delayed cord cutting--other side of the argument?

[lisavark]

I had a homebirth so we delayed clamping/cutting the cord till after the placenta was born (which took close to an hour). I thought about lotus birth but wasn't quite up for it... :D 

Anyway, a friend of mine who's pregnant with twins right now (yay!) was asking me about my birth plan. She has health issues in addition to the fact that she's got twins, so she is really not a candidate for an out-of-hospital birth. And she's not committed to natural birth either--she wanted to with her first child but ended up with an epidural, and she's planning on an epidural this time. However, she really, really does want to avoid a c-section. 

Anyway...all that is kinda OT, but when she was asking me about my birth plan, I mentioned delaying cord cutting, and she had never heard of that. So she researched it a bit and then asked her OB about it, and her OB basically said that there's a very short window during which it's ok/beneficial to delay cutting...but if you wait more than a couple of minutes, then the baby can get too much blood and have a stroke/have organ problems/die. Yes, she said that to my friend who's 38 weeks pregnant...ARRRRRRRGH! 

Ok, enough yelling, sorry. I hate OBs. Sorry to any OBs out there. I hate doctors and dentists too, it's not personal. :lol 

All that to say...I did some research and could barely come up with any real info about what I would consider "true" delayed cord clamping. Lots of studies saying it's valuable to delay, you know, 1 to 2 minutes. Everything else I can find is unsubstantiated assertions--lotus birth proponents saying it's violent to cut the cord at all, and mainstream docs saying babies can die if they get too much blood. Obviously I'm way biased toward the lotus idea, and anyway it makes no sense to me, biologically, that birth would be designed/evolved with something so artificial and awkward as cutting the cord being an urgent, necessary thing. Just seems...dumb. But I'm wondering if anybody knows of any studies on the subject at all? I'm looking for peer-reviewed, scientific studies on "long" delays in cord clamping--like waiting at least 30 minutes after the baby is born. Is there anything, or is this just too fringe to even be studied yet? 

[katelove]

There are two reviews in the Cochrane database. One for term infants and one for preterm. The original papers reviewed can be found in the reference lists of each article. To summarise briefly, the OB is talking bollocks.

http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD004074/frame.html

 http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD003248/frame.html

[WifeofAnt]

1. There are several places where the cord is not traditionally cut until several hours after the placenta is born.

2. Why would nature give us a situation that would kill massive numbers of babies without intervention?  Our DNA essentially has a copy of 'Life For Dummies'.  The desire to reproduce (babies are cute, sex feels good) is pretty much inborn, staying pregnant requires little thought for most healthy women, going into labor and giving birth is also very primal and instinctual.  Why would nature bring us so far to kill our babies as soon as they came into the world?

http://www.umbicut.com/article1.htm  You have to scroll down on this one to get to the 'chapters'.  Clicking on them takes you somewhere else.

In many cultures, people believe that all life from the placenta must be transferred to the newborn for otherwise the baby may die. Therefore the cord is usually cut after cord pulsations stop or after the delivery of the placenta.

There have been concerns that the increase in the newborn's blood volume and red blood cell volume that is associated with delayed cord clamping could result in overload of the heart and respiratory difficulties. 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.

Delaying cord clamping until the pulsations stop is the physiological way of treating the cord and is not associated with adverse effects, at least in normal deliveries.

[MsBlack]

"life for dummies"--I love it!

And now, just for more doc-speak on the topic, I heard this from a neonatologist recently: 'if you delay cord cutting too long, baby can lose blood to the placenta'

So, which is it?  Do they get too much or too little blood from delaying cord cutting???

Do we understand yet that these docs really do not have a clue about this? 

Originally Posted by WifeofAnt 

 2. Why would nature give us a situation that would kill massive numbers of babies without intervention?  Our DNA essentially has a copy of 'Life For Dummies'.  The desire to reproduce (babies are cute, sex feels good) is pretty much inborn, staying pregnant requires little thought for most healthy women, going into labor and giving birth is also very primal and instinctual.  Why would nature bring us so far to kill our babies as soon as they came into the world?

 .

[gemasita]

'if you delay cord cutting too long, baby can lose blood to the placenta'

Ok, blood is pumping back and forth.  It did this in utero and it continues after the baby is born.  Then, the cord clamps itself and blood flow back and forth stops.  Why would the baby being on the outside mean that suddenly, the placenta is sucking all this blood from the baby?  It didn't do that for 9 months!  It just pumped back and forth without a problem.  Ugh!

[gemasita]

Originally Posted by MsBlack 

Do we understand yet that these docs really do not have a clue about this? 

Originally Posted by WifeofAnt 

 2. Why would nature give us a situation that would kill massive numbers of babies without intervention?  Our DNA essentially has a copy of 'Life For Dummies'.  The desire to reproduce (babies are cute, sex feels good) is pretty much inborn, staying pregnant requires little thought for most healthy women, going into labor and giving birth is also very primal and instinctual.  Why would nature bring us so far to kill our babies as soon as they came into the world?

 .

If doctors admitted this to be true, we wouldn't need them at 99% percent of births in the US.  We would use midwives and doctors would only intervene in the 10% or less where problems occurred.  So basically, we have too many OBs and no OB wants to admit that.

Love your arguments, WifeofAnt - you have completely hit the nail on the head.

What do all the rest of the mammals in the world do?  Duh.

[lisavark]

Well, yeah. My opinion is pretty much everything you all said--it makes zero sense biologically for cord cutting to need so much management. And yes, I heard both arguments too--that the baby can get "too much" AND "too little" blood if clamping is delayed more than a minute. Of course it sounds like bollocks to me. But my friend believes her doctor, and while it's not going to make a difference for her (she's being induced today, at almost 39 weeks. That's a whole other rant. But she does have around 17 lbs of twins inside her, so I can understand!), but I really would like to know the science (if there's ANY) behind these crazy assertions docs are making. Granted, I don't trust most docs farther than I can throw them. But it's hard for even me to believe that a conscientious, tho mainstream, OB would respond to a pregnant woman's question regarding this issue with a rant that concludes "and then your baby could DIE!!!" without SOME thread of reason behind the rant. Which is why I'm looking for actual studies. Surely there's SOME basis behind this fear?

I mean, I think OBs have a crazy irrational fear of home birth too, but I can understand the basis behind that. Usually birth is safe, but sometimes things do go wrong. 99% of the time a midwife at home can do as much or more to prevent or mitigate problems, but I can understand OBs' inabity to understand that since they've never seen it.

Maybe cord cutting really is the same way--they started doing it for convenience, and then they invented myths about why it's "safer" because they needed to justify it.

I appreciate the Cochrane studies the first poster linked to, but I had already seen those and they're not what I'm looking for. They demonstrate the benefits of "delaying" cord cutting by "one to two minutes." Which is, uh, an improvement I guess?!? But that's not at all what I mean when I say delayed--I'm still looking for studies on delaying for 30 mins or more.

Maybe I should be looking for anthropological/cross-cultural studies? Hmm...I'm going to google cord cutting practices in the Netherlands and see if that turns anything up.

[mamabadger]

A nearby birth centre where I used to volunteer avoided all cord clamping whatsoever. For over twelve years, their routine was to leave the cord untouched until at least an hour after the placenta was delivered. At that point, the cord could be cut without clamping. This is still anecdotal, since no formal studies were done, but their outcomes were extremely good. They certainly never saw babies being pumped full of "excess blood" as a result. 

This Facebook group might be a good place to look. 

[katelove]

Sorry, I misread your first post and saw "delayed more than 30 secs" instead of 30 mins which is what you *actually* wrote

Sarah J Buckley has an article on Lotus Birth here  http://www.sarahbuckley.com/lotus-birth-a-ritual-for-our-times/ although unfortunately it is unreferenced. If you can get hold of a copy of Gentle Birth, Gentle Mothering (2009 edition) there is a chapter on the management of 3rd stage which has over 170 references as well as the story of her own child's lotus birth.

[carriebft]

The idea that delayed cord clamping is harmful is not supported by the findings from the
16 randomised controlled trials and 5 'controlled trials' completed over the past two decades
involving term and preterm infants and reviewed here.

http://medlaw.oxfordjournals.org/content/18/3/330.extract

I would recommend going to google scholar, searching in the years since 2008 and "delayed cord clamping". you will find a wealth of information and studies- none of them negative (as far as I have gotten)

[butterflies]

If your friend's twins share a placenta, her dr will probably tell her that delayed clamping of baby A will take away blood from baby B... the flipside they don't mention is that this also logically means that premature clamping should cause extra blood (which should have gone to baby A) to remain in the placental circulation and go to baby B (a kind of acute twin twin transfusion scenario).  There isn't a lot of research on what's optimal for monochorionic twins but to me it makes sense to leave both unclamped until they stop pulsing-- unless there is a real reason to clamp and cut the first (short cord, need to change position to facilitate delivery of baby B, etc)

When I was researching, I found the explanations in this old thread helpful. 

http://www.mothering.com/community/forum/thread/662119/delaying-cord-clamping-in-twin-hospital-birth

[honeybee]

This doesn't exactly answer your question, but it has a very interesting historical perspective on why/how immediate cord clamping came into practice. And nowhere does it mention anything about the baby getting "too much blood" or the baby "losing blood" from the placenta.

http://www.midwiferyservices.org/umbilical_cord_clamping.htm

Here is a meta-analysis of several delayed cord clamping studies.

http://jama.ama-assn.org/cgi/content/full/297/11/1241

I was able to hear a presentation from Dr. Morley, a major researcher and advocate for delayed-cord clamping, on this topic. He said that once the cord stops pulsating, valves close off in order to prevent any more passage of blood through the umbilical chord. The chord usually stops pulsating after 2-3 minutes. I don't know that there is any evidence at this point that leaving the chord after it stops pulsating provides additional benefits (except perhaps, for the fact that it keeps baby attached to mother so hospital staff can't whisk it away), but according to Dr. Morley, it's not going to hurt to leave it on longer. I did a quick search for Dr. Morley and delayed cord clamping, and didn't find something that describes this in the time I have, but if you search along those lines, you might find something. I doubt there will be a peer-reviewed study on the topic, but Dr. Morley would have a detailed description of how the biology works.

I would say in homebirth midwifery it is standard to leave the chord on longer than 2-3 minutes, just because nobody is in a hurry to clamp it. You pretty much just wait until it's convenient to do so after the cord stops pulsating. And there are certainly studies that show homebirth babies have just as good neonatal death rates than hospital births, where the cord is clamped immediately. So, the threat that the baby could DIE is pure doctor hysteria and hyperbole.

[Gena 22]

In the case with twins, unless a woman has an ideal situation and a very understanding caregiver, it's going to be hard to get anyone to delay clamping Baby A's cord.  I had a homebirth with my twins, and had somewhat delayed cord clamping, but not nearly as much as I would have liked in a perfect situation.  There are reasons to be somewhat concerned about the second twin's birth generally.  After my Baby A was born, my midwife may have waited seconds, maybe even a minute or two, but not terribly long before clamping and cutting Baby A's cord.  We had another birth to focus all our attention on.  Much delay in clamping Baby A would have been awkward and distracting, at a time when all our attention was needed elsewhere.

If that's the scene at a non-interventionist home twin birth, I think your friend will have a tough time getting much delay at a hospital.  Definitely worth asking for, but it will be difficult to get.

Which is a pity, of all babies, many twins might need delayed clamping more because of preterm births, lower weights generally, etc.  But no birth is perfect, twin births maybe doubly so.  It's worth knowing what you want, and trying for it, but knowing some things might fall by the wayside.

That said, if the OB is spouting ignorant arguments about cord clamping, that doesn't bode well.  It's hard enough to find an OB EXPERIENCED in vaginal twin birth.  You friend might have cause to question hers.

[Lady Lilya]

I read somewhere that they compared the blood levels in c-section babies vs vaginally-born ones, and found that c-section babies had a lot more blood.  The article was saying that this proves:

* that the blood was in the baby initially

* that squeezing through the vaginal canal causes some blood to get displaced into the placenta temporarily

* that it is a good idea to wait for the baby to have a chance to get its blood back before cutting the cord.

It was also saying that a large proportion of babies in the NICU are there because of issues related to not having enough blood to fully operate their organs.  

[honeybee]

A NICU nurse at a local hospital posted on another board recently that she received an email saying the hospital was changing its policy to delayed cord clamping due to the overwhelming scientific evidence of the benefits. So, FINALLY, the word is starting to get out to the docs.

[MsBlack]

Ah yes--it usually takes quite some time, but I've noticed hospitals around here also starting to catch up their protocols with the evidence.  This is somewhat heartening!
 

Originally Posted by honeybee 

A NICU nurse at a local hospital posted on another board recently that she received an email saying the hospital was changing its policy to delayed cord clamping due to the overwhelming scientific evidence of the benefits. So, FINALLY, the word is starting to get out to the docs.

[greenmama66]

THe HB  midwives in my area wait at least 3-4 hours until cord it cut. They say you have to feel right at the naval on baby to see whether it's still pulsing.

[A_Random_Phrase]

Honeybee made me curious, so I did a search and came up with these two sites that looked interesting:

http://www.midwiferyservices.org/umbilical_cord_clamping.htm

http://www.whale.to/a/morley1.html

[~Adorkable~]

Originally Posted by greenmama66 

THe HB  midwives in my area wait at least 3-4 hours until cord it cut. They say you have to feel right at the naval on baby to see whether it's still pulsing.

I'm confused about this statement, are you saying that they claim it is still pulsing at 3-4 hours? or that that is how long they personally wait and how to feel pulsing is a different separate statement?