Is it possible to delay cord clamping after pit has been given?

[tree_hugger]

Hi everyone,

I was at a birth last night where baby was born quite quickly and was slightly shocked and a bit bruised.

The baby was a bit purple and slow to breath, so the MW clamped his cord (placenta had not been delivered yet) and took him to the table for about 30 seconds or so of oxygen.

I thought it would have been better to leave him attached, as he still would have been getting oxygen via the placenta, then I realised mum had been given pit in her IV, so would this mean there was no more oxygen coming to the baby via the cord?

:

[sevenkids]

Well, if mom is given pit in labour, the cord is still attached, right? The only thing that I think would happen is the placenta seperating sooner due to the pitocin clamping down the uterus. Anyway, I've been to hospital births with pitocin augmentation/induction and cord clamping was delayed (by hospital standards) Compromised babies always benefit from delayed cord clamping + resuc efforts.

Was this a hospital birth? Was the O2 unit attached to the wall?

[wendy1221]

That's weird. I had my 3rd in a pool in my bedroom and he wasn't breathing at first. After a bit of vigorous rubbing from me, dh, and mw, the mw got her puffer thing (sorry, I forgot what is is called. I'm not a professional obviously. ) and O2 and puffed him a few times and gave him O2. He never left my arms or the water. He started breathing and was fine before the placenta was even delivered. THe cord wasn't clamped or cut for a while even after that. My mw believes strongly in letting the mom and baby bond as much as possible immediately after birth and baby doesn't leave mom's arms for at least an hour, barring an emergency, of course.

But as for still getting oxygen from the placenta, that doesn't really happen. After the baby is born, the placenta starts detaching pretty much right away, so it is no longer taking oxygen from the mom's blood to pass to the baby. So no, the baby would no longer getting oxygen from the placenta. But that still doesn't mean the baby had to be take n away.

[tree_hugger]

Originally Posted by sevenkids

Well, if mom is given pit in labour, the cord is still attached, right? The only thing that I think would happen is the placenta seperating sooner due to the pitocin clamping down the uterus. Anyway, I've been to hospital births with pitocin augmentation/induction and cord clamping was delayed (by hospital standards) Compromised babies always benefit from delayed cord clamping + resuc efforts.

Was this a hospital birth? Was the O2 unit attached to the wall?

Sorry, I should have been more clear. It was a hospital birth and the 02 was attached to the wall, so it wouldn't have reached the baby where they were.

The pit was only given as the baby was born to aid the third stage - otherwise it was a natural birth.

I guess what I really wanted to know was would the baby still have been getting O2 from the placenta at this point, or was it really better to cut his cord and take him to the table for O2.

[tree_hugger]

Thanks for your reply.

Originally Posted by wendy1221

But as for still getting oxygen from the placenta, that doesn't really happen. After the baby is born, the placenta starts detaching pretty much right away, so it is no longer taking oxygen from the mom's blood to pass to the baby. So no, the baby would no longer getting oxygen from the placenta. But that still doesn't mean the baby had to be take n away.

If this is the case, what is the benefit of delayed cord cutting? I always thought it was so the baby would continue receiving oxygenated blood from the placenta and make their transition to breathing with their respiratory system easier. Am I completely wrong on that?

[wendy1221]

No, it's because the baby's blood circulates through the cord to the placenta and back to the baby, so if you cut the cord before all of the blood has gone into the baby, the baby has lost some of its blood. It's b/c of blood, not oxygen. You need blood for a lot more than oxygen transport.

[Jane]

You can give pit and still wait for cord pulsation to stop before clamping. There's an english study that uses that very protocol as their standard active management protocol. It will, statistically, stop the pulsing sooner, cutting off that potential source of oxygen for the baby. But he/she will still likely get all the blood intended for him/her.
Pitocin exposure isn't dangerous to the baby - they are getting it all during labor, anyway. If you believe it crosses the blood-brain barrier, it's just the love hormone, anyway (some don't believe synthetic oxytocins get through).

[bionicsquirrel]

Originally Posted by wendy1221

No, it's because the baby's blood circulates through the cord to the placenta and back to the baby, so if you cut the cord before all of the blood has gone into the baby, the baby has lost some of its blood. It's b/c of blood, not oxygen. You need blood for a lot more than oxygen transport.

I understand this, it helps prevent anemia as well, but I always understood that the baby is receiving oxygen from the mother until the cord is clamped or stops pulsating.
Could you please provide your research that contradicts this?

[mwherbs]

often we don't clamp and cut until sometime after the placenta is out-- sometimes before just depends- but sure a shot of pit can occur before you clamp and cut but the shot may cause it to shut down sooner.

[tree_hugger]

Originally Posted by bionicsquirrel

I understand this, it helps prevent anemia as well, but I always understood that the baby is receiving oxygen from the mother until the cord is clamped or stops pulsating.
Could you please provide your research that contradicts this?

That's what I thought too. That's why I wondered if it would have been better to leave him attached.

[wendy1221]

Originally Posted by bionicsquirrel

I understand this, it helps prevent anemia as well, but I always understood that the baby is receiving oxygen from the mother until the cord is clamped or stops pulsating.
Could you please provide your research that contradicts this?

The cord stops pulsing within a few minutes. My 3rd ds didn't breath when he was first born. If the placenta was still delivering O2 according to you, why did he start turning blue? I mean within minutes of birth he started turning lavender, and we started massaging him trying to get him to breath. It was pure instinct for me to start rubbing him, and to do it harder and harder the longer he didn't breath. He also started going limp. This was lack of oxygen, and the cord was not clamped, and I had not delivered the placenta yet.

I think if you think it through logically, you can just see that it isn't possible for the placenta to keep supplying oxygen for more than a couple minutes after birth (I'm talking like 1-3 min.) You don't disagree that the placenta starts detaching when the baby is born, right? So how does the placenta get oxygen in the first place? It doesn't just conjure it up itself, it gets it from the mother's blood via its attachment to the uterus. When it starts detaching, it stops taking up blood from the uterus, therefor no more oxygen in circulation.

Maybe later if I have time I'll find some references.

[wendy1221]

OK, I tried looking stuff up. I had a really hard time finding anyhting. I usually search Medline, but my dh must have changed his password. From what I have found, they don't really know, BUT they do know the placenta stops supplying oxygen shortly after birth b/c if babies don't breath right away they have problems. If the placenta kept supplying O2, there wouldn't be any problems, right?

Here's what I did find: http://www.springerlink.com/content/w254270608n13qv7/
In this article, it mentions that low O2 sats at birth indicate thta it is normal for the placenta to start detaching even before birth. It's also normal for it not to, indicated by the higher O2 sats at birth. So maybe it is possible for some women to continue passing oxygen through the placenta to the baby after birth, but not for long.

This is the 2nd thing I found. http://www.madsci.org/posts/archives...9642.An.r.html The 2nd part is more helpful, imo. It mentions how if the cord is not cut right away, it constricts on its own, effectively cutting off all circulation. If you talk to a midwife about cord clamping and cutting, they'll likely tell you that it's not really necessary to clamp the cord before cutting in most cases, b/c it is already constricted if you wait long enough (if you wait until after the placenta is delivered is probably long enough.) But there are rare cases where it will continue to seep or bleed, so they clamp all babies just in case.

I also found some articles talking about how it's important for breathing fo rthe baby to receive all of the blood from the cord/placenta, so don't cut it right away. But this is because the baby needs the "extra" blood in there b/c now with lung function, it's no longer "extra" blood, but necessary blood for the lungs to function properly. They don't use their lungs in the womb, so the blood in the cord isn't in their body and that's fine but after birth, they need that blood in their bodies.

Btw, my 2 younger boys have von Willebrand Disease, a very common mild bleeding disorder. They both had problems with the cord site bleeding after the cord had fallen off of their belly button. So when the cord is seeping or whatever if it is cut but not clamped, it's probably due to a case like my boys' where the baby's blood is not clotting correctly, not because there is still blood flowing between the placenta and baby.

[SophieAnn]

Here is an article on cord clamping that I have bookmarked to read in the future. I haven't read all the way through it, but it gets very specific with regards to blood flow, oxygen and what happens in the moments following birth.

http://www.cordclamp.com/Why%20Do%20Babies%20Cr1.htm

Maybe this will help.

[wendy1221]

Thank you. That was very interesting. Especially that they cited the unusual case where it took 20 minutes for the baby to receive all of the placental blood. And I was wrong with my 1-3 minute estimate, it's actually 3-4 in most cases. So I guess it is possible, but very unlikely, for a baby to continue received oxygenated blood from the placenta for up to 20 min. For most babies, the placenta is done after 3-4 minutes. If the baby hasn't breathed on his own by then, you have to start resuscitation. I know for my babies, all born in the squatting position, so gravity helped them get their cord blood faster, their cords stopped pulsing within a minute or 2 (maybe it was a little longer and time was flying for me post birth, but it was definitely less than 5 minutes.) It looks like a live part of their body while it is pulsing, and when it stops, it gets thin and lifeless. It's very noticeable if you actually pay attention to it.

I have pictures of ds3's birth. First, he's born, I pull him out of the water, he's waving his arms and he's red. Then w/ each picture, you can see him getting paler and more blue until the last picture, the midwife and I both look very concerned and we are actively rubbing a limp baby. At that point, my sister stopped taking pictures and my midwife suctioned him, puffed his lungs a few times, and then held the O2 mask over his face. This was all while I was still holding him, cord uncompromised, placenta not yet delivered. I do always deliver the placenta within 10 mins of birth, though, so perhaps I am on the faster end of placental detachment.

[Jane]

I don't think it's likely that there is much oxygenation occuring in a normal birth. But, if possible, I think intact cord resusitation should be the goal. It's proven that low blood volume hinders resusitation - the baby needs that volume whether it's oxygenated or not.
And it's possible that oxygenation is occuring - some small amount it better than nothing.
In a severely depressed infant, the sequences of cord compression and cessation of in-utero function may also be delayed, potentially meaning those sickest babies (the ones not switching over) are most likely to get some oxygen.
Also, after a traumatic birth, the uterus can be atonic, as we all know that pph often accompanies difficult second stages or shoulder dystocia. If the uterus doesn't contract properly, there is likely to be continued oxygenation.

[bionicsquirrel]

Originally Posted by Apricot

I don't think it's likely that there is much oxygenation occuring in a normal birth. But, if possible, I think intact cord resusitation should be the goal. It's proven that low blood volume hinders resusitation - the baby needs that volume whether it's oxygenated or not.
And it's possible that oxygenation is occuring - some small amount it better than nothing.
In a severely depressed infant, the sequences of cord compression and cessation of in-utero function may also be delayed, potentially meaning those sickest babies (the ones not switching over) are most likely to get some oxygen.
Also, after a traumatic birth, the uterus can be atonic, as we all know that pph often accompanies difficult second stages or shoulder dystocia. If the uterus doesn't contract properly, there is likely to be continued oxygenation.

Well said. This is what I agree with. I don't think that the only reason for delayed cutting is oxygenation, but I do think it is one of the reason.

Also, I have attended births where the cord pulsed for a good 10 minutes after birth and the placent did not separate until pulsing stopped. Other births where the placenta didn't seperate for a couple of hours. I don't think it is true that what applies to one birth and baby will apply to another.
It seems that we all are on the same page though in terms of thinking that a cord is better left uncut until pulsating stops.

[wendy1221]

Originally Posted by bionicsquirrel

It seems that we all are on the same page though in terms of thinking that a cord is better left uncut until pulsating stops.

Definitely. I would go even further than that. I believe it should wait until after the placenta has been delivered, because even though the bulk of the blood is delivered within a few minutes in most cases, who is to say they aren't getting that last little bit? With my next baby, due the end of July, I think I might even wait until a few hours after birth. I never really felt an attachment to the cord, with my first 2 we waited till after it stopped pulsing, a few minutes, and with my 3rd until after the placenta was born, I just want to see what it's like to wait even longer. I'm not into the idea of lotus birth, though. Placentas are a little too gross to carry around for a few days. LOL. I'm more likely to eat my placenta than carry it around attached to the baby until it falls off on it's own. Everybody has their own ideas on that sort of thing.

[swissmiss2584]

I believe that babies can be born blue and not breathing because of the "blue Face" pushing the mother is told to do. If the mother would only push for 5 to 6 seconds and not 10 long seconds then the baby would be getting adequate O2 from the mother. They would have O2 storage in the placenta and cord if the mother is pushing at her own rate and breathing regularly intead of pushing to 10 one right after the other like most are told to do in hospitals. I believe they would still get O2 through the cord and placenta if the mother wasn't holding her breathe for most of the time.

[momileigh]

Originally Posted by wendy1221

So I guess it is possible, but very unlikely, for a baby to continue received oxygenated blood from the placenta for up to 20 min. For most babies, the placenta is done after 3-4 minutes. If the baby hasn't breathed on his own by then, you have to start resuscitation.

What about those videos of water births from back in the 70s where the baby was left underwater for 10 minutes or more? They waited for the baby to surface on its own, all the while feeling the cord pulsing. They stopped doing that because there were a couple deaths according to what I was told in class... but that was the exception, not the rule. I don't notice that most placentas detach immediately. It usually takes 11 minutes or so IME. (I just compiled my statistics the other night.) I wonder if it has something to do with the style of birth.

[Jane]

Cold air/differences in temperature is one way the cord is signalled to begin to cease flow. Breathing is another step - babies underwater are prevented from access to the signals (breathing, temp change, cooling) for the cord to stop pulsing.