing - http://www.time.com/time/magazine/ar...830142,00.html

Holy Toledo! Did you notice that article is from 1963?! Seems it takes some doctors longer than 40 years to absorb information!

I'm truly blown away by your awesome (and sometimes sidesplitting) responses... I feel so supported by this incredible community -- thank you, everyone!

This doctor I saw is younger than I am, and she just resumed her practice after her own maternity leave, so I assumed she would be much more "with it" than she seemed. It's a total roll of the dice what doctor I get for the delivery, I think they draw from like a 5-hospital radius, so there's no way I can possibly meet them all beforehand, a stupid system that's set up totally for the efficiency and convenience of the insurer.

I'll soon be touring the two most likely hospitals I may deliver in, and you can bet I'll be asking way more than my share of questions, and reviewing my birth plan with their staff to try to find out in advance which of my requests will seem reasonable to them, and which I may have to fight for. Wish me luck!!

[NSmomtobe]

The concern I have heard from health professionals here is that "skin-to-skin contact is not possible until after the cord is clamped" because the baby has to be kept below the level of the uterus in order to get all the blood. From what I have read, gravity does play a part in the blood flow at this point, but placing the baby on the mother gives the best of both worlds--the baby still gets some of the blood from the pulsing placenta but not so much that it increases the risk of jaundice.

[fruitfulmomma]

Holy Toledo! Did you notice that article is from 1963?! Seems it takes some doctors longer than 40 years to absorb information!

Oh, wow. No I hadn't noticed that. Yeah, not surprised that it is taking so long for changes.

I think my NICU baby could have been spared needing to be removed from me if they hadn't cut her cord. I understand why they did, because they were concerned about a possible heart defect and we had a NICU pedi team in the room at birth, but I think if they could have left it on just another minute or two until she was breathing on her own all the drama could have been done without.

[St. Margaret]

Just remember, mama, you don't need to consent to anything. Cord clamping is the kind of thing a doc or nurse will do very quickly-- so get yourself a good doula and go over which things you really want her to help you fight for. Have your partner and doula express your wishes clearly to all who will be present at the moment. Practice saying, "No, thank you" and especially "I do no consent" because those are the magic legal words. No matter what health system, you are still the one giving birth and they can't do something without consent (do not sign the blanket consent, or if they won't admit you without it, sign, and then give them a paper withdrawing it, if need be). It's good to educate yourself ahead of time about routines at the hospital, and just prepare your partner and doula, so you can relax and just birth.

[Nicole730]

PPs have pretty much said it all. My first was clamped earlier than my second and my first had a little bit more jaundice - both were minor.

Originally Posted by WifeofAnt

(picture of the first 3 with attached placentas, one placenta is hiding.. Hopefully that works.)

And I don't know if it's my hormones or what, but I totally looked at this picture and said, Awww, look at those cute little placentas.

[misskira]

Makes you wonder how our ancient ancestors survived after birth without sterile scissors and cord clamps handy, doesn't it?