Doctors okay with delayed cord clamping?

[cameragirl]

For those of you that use OB's, have you asked for delayed cord clamping after a vaginal delivery? Was the doctor willing, did they suggest a compromise, or just turn it down?

[AfricanQueen99]

Perfectly fine with my first.  Nobody arrived for my second so it wasn't cut until placenta was delivered.

[cameragirl]

My doctor has a good reputation for being accommodating and she really prefers vaginal deliveries. I haven't brought it up yet because I'm only 12 weeks, but I do need to make a list to go over with her over the next couple of appointments. So far she and the perinatologist are good with a VBAC, and I'd really like to let the baby have their blood instead of sending it off somewhere.

[Toposlonoshlep]

I had a natural hospital birth and although my OB was somewhat skeptical, I did have an awesome team of nurses on my side and I made sure to have my birth plan in writing and ready to go over. The OB explained that she will have no problem delaying clamping if the baby scores at least an 8 on apgar. He came out, she placed him on my chest, cord attached for about 5 minutes. Then he started to get a little cold, so they asked me if it would be ok to clamp since it was already done pulsing. I said sure, my mom cut it, they warmed him up, and all was well with the world. I definitely think it helps to have it in your birth plan in writing to go over, but not in any militant way. In my birth plan I had written that I understand that my and my baby's health and well-being come first, so my requests were preferences, not expectations. My wishes were better received that way. 

[mylilmonkeys]

With my #3, we ended up transferring to hospital during labor for a stuck swollen lip.  The oncall OB was respectful of delayed cord clamping, the hospital version which equals about 3 min vs. immediate, and then proceeded to try to pull my placenta out before detachment and caused a lovely hemorrhage.  Just what I needed after a 27 hour labor, 7 of those hours spent pushing!

With our twins, the backup OB we consulted always practices delayed cord clamping anyway so it wouldn't have been an issue, but we did a home birth.

[Cheshire]

Mine was open to it and she wanted to know why I wanted it.  I brought her a copy of this study (http://www.womenandbirth.org/article/S1871-5192%2808%2900081-4/abstract) and left it for her to read.

Next visit she said she liked the study and it would be fine with her if all was well.

A year after my daughter was born I went in for my regular check up. She was glad to tell me she'd been doing delayed clamping.  At one delivery the dad was super excited to see her do it.  Seems that the mom was a doc and the dad was a NICU doc.  Both had recently moved to our area and had come from a very prestigious hospital.  The dad said he wished more doctors would practice it and he especially sees many babies in the NICU who could have benefited from it.  (of course, plenty of the babies he sees there wasn't time for it but when there is time he thinks it is very beneficial).  She said she told him I had shared the study with her and she had added it to her practice.  His enthusiasm for it seemed to give her a big pat on the back.

Best wishes!

[1love4ever]

I didnt know about any of that with my first so the Dr just cut the cord right away without asking or giving it a second thought:(

I have a friend who told her OB that she wanted the cord clamping delayed and her OB said absolutely not, she would not do it.  My friend asked why, Dr said it is dangerous.  Friend asked how so, Dr could not and would not give her an answer.  My friend ended up compromising on this, and her babys cord was cut right away, but she said that she asked the Dr several more times why she thought it was dangerous and she said every time the Dr changed the subject, never once had an answer for her.  I thought it was ridiculous, considering it is actually SAFER to leave cord alone for a bit!

[Magali]

I delivered with a Family Doctor in the hospital and she didn't want to delay very long, she gave it a minute (I timed it when I watched my birth video).  She said it upped the risk of jaundice.  I didn't argue because in the end, it turned out to not be all that important to me.  But I wouldn't be suprised if she was also concerned about how delayed cord clamping would mess up their after birth routine and get her home later....who knows?

[Autumn Breeze]

Depends on your definition of 'delayed' for some that means 90 seconds, others 5 minutes. If you're SUPER lucky around here, in the hospital you might get 10, if they're not watching the clock. At home, a midwife would let it go considerably longer.

[Toposlonoshlep]

I always wondered about that. It seems to me that once the cord is done pulsing (usually up to five minutes), it is no longer transferring anything from mother to baby. What is the purpose of keeping it attached for so long? All of the studies I've read were based on 5 minutes and under.
 

Originally Posted by Autumn Breeze 

Depends on your definition of 'delayed' for some that means 90 seconds, others 5 minutes. If you're SUPER lucky around here, in the hospital you might get 10, if they're not watching the clock. At home, a midwife would let it go considerably longer.

[Autumn Breeze]

Originally Posted by Toposlonoshlep 

I always wondered about that. It seems to me that once the cord is done pulsing (usually up to five minutes), it is no longer transferring anything from mother to baby. What is the purpose of keeping it attached for so long? All of the studies I've read were based on 5 minutes and under.
 

With my second pregnancy, my midiwfe and I discussed what Anne Frye wrote about, here is a small bit in this article.

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

We didn't clamp and cut until the my daughter was 2 hours old.

[APToddlerMama]

I don't want to thread jack but I am considering the same thing and was wondering..... If you delay clamping the cord, does that mean the OB cannot give you the shot of pitocin as the shoulder is being delivered and then "actively manage" the delivery of the placenta? 

[Toposlonoshlep]

I'm not sure what the shoulder part is all about, but my baby's cord was clamped after 5 minutes and THEN I got some pitocin because I was bleeding quite a lot and they needed me to contract. 

Originally Posted by APToddlerMama 

I don't want to thread jack but I am considering the same thing and was wondering..... If you delay clamping the cord, does that mean the OB cannot give you the shot of pitocin as the shoulder is being delivered and then "actively manage" the delivery of the placenta? 

[cameragirl]

I don't believe it makes a difference. They've started delaying clamping for 1-2 minutes in c-sections in other countries, even. It still takes some time to deliver the placenta. The only reason I can see to not delay and give pitocin immediately is active management if there is bleeding.

[Autumn Breeze]

It is not always necessary to have a shot of pitocen immediately after a baby is born. In a normal birth, the rush of blood usually signals that the placenta has detached and is nearly ready to be birthed. The part that is pulsating, is on the baby's end of the cord, and does not rely on the mother's side of the placenta to move the blood to the baby.

A highly managed second and third stage is not (always) necessary either.

[APToddlerMama]

Originally Posted by Toposlonoshlep 

I'm not sure what the shoulder part is all about, but my baby's cord was clamped after 5 minutes and THEN I got some pitocin because I was bleeding quite a lot and they needed me to contract. 

All I know is that OBs are starting more and more to give the shot of pitocin at the same time as the shoulder is coming out, and then I have heard that if they do that, then they need to clamp right away because they don't want the baby to get too much pitocin.  That is what I read but it doesn't make complete sense since they use pitocin during labor.  How long after did they have to give you the pitocin? 

Originally Posted by cameragirl 

I don't believe it makes a difference. They've started delaying clamping for 1-2 minutes in c-sections in other countries, even. It still takes some time to deliver the placenta. The only reason I can see to not delay and give pitocin immediately is active management if there is bleeding.

I am still trying to figure it all out because there is a lot of conflicting info on active management but most of the research I have read shows there is less risk of retained placenta and heavy bleeding if they actively manage the 3rd stage (pitocin and cord traction).  It really *feels* wrong to me though, but I have some other risk factors that make me wonder if active management actually might be a good idea in my case.  It totally turns my stomach though to think of it, so I don't know... I feel like the research supports it but it seems really icky. 
 

Originally Posted by Autumn Breeze 
It is not always necessary to have a shot of pitocen immediately after a baby is born. In a normal birth, the rush of blood usually signals that the placenta has detached and is nearly ready to be birthed. The part that is pulsating, is on the baby's end of the cord, and does not rely on the mother's side of the placenta to move the blood to the baby.

A highly managed second and third stage is not (always) necessary either.

Do you know if waiting to see how much bleeding, etc. before pitocin works as well as doing it with the delivery of the shoulder? 
 

[mylilmonkeys]

Originally Posted by APToddlerMama 

I don't want to thread jack but I am considering the same thing and was wondering..... If you delay clamping the cord, does that mean the OB cannot give you the shot of pitocin as the shoulder is being delivered and then "actively manage" the delivery of the placenta? 

That is why the OB messed up my third stage.  He was so used to active management, he forgot I didn't have the pit.  So after delaying clamping, he caused a significant hemorrhage.  I remember asking the nurse in the midst of it (I'd squatted and had a giant puddle at my feet, and ever the student...) and she estimated 1000cc's.  I don't know what the end estimate was, but I could barely get up on my feet for the first week and couldn't carry my 10lb 14oz baby around for nearly 2.

[APToddlerMama]

Originally Posted by mylilmonkeys 

That is why the OB messed up my third stage.  He was so used to active management, he forgot I didn't have the pit.  So after delaying clamping, he caused a significant hemorrhage.  I remember asking the nurse in the midst of it (I'd squatted and had a giant puddle at my feet, and ever the student...) and she estimated 1000cc's.  I don't know what the end estimate was, but I could barely get up on my feet for the first week and couldn't carry my 10lb 14oz baby around for nearly 2.

eeeeeeeeeek!  I am really sorry that happened to you.  That is my biggest fear.... I have read stories of OB's planting their feet against the bed to yank the placenta out (ouch!).  On the other hand I have read that if it is done right that it can reduce risk of hemorrhage and retained placenta. 

In case anyone is interested...I asked my OB today and I guess you can delay cord clamping and still have active managment of the third stage if that is what you want. 

[1love4ever]

I dont think that in a normal healthy pregnancy/birth, a shot of pitocin is routinely necessary.  It is often given for liability reasons, just like when babies get antibiotic eye drops.  As long as the mom has a high intake of vitamin K there should be a minimal risk of hemmorage.  Another reason that I have heard of the pitocin shot being given although I have not researched it, is so that the placenta can be delivered faster so that the Dr can be there for less time.

[hjdmom24]

With my last birth I had it in my birth plan that I wanted delayed clamping. Due to a mix up an OB I had never met came in for the delivery. He never said a word to me about it..although he had seen my plan hours before and just went ahead and clamped the cord right away. Both my doula and I questioned him (I was pissed) and he said if I didn't want the pit and traction that was how it had to be done! I am still so upset that he never came in and discussed it with me or gave me any options. But it's interesting that he made it sound like if I would have taken the pit he would have done it and others are being told it can't be done because of the pit.