any medical reason at all for cutting the cord? - Mothering Forums

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Old 08-15-2009, 10:49 AM - Thread Starter
 
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I had a student in my childbirth class ask me why they clamp the cord so quickly, if there are so many good reasons not to. Does anyone know why they do it? Is it just to get on with things and check it off the list?

(I am talking about in non-emergency situations.)

Thanks!
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Old 08-15-2009, 11:07 AM
 
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Yes, I believe it is for the sake of getting on with it for the doc. They ignore all the research about resulting health issues.
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Old 08-15-2009, 11:40 AM - Thread Starter
 
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Wow. Sadly, that's what I thought. Thanks.
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Old 08-15-2009, 12:35 PM
 
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Ironically my birth was an emergency and the midwife still let the cord pulse for a few minutes. Better than nothing???

:CLC,Doula :Mama to 2
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Old 08-15-2009, 12:48 PM
 
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THe short answer is NO.

But cutting the cord makes it much easier for the doc/nurses to gain immediate and total control over babies, to do as they like to do with neonates....evidence-based or not (mostly, NOT).
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Old 08-15-2009, 01:12 PM
 
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Once the cord is cut, the OB is no longer responsable or liable for the baby, the neonatal staff is.
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Old 08-15-2009, 01:26 PM
 
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Actually there is a reason they cut the cord quickly, because MD's believe it prevents jaundice. It is believed but not evidenced based, that waiting too long could allow an excess of red blood cells to thicken a baby's blood, possibly stressing the newborn's heart and breathing or even prompting jaundice or brain damage.

That's not true, but it's still deeply ingrained in medical academia and transferred to hospital culture. So they still do this, i don't think it's any big conspiracy, it's just routine as most care is done to a newborn in a hosptial. When parents ask they almost universally allow you to wait.
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Old 08-15-2009, 05:02 PM
 
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so at birth often we don't cut cords but just deliver the placenta- depends on how long the cord is and if mom needs to get up to push the placenta out-

there are some very old studies that pretty much match up with what they are coming out with now as far as delayed cord cutting- I think there is one fairly large study on waiting 5 minutes that was published in the 50s

but how the hospital is set up- the neonatal staff do resuscitation in the isolette
that has a lamp warmer and the wall suction and room for supportive help and all the other things like bag/mask, meds... hard to get that baby onto that setup without cutting a cord- generally an OB just hands a baby off- at home we not only catch but are the ones responsible for starting resuscitation if needed so often do not need to cut the cord to start resuscitation
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Old 08-16-2009, 05:50 PM
 
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I have always read that the baby is still getting blood and oxygen until the cord stops pulsating and never questioned that.

But what is generally believed is that the baby no longer gets blood or oxygen after it starts breathing on its own. Even my midwife with my current pregnancy (a CPM) said this.

Does someone have a link or can explain exactly how this whole cord thing works? (I'm a CBE in training by the way.)
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Old 08-16-2009, 07:14 PM
 
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Quote:
Originally Posted by MichelleAnnette View Post
I have always read that the baby is still getting blood and oxygen until the cord stops pulsating and never questioned that.

But what is generally believed is that the baby no longer gets blood or oxygen after it starts breathing on its own. Even my midwife with my current pregnancy (a CPM) said this.

Does someone have a link or can explain exactly how this whole cord thing works? (I'm a CBE in training by the way.)
http://en.wikipedia.org/wiki/Umbilical_cord
Wikipedia is a good start, it sites some studies.
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Old 08-16-2009, 08:03 PM
 
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I always thought they cut the cord because of pitocin use in managing 3rd stage labor that is common in hospitals.
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Old 08-16-2009, 08:34 PM
 
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I am under the impression that the cord is clamped after the first twin is born in order to keep the placenta from detaching, risking bleeding for mom and stressing twin #two.

That's the only non-emergency reason I know for cord clamping and cutting.
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Old 08-16-2009, 10:03 PM
 
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Quote:
Originally Posted by sweet.p View Post
Actually there is a reason they cut the cord quickly, because MD's believe it prevents jaundice. It is believed but not evidenced based, that waiting too long could allow an excess of red blood cells to thicken a baby's blood, possibly stressing the newborn's heart and breathing or even prompting jaundice or brain damage.

That's not true, but it's still deeply ingrained in medical academia and transferred to hospital culture. So they still do this, i don't think it's any big conspiracy, it's just routine as most care is done to a newborn in a hosptial. When parents ask they almost universally allow you to wait.


Ummm, yes, it **IS** evidence-based. Hopefully anyone working in the birth world is familiar with the Cochrane Database:

http://www.cochrane.org/reviews/en/ab004074.html


Now whether or not the bilirubin levels they consider to be clinically significant really ARE clinically significant, or merely skewed by decades of cord clamping and resulting skewed numbers, that's another matter. And certainly most people I work tend to err on the side of allowing the cord to fully pulsate. But the jaundice issue isn't just pulled from nowhere.

I'd also like to see some research on the bilirubin levels of babies born after unmedicated births with fully-pulsed cords, vs. the bilirubin levels of those who had epidurals/narcotics and allowed the cord to pulsate. So much of our research is skewed by studying ABNORMAL birth.
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Old 08-16-2009, 10:13 PM - Thread Starter
 
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Well, this is what makes me think then, maybe there's actually something to jaundice that somehow benefits a baby. I mean, I just really cannot believe that the design is so flawed that babies would be born and have that need for the cord to be immediately clamped or else. How did we survive as a species if that were the case?

My second child actually did have some jaundice, and he was the one baby that I allowed the cord to stop pulsing before clamping. But, I was told it was the kind that was no big deal, would just go away on its own, and it did. it was the kind that starts later and then lasts longer, but they don't do anything to treat it. Our family doctor called it "breastmilk jaundice" but I don't know the right term for it. But, there was never any concern about it at all. Makes me wonder if there is something there. I am off to read the research I guess.

ETA: Actually I am not remembering now if it was actually "breastmilk jaundice" or not. All I remember is that no one was at all concerned about it, they didn't even monitor it or anything and it was all perfectly fine.
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Old 08-16-2009, 10:30 PM
 
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Do you have to cut or clamp the cord in a twin birth before the second twin is born?

Lindsay: DS#1 (06/06) DD#1 (09/07) DS#2 (10/08) DD#2 (06/09). AND A BABY DUE NOVEMBER 2013

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Old 08-16-2009, 11:38 PM
 
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Totally anectodal but all of my kids have had jaundice. The worse had her cord cut pretty quickly, my first was cut immediately, and my third we waited a good 10 minutes. Oddly she had the longest case of jaundice but was the only one who didnt need any treatment for it, as it was mild. She was jaundice for over 10 weeks-but again, her levels were low and treatment wasnt necessary. She was just a slightly more sleepy baby, which made those first couple of months much easier on me!

My fourth also had his cut immediately, but he was a preemie so I think jaundice was expected.

Cari-mama to Eriq, Lile, Paikea, Kaidyn, and Mieke is here!! 2/9/10
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Old 08-17-2009, 12:20 AM
 
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If they were truly concerned about jaundice, wouldn't they also be working hard to lower vacuum assisted births? That bruising increases jaundice. So they should be having more women birth upright or on all fours and provide doulas to lower the epidural rates.... but they only seem to let the "evidence" impact their practice when it also makes it faster/quicker/easier for the care provider!
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Old 08-17-2009, 06:34 PM
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Quote:
Originally Posted by JessicaE View Post
Ummm, yes, it **IS** evidence-based. Hopefully anyone working in the birth world is familiar with the Cochrane Database:

http://www.cochrane.org/reviews/en/ab004074.html


Now whether or not the bilirubin levels they consider to be clinically significant really ARE clinically significant, or merely skewed by decades of cord clamping and resulting skewed numbers, that's another matter. And certainly most people I work tend to err on the side of allowing the cord to fully pulsate. But the jaundice issue isn't just pulled from nowhere.

I'd also like to see some research on the bilirubin levels of babies born after unmedicated births with fully-pulsed cords, vs. the bilirubin levels of those who had epidurals/narcotics and allowed the cord to pulsate. So much of our research is skewed by studying ABNORMAL birth.
Words right out of my mouth. According to my textbook the transient polycythemia resolves within 24 hours and does result in increased jaundice.
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Old 08-17-2009, 06:38 PM - Thread Starter
 
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So, I'm confused now. Does delayed cord clamping result in increased levels of jaundice that ARE clinically significant OR deleterious in some way? Or not? Or no one knows for sure?
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