Does anyone have an information or stories about convincing an OB to delay cord clamping in the case of a c-section?
Delayed Cord Clamping and C-section
Hey there! I asked my doula the same thing when writing my most recent birth plan (due anyday now, this is my 2nd VBAC but could end up in a C-section). She said it mostly likely won't happen in the case of a c/s because the doctors want to close you up as soon as possible. Have you asked your doc about this? Are you definitely having a c/s (I see you are expecting twins!) or is this a just-in-case?
Btw, congrats on your twins! How exciting! :)
I don't think delayed cord clamping after a c-section has the same benefits. with a vaginal birth blood is squeezed from the baby into the placenta as the baby passes through the birth canal, and the blood has to be given a chance to go back into the baby. that doesn't happen with a c-section, baby's blood stays in baby. also, I don't think the closing of the blood vessels happens the same because of lack of labor hormones and contractions. also, the differing blood pressures before, during, and after a vaginal birth seem to be a big part of what tells the placenta its job is done. honestly, there's probably more benefit to having them clamp immediately and getting the baby to your breast to help the uterus contract so you don't lose as much blood.
Thanks for the responses. I definitely don't WANT a c/s but it is more likely with twins so I'm trying to be prepared. I did find this article: http://www.ncbi.nlm.nih.gov/pubmed/16585320?dopt=Abstract
"Delayed cord clamping seems to protect VLBW infants from IVH and LOS, especially for male infants." and that was just a 30-45 second delay AND in premature babies (so, assuming there were neonatologist that wanted to get their hands on the babies.
And this one: http://www.ncbi.nlm.nih.gov/pubmed/11039135
"Delayed cord clamping of 45 s is feasible and safe in preterm infants below 33 weeks of gestation. It is possible to perform the procedure at caesarean section deliveries and it should be performed whenever possible. It reduces the need for packed red cell transfusions during the first 6 weeks of life."
I'm going to try to bring this up instead of convincing her that she SHOULD for the benefits just show her that she CAN to make me happy.
I have become so convinced of the importance of DCC that a c/s just scares me even more now. This really needs to be the standard of practice and it is an almost risk free thing!
Still hoping someone has done this successfully!!! Come on it!
It is SO important, I agree!
BUT - Like SO many things in American obstetrics today, it is another one of those things with false scare tactics, and uninformed care providers. I read a post on here about a nurse telling the mom that DCC was actually dangerous to the baby. Frustrating, isn't it? Even more frustrating that you are preparing to fight for even 30-45 seconds, when what you really want is 10 minutes or longer!
Please update this post with your journey. I think you can help others!
I think a time of a couple minutes or more would be basically impossible to convince given risks of surgery of infection etc. and wanting to get to hold/bond with baby ASAP. I honestly wouldn't want an incision on me sitting there for too long. BUT with those studies you have of the possible benefits and low risks of short times of delayed clamping you might have a shot. Maybe. Worth a try at least!
OP - the book "Gentle birth, gentle mothering" by Dr. Sarah Buckley had a little on it. It cites lots of sources & was just published in 2009, so worth checking out.
Interesting - but isn't one primary benefit of DCC to have baby get more blood volume? The book "gentle birth" listed studies showing potentially large increases in baby's total blood volume with delayed vs. premature CC. & if the placenta is removed, it can't be 'pumping' the blood into the baby anymore anyway, right? Because there can't be blood 'pumping' when it's not hooked up to mom's cardiovascular system, where her heart is what 'pumps' the blood around.
In other words, is there really any point to leaving baby hooked up to the cord after placenta is delivered?
& leaving cord in tact after placenta is delivered, all the way until the cord falls off naturally, is known as lotus birth. From what I've read, it has zero physiological benefits.
hmmm ... interesting point! I did make an assumption there. Maybe I was too fast in posting, my apologies. (I hate having mis-information out there.... so if you remove the quote from me, I will remove mine too!!)
AND - I also agree and love that book - Gentle Mothering....
And I agree with the above poster, that it is totally worth asking the docs! Worth a try!
Thanks for the hint about Gentle Mothering! Always looking for great resources. I guess the other uphill battle in my case is that waiting 45 seconds to clamp/cut babyA's cord means baby B is still waiting to be born.
I also found out I have GD so I'll be fighting some battles there. It is frustrating to say the least but I did *choose* a hospital birth this time (I birthed DD in a birth center) because I wanted the expertise of NICU docs. I'm going to have to pick and choose my battles. /sigh.
I love this description of a mom/baby-friendly c-section: "After his head is delivered, the rest of his body is left in the womb for several minutes. The squeezing of the womb on his chest imitates the trip down the birth canal in which liquid is squeezed from his lungs, preparing him for breathing. Meanwhile, the baby is still attached to the umbilical cord, as he would be during a vaginal delivery. Instead of being pulled quickly out of his mother’s abdomen, the baby has time to acclimate to his new surroundings." http://www.pregnancy-info.net/friendly-cesareans.html
I was just at a c/s last week, where some delay was undertaken. We had asked if it could be possible at the last appointment and the doctor said no because of blood loss and that they would need their hands then free to deal with the incision (obvious and valid point!) wish was fine. Then at the c/s the doctor let the bub lie on mum's stomach for about 30-40 seconds and then said the baby's started to breathe/cry we can cut the cord :) She said later that there wasn't much bleeding which was why she able to do it.
Hope your birth went well
You might want to try contacting Dr. Morley, in Michigan. I think you should be able to google for his website. He has done a lot of chord blood research. He arranged for his daughter's child to have delayed chord clamping after her c-section, and he monitored the blood volume took pictures, etc. The results were significant.
I realize this is an old topic, but I was encouraged by a friend to share my and my wife's experience with delayed cord clamping cesarean births. Thus, you have it below.
My wife and I successfully negotiated a two-minute delayed cord clamping and received a three-minute clamping. I am not going to go into all of the details, but the following is a summary of how we did it:
Original Plan: Home Birth. Plan changed when our daughter would not turn over from a breech presentation and my wife's water broke. We had a week and a half warning about the breech and that our plans may require us to go to a hospital. We had no specific doctor lined up at a hospital, so we got whoever was there.
Solution: Hospital Birth Plan. We laid down everything we wanted in a hospital plan, we laid it out clearly, we explained that we were flexible because we do not know everything and not everything is possible in every situation, and we knew our research resources. Resources were standard medical practice journals, articles, and other information. We had read the studies or spoken to people who had, so we were able to argue with knowledge. On the other hand, in the future, I will be sure to cite the sources in my birth plan - this will improve your odds of getting what you want. Take at least five and as many as ten copies of your birth plan printed out with you to the hospital.
Birth Experience: Water broke, we went to the hospital. First shift was nice to us, prepped us for the idea of having a cesarean. We explained our birth plan, gave out copies of it, and explained or situation. They were great.
Shift change. New doctor came on. Met the resident and the obstetrician. The resident was flexible, said we may be able to do things from our birth plan, took the time to read it. The obstetrician was obstinate, refused to read our birth plan, told us we were doing things her way, put the resident in line with her desires, and basically told us to suck it up. She made my wife cry, I asked her to stop talking and to back off so I could comfort my wife and my wife could explain things to her. The obstetrician continued informing my wife that we were going to kill our baby with our demands or seriously harm it. After trying to get the obstetrician to back off several times, I finally told her to shut up and leave the room. She told me I could not talk to her that way and stalked off.
Nurse in Charge came in twenty minutes later. We explained our situation to her, what we wanted, and that we felt it was not unreasonable to at least get some of our requests. We were shooting to get the delayed cord clamping, but we knew it may not be possible. We explained that we would be willing to wait for the next shift change, as long as my wife's labor did not progress too far -- a labor that was already set back due to the stress of dealing with the previous obstetrician.
Next doctor came in twenty minutes later. He was the doctor we had actually planned on meeting that day to do a version, after having had several other doctors tell us know. He was amazing, one of the nicest, friendliest, truly caring, smartest, best doctor's I have ever met. We asked for a delayed cord clamping. He explained that it is now routine to do them for premature babies, but in a standard cesarean they are not done due to the risks to the mother of being left open. We discussed the research with him, he was open to hearing about it. We explained why it was important to us and we talked about the other things we wanted. We conceded to him when he explained why something would or would not be good. Finally we came back to the delayed cord clamping, he recognized we were reasonable and concerned with the welfare of mother and baby. We told him that we knew it would not always be possible in the heat of the moment, but if it could be done we wanted it. Ultimately he agreed to do a two minute clamping. Procedure was to place the baby lower on the mother's leg after it was removed, to start massaging the placenta free while it was still attached to the baby, and to have someone hold the baby in place and make sure everything was fine. Then to clamp and remove the baby. However, the doctor did warn that he was going to have to explain it to the pediatricians and convince them to wait (which he did).
The Experience: Wife was given a spinal plus epidural. We waited until they fully took affect. We went in to the operating room and everyone prepared to go. Things happened quickly. Incision, clean up an old scar, reach in and pull out the baby. APGAR was a 7. Doctor reminded everyone that we were doing a delayed cord clamping. They laid the baby on my wife's leg, wrapped her and it with a towel, and started to massage out the placenta as the time ticked away. Two minutes passed, APGAR was a 10, doctor said everything was looking good, decided to wait another minute. Three minutes, cord clamped, baby passed off to pediatricians.
Afterwords everyone in the hospital was shocked that we got what we wanted. We talked to them about it, they were all happy to have done it. It was a great experience for everyone. And now, we have a beautiful, happy baby girl that is excelling through all the benchmarks.
Now for the short list of tips and tricks to get what you want from a doctor.
Tips & Tricks:
1) Be clear on what you want. Write it down. Explain it. Cite your resources. Make sure your resources are credible medical resources - blogs do not count. Understand what you are asking for. Understand the risks and benefits. Be able to explain them in at least general terms and refer to your birth plan - where you wrote it all down - when you need to.
2) Print off multiple copies of your birth plan. Give a copy of one to every person you come in contact with. Remind them of what you want, that it is possible, and that they are helping you.
3) Be flexible. Explain that you understand that not every birth is the same and that emergency situations can happen that will force you to deviate your plan. Understand that if you have to deviate, it is not your fault, it is not your partner's fault, it is not your doctor's fault.
4) Have your partner prepare to be the person to explain everything from the birth plan to the doctor. While you may be able to do it, you are in labor, you need to be able to focus on that. You may do all the talking, but when push comes to shove you need to have your partner there to comfort you and give a push to get what you want. Remember this is a sensitive time, your partner can be the jerk to demand what you want and need - let your partner do it for you. If not your partner, then a friend, but always make sure you have someone in your corner who can demand what you want. At the same time, remind that person to be flexible.
5) If you are not in an emergency that requires you to be opened up right now, be prepared to fire your doctor. If you are not comfortable with the doctor, you have the wrong doctor. Explain what you want, what you need, and how the staff and doctor can help. If you have to, tell them you are ready to transfer hospitals so you can find a doctor you are comfortable with. Again, be flexible, you may not be in a position where you can demand this or make this request - you may have to give birth right now.
6) Remember that not everyone is against you. The nurses and other staff can often be brought to your side and help. If you need to, ask for the nurse in charge. Get someone on your side.
7) Believe in yourself.
8) At the end of the day, remember that the most important thing is Healthy Mom Healthy Baby.
And for everyone, always plan ahead. Plan for the cesarean, even if you do not want one. Plan for it like it is inevitable, know what you want if you have are forced into one. It is a hard thing to think about, but it is worth it. We had done our research, but we had not really planned for a hospital birth at all. As a result we were scrambling at the last minute, do not be that person - it is stressful!
We had originally planned a home birth. When we found out our daughter was breech, we tried to find someone willing to do a vaginal breech birth on a first time mother. We did find people willing to do that, but none of them were available the day our daughter was born. However, we did find out that OHSU in Portland, Oregon will do vaginal breech births for first time mothers - as long as you consent to doing an MRI to measure hip vs head size. We were given the option to fly down and do that, we declined because there was no guarantee. However, if others find themselves in that situation, know that it can be done at the very least at OHSU in Portland, Oregon and at the teaching hospital in Vancouver, BC.
Good luck, and if you have any specific questions feel free to ask. If you are in Seattle, Washington and want to meet and talk about it or know the names of the doctors we went through, contact me.