Is it possible to delay cord clamping after pit has been given? - Page 2

[nashvillemidwife]

They really left the babies underwater for 10+ minutes? I've never heard that. I do know that whenever I've watched the baby swim around in a waterbirth video is seems a lot longer than it really is.

[mwherbs]

I don't know where you can see those films- yes they held babies down under water- if you watch some of the babies start posturing not good


no one knows completely how it all juggles out-
as the baby moves through the birth canal the lungs/chest are compressed this causes some blood displacement toward the placenta - because the body is compressed , with a change in pressure-you have some lung expansion an in influx of blood that has been in the placental bed- the capillaries and aveoli get a flush of blood, in about a minute the blood flowing from the baby back toward the placenta slows and the baby collects blood coming from the placenta-- oxygen levels should be increasing here and a change in pH
complete change over in circulation shunting takes a while 1hr-3 postpartum usually --
Karen Strange is who to ask about this info--

[momileigh]

I took NRP from Karen Strange and I LOVED it! I agree, she would be a great person to talk to about this.

The films I saw were part of my teacher's library. I don't know where she got them or anything. One in particular we saw about 5 minutes of footage of the baby underwater, but they were quoted as saying she was under for almost 20 min. A lot of the students in the class were freaking out watching the video. I just used it for myself to help me realize that we don't have to rush the baby out of the water. Even if we have the baby under for longer than we're used to, it is never more than a minute or so anyway.

[wendy1221]

Originally Posted by momileigh

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.

They don't completely detach immediately, they START detaching right away, big difference. The more the placenta is detached, the less of the mom's blood it's getting, so the less oxygen. It's just common sense.

I've seen those videos. I've never seen one where the baby was under for more than 4-5 minutes, it just feels like forever. As for claims that the baby is held under for 20 minutes, I would NEVER take that chance. It's just stupid, imo. What's the point?

[momileigh]

I don't know anyone who *would* take that chance, personally... I agree that its stupid, but if you've got some kind of philosophy that requires the baby to surface on its own for some reason and you believe it is important for this or that reason, that's why you do it. Just like there are people out there who believe it is really important for people to be rolled up in carpets and fight their way out to be rebirthed.

My point is that placentas don't detach that fast most of the time. It seemed to me people were saying that there is very little to zero oxygenation through the cord after a very short amount of time. If that were true, all those 5-10 minute water babies would have drowned.

[wendy1221]

I think that in the links, it's mentioned that either the baby reaching air or the cord reaching air is what they think triggers the cord to start limiting the blood pumped back to the placenta (so the baby is still getting the blood from the placenta, but it's not going back from the baby.) So it would make sense that some babies will be ok if left underwater for a while b/c no air (probably the temp change, not the actual air) triggered this reaction. But then again, one of the links about showed that for SOME babies, the placenta started detaching even before the baby was born, so it would be a disaster for these babies to not start breathing ASAP. And I can kinda get wanting to the baby to surface on his own. I also thought it might be cool to let the baby crawl on his own up to my chest (never did it, didn't feel right to not immediately pick the baby up to my breast on my own immediately.) But if the baby doesn't start surfacing fairly quickly, I can't understand how someone could leave him underwater for so long. It seems like it would go against our basic instinct to protect our young. I personally have a REALLY hard time going against my instincts. This is why I have NEVER claimed the "AP" label. I've never done anything but follow my instincts b/c that is all I'm capable of doing. It's nice when there's research to back them up, but if not, I'd do it anyway.

[mwherbs]

the air thing is just a guess-- there is also all kinds of beliefs about touching the cord will cause it to clamp down- but if that were true then the baby who touches the cord all the time- gets wrapped around the baby would shunt the cord--I believe that it does not have nerves so am not too sure that sensation of any kind is what effects the cord--

so here is a free full text article on anatomy of the umbilicus

http://www.pubmedcentral.nih.gov/art...bmedid=8655418

[wendy1221]

It doesn't have to have nerves for a cooler temperature to constrict it slightly or change the chemistry. Yes, it's just a guess, they really don't know, they just know something happens when the baby and cord are exposed to room temp air (which is much cooler than the womb of course. Makes we wonder about babies born in tropical places where the temp is close to 100 degrees, the same thing happens, doesn't it? So obviously this theory isn't perfect.)

[nashvillemidwife]

Conversely, does anything different happen to babies born in igloos?

[mwherbs]

so some of the things that have been studied- besides surfactant that develops in the lungs in prep for birth, babies also reduce their practice breathing movements and the lungs also produce less fluid in prep- the surface cells change and the sodium transport system changes- they are studying the sodium transport to try and figure out what to do to help treat problems--
since I have drawn off blood from cords and from placentas-- yes as it air dries and there is no continued circulation there is a change over- but I think it is inside the baby's body where the changes occur not the cord--

having done midwifery in both hot/very hot environments and very cold-- I would not say there is much difference in when the cord stops pulsing-- yes we try to keep rooms warmer for comfort but there is always many considerations during birth-- and in the summer here the outside temps can be 117- and indoor temps with a swamp cooler are probably 90 on those days and at 90 degrees cords stop pulsing and babies do breathe and I have seen births at 65 degrees-- and what about the Black Sea water births-- that is cool water a good percentage of the year

[riomidwife]

Originally Posted by Apricot

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.

apricot, can you explain your thinking here, on why baby will still get the complete blood volume intended following pit? thanks!