Baby on chest OR delaying cord clamping ... have to pick one? - Mothering Forums

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Old 01-25-2010, 06:09 PM - Thread Starter
 
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I just got back from my OB appointment, and I shared my birth preferences (I don't really like to say "plan") with my OB. She was cool with everything I listed -- which I was happy about since I'm a VBAC -- except for one thing.

She told me I'd basically have to choose between baby being placed on my chest immediately OR delaying cord clamping. Huh? I'd never heard that before.

Her reason was that if baby is placed on Mom's chest, then the cord is above the placenta, and baby doesn't get the added benefits of the extra cord blood because gravity does its job and makes the cord blood flow down and back toward the placenta anyway. I guess it kind of makes sense when explained that way, but I'd still never heard it and don't understand why we can't at least "try" doing both and see what happens. I mean, it can't hurt anything, right? If I delay clamping, she said they'd basically hold baby down lower than the placenta until the cord stopped pulsating.

So I want to look into this more and take my findings to her. Like I said, this is the only thing she told me that I wasn't happy with, and I was surprised to hear it, because I'd heard that delaying cord clamping is a pretty common thing nowadays.

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Old 01-25-2010, 06:19 PM
 
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I think as long as the cord is pulsing it is probably getting the blood to the baby regardless of gravity...it does that before the baby comes out, right?

But if she insists, instead of holding the baby below the placenta, why not hold the placenta above the baby, while he or she is on your chest? Surely someone could do that for you.

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Old 01-25-2010, 06:40 PM
 
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We just talked about this in my natural childbirth class, but it was not presented as an either/or. Basically the childbirth educators said that after the birth, the baby could be on the chest with the cord attached, possibly breastfeeding and you could deliver the placenta all at once. I will ask about the gravity issue.

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Old 01-25-2010, 06:47 PM
 
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Erm, I think the answer is in the request....you're waiting for the cord to stop PULSING. ACTIVELY pushing blood using YOUR blood pressure. Not for it to stop DRAINING. The point of delayed clamping is that the connection is still open and blood is still being pushed/circulated. I mean, does she argue that if the baby is above the placenta in the uterus it doesn't get blood flow? It's a pump, not a siphon.

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Old 01-25-2010, 06:52 PM
 
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Erm, I think the answer is in the request....you're waiting for the cord to stop PULSING. ACTIVELY pushing blood using YOUR blood pressure. Not for it to stop DRAINING. The point of delayed clamping is that the connection is still open and blood is still being pushed/circulated. I mean, does she argue that if the baby is above the placenta in the uterus it doesn't get blood flow? It's a pump, not a siphon.
yes, this. I sincerely hope that your OB doesn't really think that the baby would have to be below the placenta to receive all of his cord blood. Would she have a nurse hold the baby half way down to the floor if you chose to wait for the cord to stop pulsing over having the baby up on your chest??
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Old 01-25-2010, 06:53 PM
 
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If I delay clamping, she said they'd basically hold baby down lower than the placenta until the cord stopped pulsating.
I just can't picture this in my mind. So they will need to be holding the baby under the level you are? Are they going to put the baby on the floor? I mean, I just don't get this. Never have I heard such a thing. Not to mention that this theory is off the wall. If that were true, our heads would never get circulation. Do they know how circulation works? I mean sure, if you hold your hand in the air long enough, eventually it will start to get tingly, but it's not like NO blood is being sent there. I don't understand why it's an issue anyways. There are no ILL effects to doing both, even IF the baby doesn't receive the cord blood. You want your baby on your chest, and you don't want the doc cutting the cord. End of story. Why is it an issue?

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Old 01-25-2010, 07:14 PM
 
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If she is inflexible about this I don't think its a HUGE deal breaker in my world. for us as soon as dd came out the were sucking noses/wiping her nose off and then laid her on my stomach to clamp anyways...so maybe present this situation and ask if as a compromise the baby could be laid on your lower belly with you able to touch baby until the pulsin stops.
I am amazed someone can nurse while the cord is pulsing! I am fairly tall with a longish torso and I would be amazed if the cord could actually safely stay attached to me and baby while the baby was anywhere near my breasts. Maybe this is what she was thinking??
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Old 01-25-2010, 07:17 PM
 
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I just got back from my OB appointment, and I shared my birth preferences (I don't really like to say "plan") with my OB. She was cool with everything I listed -- which I was happy about since I'm a VBAC -- except for one thing.

She told me I'd basically have to choose between baby being placed on my chest immediately OR delaying cord clamping. Huh? I'd never heard that before.

Her reason was that if baby is placed on Mom's chest, then the cord is above the placenta, and baby doesn't get the added benefits of the extra cord blood because gravity does its job and makes the cord blood flow down and back toward the placenta anyway. I guess it kind of makes sense when explained that way, but I'd still never heard it and don't understand why we can't at least "try" doing both and see what happens. I mean, it can't hurt anything, right? If I delay clamping, she said they'd basically hold baby down lower than the placenta until the cord stopped pulsating.

So I want to look into this more and take my findings to her. Like I said, this is the only thing she told me that I wasn't happy with, and I was surprised to hear it, because I'd heard that delaying cord clamping is a pretty common thing nowadays.
Wow, mine said the exact same thing. Hope we both can find answers that will satisify our prefernces.

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Old 01-25-2010, 07:37 PM
 
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If she is inflexible about this I don't think its a HUGE deal breaker in my world. for us as soon as dd came out the were sucking noses/wiping her nose off and then laid her on my stomach to clamp anyways...so maybe present this situation and ask if as a compromise the baby could be laid on your lower belly with you able to touch baby until the pulsin stops.
I am amazed someone can nurse while the cord is pulsing! I am fairly tall with a longish torso and I would be amazed if the cord could actually safely stay attached to me and baby while the baby was anywhere near my breasts. Maybe this is what she was thinking??
The average length of an umbilical cord is about the same of the average length of a woman's torso from crotch to shoulders. Unless the baby had a short cord and the mother had a long torso, breast feeding with the cord attached shouldn't present a problem. Especially if the woman sits up. I don't think the OP should have to compromise on this to make her OB happy if there is no medical reason that she can't do it. I sure wouldn't. There is also no need to suction or wipe the baby right away, or at all. (I'm not trying to call you out or anything, just wanted to point out that in most cases these things shouldn't have to prevent immediate contact with mom).

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Old 01-25-2010, 07:41 PM
 
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Totally crazy. Many women have placenta previa (covering the cervix--ie, below the baby) early in their pregnancies with no ill effects. Pulsing/circulation is what's happening. Same thing at the end of the pregnancy, through to the point where it STOPS pulsing! Duh!!

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Old 01-25-2010, 07:52 PM
 
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Also the umbilical arteries close before the vein does. The baby continues to get oxygenated blood even after the arteries have stopped returning blood to the placenta.

I've heard this line from OBs before but less blood gets to the baby with immediate cord clamping than with an elevated baby. It is true that the baby gets the most when held below the level of the placenta, but babies do just fine when being held up by their moms.

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Old 01-25-2010, 08:23 PM
 
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The average length of an umbilical cord is about the same of the average length of a woman's torso from crotch to shoulders. Unless the baby had a short cord and the mother had a long torso, breast feeding with the cord attached shouldn't present a problem. Especially if the woman sits up. I don't think the OP should have to compromise on this to make her OB happy if there is no medical reason that she can't do it. I sure wouldn't. There is also no need to suction or wipe the baby right away, or at all. (I'm not trying to call you out or anything, just wanted to point out that in most cases these things shouldn't have to prevent immediate contact with mom).
The average cord length is roughly 22 inches. Measuring on myself from my vajayjay to breast is 21.5inches. That is simply not long enough, the cord will still be attached to the placenta which is attached somewhere along the wall of my uterous(sic??) which could be anywhere from another 3'' up to another 8''. In that case the only option would be me having to sit up and hunch over just to attempt to nurse.
I was merely sharing part of my birth story with my daughter and helping the op by sharing what I thought was a reasonable compromise...in other words basically what happened at my birth. My daughter was laid on my stomach within 30secs of being born, probably even less ( I wasn't counting) this is pretty immediate to me.
The op should not have to compromise just to make her doc happy but on the other hand if this is the only doc availble or she doesn't want another one then a compromise does indeed need to be reached.
I DO find it intresting that the doc seems to think the baby will get no blood from the PULSING cord if laid on the stomach...sometimes I do not think medical professionals think before they say things...
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Old 01-25-2010, 08:29 PM
 
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Intresting achived post about similar thing...
http://www.mothering.com/discussions...p/t-36965.html
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Old 01-25-2010, 08:43 PM
 
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It's a misinformed statement. Hopefully, you will be able to show her some information that proves it is unnecessary. I have seen tons of births where the baby is on mom's chest immediately and not a single one exsanguinated .

If you can't convince her and don't want to change providers, I have a doula friend who has had clients compromise by side-lying and having the baby lie next to them so the baby is on the same "level" as the placenta and you can also nurse, do skin-to-skin, etc. It shouldn't be necessary, but if you are stuck, this might work for you.

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Old 01-25-2010, 08:51 PM
 
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I agree with the pp's who said 'nonsense'. Apparently nature is flawed??

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Old 01-25-2010, 09:02 PM
 
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i wonder if what the doc was thinking about what having the baby higher once the placenta detached and was being birthed? i have heard that the open side can bleed and possible pull back some blood from a baby, since by then the pumping has completely stopped and gravity is at work.
but before the pulsing stops it seems a completely different story, it seems perfectly safe. the only issue i would see come up is if the cord were extra short and pulling the newborn to your chest tugged inappropriately on the placenta before it was ready to detach causing unnecessary bleeding.

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Old 01-25-2010, 09:52 PM
 
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You do not have to keep the baby lower. Someone in my birth class had their doc say the same thing and my birth instructor was incredibly passionate on how inaccurate that is. Whenever the uterus contracts blood moves regardless of where the baby is relative to the placenta. There is no need for holding the baby lower to get blood, just as the opposite is true, there is no need to squeeze the blood in the cord to the baby. The baby can easily be placed on your chest and have delayed clamping and receive its benefits. Our birth instructor was handing out copies of a study (I didn't need one...) to those people to educate their doctors on this subject. She noted that the research is done on the pediatric side of medicine and unfortunately OB's don't have the info .

I do know that there have been some studies where the control group was clamped right away and the experimental group was held below the placenta to use gravity - its possible those studies are the ones familiar to the doctor.

ETA - found studies that talks about baby positioning:
1. JAMA article: http://jama.ama-assn.org/cgi/content/full/297/11/1241

This part of the study says: "The favorable effect of late clamping on neonatal hematocrit at age 6 hours remained significant whether newborns were kept at the level of the placenta or placed on the mother's abdomen. The subgroup analyses for data collected for hematocrit at 24 to 48 hours and at age 5 days showed significant differences in favor of late clamping, irrespective of the level of the infant during the delayed time (hematocrit at 24-48 hours in infants kept above level of placenta [3 trials, 311 infants]: WMD, 6.08%; 95% CI, 4.63% to 7.54%; in infants kept at level of placenta [1 trial, 30 infants]: WMD, 16.00%; 95% CI, 12.05% to 19.05%. Hematocrit at 5 days in infants kept above level of placenta [2 trials, 60 infants]: WMD, 9.03%; 95% CI, 6.46% to 11.60%; in infants kept at level of placenta [2 trials, 60 infants]: WMD, 15.00%; 95% CI, 12.35% to 17.65%)."

(WMD = weighted mean difference)


2. Here is another study from the AAP which has the location of the babies for the study on their mothers' chests: http://pediatrics.aappublications.or...aef22e36d905 f

"For vaginal deliveries, newborns assigned to delayed cord clamping were held by mothers in their arms while waiting for the cord to be clamped. In the case of cesarean sections, newborns were placed on their mother's laps and swaddled to prevent heat loss. No additional interventions were performed. "

The babies had positive results with this study with the baby on the mother's chest.

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Old 01-25-2010, 10:40 PM
 
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The average cord length is roughly 22 inches. Measuring on myself from my vajayjay to breast is 21.5inches. That is simply not long enough, the cord will still be attached to the placenta which is attached somewhere along the wall of my uterous(sic??) which could be anywhere from another 3'' up to another 8''. In that case the only option would be me having to sit up and hunch over just to attempt to nurse.
I was merely sharing part of my birth story with my daughter and helping the op by sharing what I thought was a reasonable compromise...in other words basically what happened at my birth. My daughter was laid on my stomach within 30secs of being born, probably even less ( I wasn't counting) this is pretty immediate to me.
The op should not have to compromise just to make her doc happy but on the other hand if this is the only doc availble or she doesn't want another one then a compromise does indeed need to be reached.
I DO find it intresting that the doc seems to think the baby will get no blood from the PULSING cord if laid on the stomach...sometimes I do not think medical professionals think before they say things...
I didn't mean to diminish your situation or your previous birth. I hope you didn't take offense to it. Yes, I agree that nursing while the placenta is still attached (for you) would be difficult. Even if this became a concern for the OP though, she could still have babe placed on her belly directly after birth.

These kinds of things get my blood boiling a little because IMO they are an attempt by care providers to take more control of the birth. Logic and reason stand against what this OB is saying. Logically, even if what she said is true, cutting the cord won't be giving any cord blood to the baby either. It should be a non issue for the OB.

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Old 01-26-2010, 12:12 PM
 
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IMO, this is a control issue on the OBs part. It certainly doesn't HURT anything to leave the cord uncut while you have baby on your chest, so what's the big deal? It's YOUR baby, and YOUR birth. If you want them to not cut it, hold your baby and firmly and politely tell them not to cut the cord until you're ready. They may not like it, but I'm not having a baby to please the hospital staff.

Also, it should be known that I am a HB mom for these kinds of reasons. Illogical rules that are in place simply for the convenience of the staff infuriate me. Remember, you are paying them!

Good luck!
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Old 01-26-2010, 12:33 PM
 
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I had the same conversation with my doctor and I managed to convince her to agree to the delayed clamping and skin-to-skin contact by sharing research I had found (I can't find it now, unfortunately) that suggested that while keeping the baby below the level of the mother/placenta reduces the amount of time it takes for blood to flow from the placenta to the baby, putting the baby on the mother's belly/chest optimizes the flow so that the baby does not get too much blood (leading to jaundice) or too little. It just takes a few minutes to wait for the the cord to stop pulsing whereas I think it takes 1 minute if the baby is kept below the mother. She said she would wait at least a minute before clamping as long as the baby was not in distress.

In the end, delayed clamping was not an option for me because apparently there was meconium in the amniotic fluid, so my son had to be suctioned by the NICU team at birth, which meant immediate clamping and delayed skin-to-skin.

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Old 01-26-2010, 01:00 PM
 
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I DO find it intresting that the doc seems to think the baby will get no blood from the PULSING cord if laid on the stomach...sometimes I do not think medical professionals think before they say things...
I think they think about it, but think that we won't pick up on it....

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Old 01-26-2010, 01:06 PM
 
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In the end, delayed clamping was not an option for me because apparently there was meconium in the amniotic fluid, so my son had to be suctioned by the NICU team at birth, which meant immediate clamping and delayed skin-to-skin.
I don't undestand that either, sigh. I mean, I know that they will do it like that, but is there a real reason they have to take the baby AWAY to do it? Are they so inefficient at suctioning that it has to be done on a table well away from you?

Does it make sense to take a meconium baby off of life support, so to speak (cutting the cord)?

I know my homebirth midwife could have managed to suction the baby on my chest if need be (she didn't, but I'm just saying I'm certain she was capable of it). Why a doctor would not be, is beyond me.

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Old 01-26-2010, 01:11 PM
 
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This would make me wonder how misinformed my OB is in other areas... and make me veeeery leary to have such a person "in charge" at my birth.

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Old 01-26-2010, 01:23 PM
 
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I don't undestand that either, sigh. I mean, I know that they will do it like that, but is there a real reason they have to take the baby AWAY to do it? Are they so inefficient at suctioning that it has to be done on a table well away from you?
This was done in the same room, at least, but far enough away that I couldn't see what they were doing (I did get to watch them cut the cord and carry him over there). He was placed on my chest (briefly) when the NICU team was done with him. I didn't get to breastfeed him until after I was stitched up, which took an hour and a half.
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Does it make sense to take a meconium baby off of life support, so to speak (cutting the cord)?
I was wondering about this too, but I knew I was in no position to argue against hospital policy at that point. High risk babies do not have the option of delayed clamping (because apparently it prevents them from getting the help they need in time).

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Old 01-26-2010, 01:35 PM
 
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I was wondering about this too, but I knew I was in no position to argue against hospital policy at that point.
Oh, I KNOW.

I had a homebirth but admitted DD to the hospital for jaundice 3 days later. The hospital is a scary place, and it would be beyond me to have been making demands with all that hustle and bustle. I'm sure they had the cord clamped and cut before you could have even said "Wha..?" even if you had superwoman guts to argue with them, and even if you weren't worried about your baby which obviously you were.

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Old 01-26-2010, 01:35 PM
 
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Since I did research this extensively, I will say that I did see evidence that gravity can (and does) affect the blood flow from the placenta to baby and vice versa, but I don't think that putting the baby on the chest counts as lifting it high enough above the placenta.

Here are some of the links I looked at:
http://onyx-ii.com/birthsong/page.cfm?cord
http://www.sciencedaily.com/releases...0415194222.htm
http://magazine.lamaze.org/BuildingC...lt.aspx#expert

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Old 01-26-2010, 01:41 PM
 
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At least 3, maybe 4 of my babies went straight to my chest (I grow ridiculously long cords for some reason) after birth with no cord cutting. Their cords were cut a few minutes later. No harm to babies or me.

Karen, homeschooling Catholic mom to 8. #9 due 6/10
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Old 01-26-2010, 01:51 PM - Thread Starter
 
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Thanks for all the great information, ladies!

And JenBuckyfan, thanks for the links to the studies. I will share them with my OB at my next appointment. She's a reasonable woman, so I don't think she'll give me a hard time. And if she does, I'll just drop the subject for now and then demand at my baby's birth that she do what I want.

Married 6.10.06   Mommied 4.17.08 and 4.12.10

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Old 01-26-2010, 02:20 PM
 
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Well at my recent hb, I pushed the baby out on hands and knees, the mw passed her into my arms through my legs, people helped me sit back up on the birthstool, then eventually escorted me to lay down in the bed to deliver the placenta. I did this all while holding the baby with the placenta inside.

That was about 15 mins time from birth to laying down. Honestly, I think the cord was cut 20 mins or so after birth. There was never any rush or mention of it.

Mama to 4. winner.jpghomebirth.jpg
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