Is when to clamp the cord really a controversy? - Mothering Forums

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Old 04-23-2010, 12:54 AM - Thread Starter
 
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I spend a bit of time tonight talking to a nurse who said that there is a bit of controversy over whether delaying cord clamping actually has any benefits. She said that there are risks for not clamping the cord right away and that it's especially bad to wait if the mom is diabetic or the baby is preterm.

When I got home, I read everything I could about cord clamping and all of the literature I can find is in favor of DCC (delayed cord clamping) and says that there's only benefit to waiting, no real risk.

So what's the deal?

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Old 04-23-2010, 01:59 AM
 
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I don't get it either. I hear reasoning like the baby will get too much blood (one doc even says "the baby will explode"). I also hear that the baby will lose blood if you don't clamp immediately. I don't know about pre-term/diabetic/not normal birth, but it seems ridiculous to think that a physiological third stage (placenta empties of blood, baby gets all its cord blood, cord clamps itself) is somehow dangerous.

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Old 04-23-2010, 08:45 AM
 
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I have thought that was interesting also. When I took my HB baby into the hospital they were very suspect of his blood attributes, things were higher and odder then the quick cutting hospital babies were (i'm sorry I don't remember exactly which parts they were overtly concerned with) They were REALLY FREAKED OUT and I have no idea why, they tried their hardest to find something wrong with him but he was just slightly dehydrated. I bet his blood seemed different because of the delayed cord clamping so he had MORE stuff then what they are used to and to them that was bad, dangerous, scary.

Anyway I also wonder WHY the general MS medical community is freaked by it.
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Old 04-23-2010, 12:20 PM
 
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It is interesting that she thought it was especially bad to wait if the baby is preterm since those are the babies that show the most benefit:

http://www.sciencedaily.com/releases/2007/08/070816193328.htm

Quote:
For pre-term babies the beneficial effects of delayed clamping may be greater, he says. Although the studies are smaller, delayed clamping is consistently associated with reductions in anaemia, bleeding in the brain (intraventricular haemorrhage), and the need for transfusion.

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Old 04-23-2010, 12:29 PM
 
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yup, the latest evidence does overwhelmingly support delayed cord clamping. Perhaps they are, sadly, just not up to date?

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Old 04-23-2010, 03:16 PM
 
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We had a client once whose baby got polycythemia. It got pretty serious, and a unilateral decision was made to clamp immediately with the next birth. The next baby didn't get it. I get clamping early if mom has a history of polycythemia.
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Old 04-23-2010, 06:40 PM
 
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NICU staff is currently trying to institute delayed cord clamping for preterm infants at our hospital to improve outcomes-so there must be some evidence to suggest it's beneficial.
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Old 04-23-2010, 07:38 PM
 
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It was explained to me that the placenta can hold up to 1/3 of the baby's blood volume. (an adult would probably go into shock if they lost 1/3 of their volume) When there is a delay in cord clamping, the baby will receive all of it's blood. If the baby is held at the same level as the placenta (on the mom's chest for example) then the vein and arteries in the cord will be able to equalize the baby's blood volume. If the baby doesn't have all of his/her blood that it needs, organs will shut down or not work properly. (Think of when you get cold and heat goes from your extermities to your organs where it is most needed.

Another reason delayed cord clamping is better is because some babies are slow to start. The cord can be the baby's lifeline for oxygen for a short time until he/she starts breathing. Cut the cord and you've lost your temporary back up.

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Old 04-23-2010, 07:54 PM
 
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NICU staff is currently trying to institute delayed cord clamping for preterm infants at our hospital to improve outcomes-so there must be some evidence to suggest it's beneficial.
I know what you mean, and I'm an AVID supporter of avoiding premature cord clamping (I prefer that to saying "delay" cord clamping) - but I had to snort. Just because NICUs are doing something doesn't mean it's evidence-based. The whole premature cord clamping thing being standard these days is a good example.

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Old 04-23-2010, 08:13 PM
 
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Some studies that were publicized last year found a higher incidence of physiological jaundice (that is, normal low level jaundice at 3-5 days old from the red blood cells normalizing) in delayed clamped babies. Let's see, jaundice vs anemia, tough choice .
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Old 04-23-2010, 08:42 PM
 
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Originally Posted by phathui5 View Post
I spend a bit of time tonight talking to a nurse who said that there is a bit of controversy over whether delaying cord clamping actually has any benefits. She said that there are risks for not clamping the cord right away and that it's especially bad to wait if the mom is diabetic or the baby is preterm.

When I got home, I read everything I could about cord clamping and all of the literature I can find is in favor of DCC (delayed cord clamping) and says that there's only benefit to waiting, no real risk.

So what's the deal?
The nurse is lying, the science on this is rock solid on favor of delayed clamping, even for preemies.
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Old 04-23-2010, 10:38 PM
 
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Originally Posted by JamieCatheryn View Post
Some studies that were publicized last year found a higher incidence of physiological jaundice (that is, normal low level jaundice at 3-5 days old from the red blood cells normalizing) in delayed clamped babies. Let's see, jaundice vs anemia, tough choice .
I read something somewhere that suggested that there is a benefit to bilirubin to the brain. I can't for the life of me remember where but I'm going to find it. When I do, I'll post it up.

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Old 04-23-2010, 11:04 PM - Thread Starter
 
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Thanks everybody. It didn't sound right to me.

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Old 04-23-2010, 11:46 PM
 
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http://pediatrics.aappublications.or...ull/113/6/1776

Excerpt:
why would nature develop a system that generates "elevated" bilirubin levels in a high proportion of all neonates? Nature may not be altogether foolhardy, as the mildly to moderately elevated levels of bilirubin in neonates are not always toxic. In 1965, in this journal, Wishingrad and associates14,15 argued that hyperbilirubinemia of premature infants is not as deleterious as previously thought.


and

The combined evidence from animal and human studies indicates that bilirubin is a major physiologic cytoprotectant. A protective action of modest levels of bilirubin does not alter the well-established dangers of kernicterus associated with major elevations of serum bilirubin.

Uric acid was once regarded solely as a toxic metabolite responsible for gout, whereas it is now increasingly appreciated as an antioxidant.86 Similarly, physiologic antioxidant roles for bilirubin may detoxify its traditionally nefarious reputation.

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Old 04-24-2010, 06:54 PM
 
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Another reason delayed cord clamping is better is because some babies are slow to start. The cord can be the baby's lifeline for oxygen for a short time until he/she starts breathing. Cut the cord and you've lost your temporary back up.
This was my 2nd baby! It took the midwife a good 10 minutes to get her to pink up. In the hospital I am sure she would have been whisked away to be worked on when all she needed was a little massage and a little time.

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Old 04-24-2010, 06:57 PM
 
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(one doc even says "the baby will explode").

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Old 04-24-2010, 10:54 PM
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Originally Posted by onlyboys View Post
We had a client once whose baby got polycythemia. It got pretty serious, and a unilateral decision was made to clamp immediately with the next birth. The next baby didn't get it. I get clamping early if mom has a history of polycythemia.
After delayed cord clamping, many babies will develop transient polycythemia that resolves within 24-48 hours. I am not that knowlegable about the topic, is there a condition that makes it more dangerous?

Editing to change it from "most" babies to "many" babies after checking the numbers. 20% more babies develop polycythemia after DCC than after immediate clamping according to cochrane- but these babies are asymptomatic and no issues result. My textbook (I think Blackburn) says that most babies develop polycythemia after DCC with no issues resulting from it.
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Old 04-25-2010, 12:34 AM
 
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I always think it's interesting that medical science has determined what the "correct" levels (for bili or polycythemia) based on premature cord clamping when in fact those levels may actually be far below "normal" physiologically. If delayed cord clamping is actually the biological norm, then all the "normals" are actually artificially low, yes?

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Old 04-25-2010, 01:22 AM
 
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Makes sense to me!


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Old 04-25-2010, 02:18 AM
 
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The mention of polycythemia got me googling and thinking. We've done delayed cord clamping for my kids, and they've been rather red as newborns. I just thought it was because normal, or because their skin was so thin/transparent when they were new. Incidentally, my oldest didn't have delayed cord clamping and she was yellow -- a mild case of jaundice.

A random stranger asked if my youngest was homebirthed when she saw him at 4 or 5 days old. She said that she thought maybe he was because of how red he was -- that she had noticed that homebirthed babies tended to be red (I think I must give off homebirther vibes, or my use of a sling makes people think that?? I've been asked MANY times if he was born at home.) I had never heard of such a thing. Anyway... is she be right? Is the average homebirthed baby redder than the average hospital birth baby, because of delayed cord clamping? Does that extra blood volume change the newborn's physical appearance?
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Old 04-25-2010, 01:07 PM
 
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Originally Posted by onlyboys View Post
We had a client once whose baby got polycythemia. It got pretty serious, and a unilateral decision was made to clamp immediately with the next birth. The next baby didn't get it. I get clamping early if mom has a history of polycythemia.
The thing about this is that if it really is due to placental blood then that was the baby's blood to begin with. I'd worry about the risks to the next baby of depriving them of so much of their blood supply.

Anecdotally I only know one person who has had a newborn with polycythemia. It was her third baby, first and second were fine. She went on to have two more babies and both of them were fine too. #1-4 were born in the hospital so I don't know how long their cords were left to pulse (including #3 who was also hospital born), #5 was homebirthed. I was present, and while I believe Mom would've waited longer for the cord to be cut if she'd been asked it was certainly left pulsing much longer than is standard in our local hospital.

Since polycythemia is a condition of the baby, not of Mom, would there really be a history of it based on whether or not same Mom is delivering another baby?

Also when I was doing some research on polycythemia all causes are lumped together it seems, with placental transfusion being only one of them. I'd be interested to see real research on how "dangerous" it is if baby "just" has their full blood volume transferred, with no other underlying issues.

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Old 05-15-2010, 08:37 PM
 
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How long do they suggest waiting until the cord is clamped?

Nicolle mommy to Kasey (11.16.08-12.19.08) Expecting baby girl 6.11.10
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Old 05-16-2010, 11:22 AM
 
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How long do they suggest waiting until the cord is clamped?
If for purely blood volume reasons, 2 minutes in a good aim (you can get all this info at Karen Strange's NRP workshop). That doesn't mean there aren't other good reasons to continue to delay, but simply that the majority of blood volume exchange has occurred by then. Hospital birthers can bargain with their doctors for a 2 min delay as opposed to saying "when it quits pulsing". Some doctors are going to be a lot more open to waiting 2 min than some open-ended amount of time in which they can't just leave because their job isn't done.
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Old 05-17-2010, 11:06 PM - Thread Starter
 
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I had the priviledge of sitting in Karen Strange's workshop today on the baby's experience of being born. She said that if you can even get the doctor to wait 40 seconds, the baby can get a lot of their blood volume back.

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