Delayed cord clamping, dangerous? - Mothering Forums

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#1 of 40 Old 10-19-2010, 10:13 PM - Thread Starter
 
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I'm 26 weeks along with my first, I met with my doctor last week and asked if there would be any problem with my desire to let the umbilical cord stop pulsing before it is clamped & cut. She seemed surprised that I would want to do such a thing, and said that contrary to what I might think, the baby can actually experience blood loss this way, and most delivering doctors would have a problem with my request.

If what she says is true, then by all means clamp away, but I haven't heard anything like that before, and lots to the contrary, that delayed clamping gives the baby the benefit of those wonderful stem cells hanging out in the cord blood.

It's this sort of thing that makes me really nervous about a hospital birth, because it feels like if I don't remember to ask every question and research every option beforehand, I may not be prepared enough to argue my point successfully at the time when it matters most. Add to that the problem that my insurance system (Kaiser) will not let me have the doctor of my choice attending my birth, but just assigns whomever happens to be on call at the time, most likely someone I've never even seen before.

I told my doctor that , in a perfect world I would have my baby at home, and she responded that it was such a miracle that I even achieved a natural pregnancy at my advanced age (43) that I shouldn't press my luck, that my risk of complications at birth goes up with my age (which was also news to me).

Anyway, sorry for the novel, just needed to get the whole story out... any info on the cord issue, or any generally supportive comments very much appreciated!
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#2 of 40 Old 10-19-2010, 10:37 PM
 
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Maybe if you hold them up in the air and purposely drain all the blood back before clamping it... I just have a few little smart aleck remarks, lol.

1. Why isn't this a problem in other countries? In many cultures the cord isn't severed until hours after the placenta is delivered.
2. Why isn't this a problem for other animals? No other placental mammal severs the cord before the wharton's jelly stops blood flow to and from the placenta.
3. Just google 'delayed cord clamping risks'. The only proven risk that comes up is a slight increase in jaundice. Jaundice is totally treatable with lots of breastfeeding (colostrum is a natural laxative and helps move the bilirubin out) and bili lights or sunlight.

There's also a facebook page with more resources:
http://www.facebook.com/delayedcordclamping

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#3 of 40 Old 10-19-2010, 11:31 PM
 
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Moved to B & B

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#4 of 40 Old 10-20-2010, 12:39 AM
 
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when i first heard about delayed cord clamping, i decided to research it to see if it was right for us and i never heard of anything like that. some doctors don't believe that it has medical benefits for baby, but ive never heard of one saying that it was dangerous.
my partner and i were debating whether or not to bank the cord blood or delay the clamp because our midwife said we cant do both she's all for delayed clamping, and in fact.. said that if baby was struggling for whatever reason, she wouldn't clamp because that blood is so important to the baby. she told us this during our initial interview.. just in case we had decided to bank the cord blood already.. but we had already decided to delay the cord clamping until it stops pulsing.. so no biggie.

your doc is interesting.. you should ask him for sources/references on that info and see what he says lol

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#5 of 40 Old 10-20-2010, 02:35 AM
 
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My OB and my Ped both were fine with us delaying clamping for dd2. Neither had any concerns; the only caveat that the OB had was that if I were hemorrhaging then he'd have to clamp and deal with the hemorrhage, so he wanted me to know that was a remote possibility.

Incidentally, dd2 had less jaundice than dd1 (who was clamped at birth).

My OB told me that it is an unusual request for him, but that he doesn't have any concerns about it.

Personally I'd be checking with your insurance company and looking for a different OB (or a MW). Find someone whose practice meshes more with what you want. The fact that your OB told you that delayed cord clamping is dangerous (well, seriously, does she understand human physiology if she thinks that the blood can pump back INTO the placenta/Mom?) -- and additionally that she's starting to wave the "Oh, you are an older mother and therefore at higher risk" flag both make me wonder how many medical interventions she would want to push on you - early induction, EFM, etc.??

Sorry - I've had a few friends pushed into very medicalized, c/s births lately as a result of the cascades of interventions, and your description worries me.

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#6 of 40 Old 10-20-2010, 07:41 AM
 
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Originally Posted by WifeofAnt View Post
Maybe if you hold them up in the air and purposely drain all the blood back before clamping it... I just have a few little smart aleck remarks, lol.

1. Why isn't this a problem in other countries? In many cultures the cord isn't severed until hours after the placenta is delivered.
2. Why isn't this a problem for other animals? No other placental mammal severs the cord before the wharton's jelly stops blood flow to and from the placenta.
3. Just google 'delayed cord clamping risks'. The only proven risk that comes up is a slight increase in jaundice. Jaundice is totally treatable with lots of breastfeeding (colostrum is a natural laxative and helps move the bilirubin out) and bili lights or sunlight.

There's also a facebook page with more resources:
http://www.facebook.com/delayedcordclamping
Um, WifeofAnt....sorry, have to mention:
In most mammals, the cord actually rips away from placenta during birth, before wharton's jelly has had time to form at all. Babies are born unattached, most often (and I've seen many a puppy, kitten, foal and goat-kid get born). However, that is physiologically normal for them, and only rarely causes problems (of dozens of kittens I've seen get born, for instance, only ONE bled-out through cord stump within few min of birth...surely there was some other underlying problem for the kitten).

It's true that jaundice is not a problem, though, most often. It's actually normal for newborns when it occurs, and only rarely a cause of problems. Far more babies are treated for jaundice than actually need any treatment, mainly because the med world does not seem to understand how it is normal in neonates.

By the way--in my practice, I don't call it 'delayed cord clamping', I call it 'normal cord clamping'. We just aren't thinking about the cord, except 'by the way' (by the way, mama, mind the cord when you move baby to your other breast...), until a pretty long time after birth. Only rarely do cords get cut sooner than 15 min--and more often it's 30-60 min, depending on when the placenta comes out mostly.

What they do in hospitals is PREMATURE cord clamping. Docs have decided that their way of cutting cords immediately is 'normal', and that waiting is a 'delay'. They are wrong, of course. As wifeofant points out, traditionally cords have not been cut instantly upon birth--and are rarely cut immediately at any homebirth now. We are not 'delaying' the cord clamping--the Docs are HASTENING it, clamping prematurely.

The doc who told you this is simply ignorant. Sadly, she does not even know she is ignorant on this topic...sadly, most docs are fairly ignorant on the subject of Normal Birth, and they do not know it. Most often their clients don't know it, either--but you are someone who can help educate her!
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#7 of 40 Old 10-20-2010, 10:37 AM
 
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Ah, those amazing vampire placentas- they faithfully nourish the baby for 9 months, but the instant the baby is born, they suck the blood right out of him.

A very quick look at Google Scholar shows that your doc is full of... Here are some references to show her:

Current best evidence: a review of the literature on umbilical cord clamping. Mercer, J. Journal of Midwifery & Women's Health Volume 46, Issue 6, Pages 402-414 (November 2001)

The Effect of Timing of Cord Clamping on Neonatal Venous Hematocrit Values and Clinical Outcome at Term: A Randomized, Controlled Trial. Ceriani Cernadas, J.M. et al. Published online March 27, 2006 PEDIATRICS Vol. 117 No. 4 April 2006, pp. e779-e786 (doi:10.1542/peds.2005-1156)

A Systematic Review and Meta-Analysis of a Brief Delay in Clamping the Umbilical Cord of Preterm Infants. Rabea, H., Reynolds, G., Diaz-Rossello, J. Neonatology Vol. 93, No. 2, 2008

I'd at least look at your other options, as far as providers go. Someone who already views your pregnancy as a miracle and you as a ticking time bomb SOLELY BECAUSE OF YOUR AGE is not likely to be a provider who is willing to support your birth as a natural, normal process. She's much more likely to want to step in and save your miracle baby from you and your vampire placenta.
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#8 of 40 Old 10-20-2010, 11:08 AM
 
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Originally Posted by MsBlack View Post
Um, WifeofAnt....sorry, have to mention:
In most mammals, the cord actually rips away from placenta during birth, before wharton's jelly has had time to form at all. Babies are born unattached, most often (and I've seen many a puppy, kitten, foal and goat-kid get born). However, that is physiologically normal for them, and only rarely causes problems (of dozens of kittens I've seen get born, for instance, only ONE bled-out through cord stump within few min of birth...surely there was some other underlying problem for the kitten).
Eh, I've only seen kittens born and they all came out in pretty much the same pattern. Kitten first, placenta about a minute or two later (still attached to the cord), repeat until all kittens are born. Then once they were all out she started eating the placenta and severing the cord. Maybe my cat was just odd but all 8 kittens followed the same pattern.

(picture of the first 3 with attached placentas, one placenta is hiding.. Hopefully that works.)


My original point is that across the animal kingdom reproduction, pregnancy, and birth are almost surely idiot-proof. Most everyone is going to have to figure out how to do it if the species is to continue. Nature wouldn't hand us a widespread situation that has the capacity to destroy the species such as the baby 'bleeding back' and expect us to last very long.

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#9 of 40 Old 10-20-2010, 11:59 AM
 
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Hm time to educate that obgyn. If she refuses to learn, time to find a new one.
Delayed cord clamping should be normal and is highly beneficial, premature cord clamping is only warranted when baby is in severe distress and needs to be whisked to the NICU asap. In all other cases, no way!
A lot of obgyns prefer premature cord clamping and then active delivery of the placenta to get it over with instead of waiting around. Unfortunately.
All my friends and family back home (Germany) had their cords clamped until after the cord stopped pulsating while baby was on their chests hanging out or nursing. They all had hospital births with obgyns and midwives, but the obgyns managed the actual 2nd and 3rd stages... And for your ob to know, there is a way better maternal and fetal outcome over there! So hm no, delayed cord clamping (which should be called normal cord clamping) is totally harmless and highly beneficial.
Don't let them tell you that if you do delayed that baby has to be lower than the placenta. Studies showed that any position within a few inches below or above the placenta is fine, of course best is on mom's chest. And if nursing can be initiated asap it will help with the 3rd stage without any active management.
If you are interested in changing obgyns, my SIL had a great experience with a natural minded obgyn at Sequoia Hospital in RWC.

@ WifeofAnt: How cute, I just love cats. I once witnessed the exact same thing with our cat back home back in 1990! She bit the cord only once the placenta was delivered...
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#10 of 40 Old 10-20-2010, 12:25 PM
 
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I don't have any advice about delayed clamping, but I do have experience with Kaiser. I also have Kaiser and had to switch OBs three times before I found one that really listened to me. I know I may have a stranger deliver my baby, but I am hoping that I can at least get my birth plan the way I want prior to that.
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#11 of 40 Old 10-20-2010, 12:35 PM
 
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I'm not sure what counts as "delayed" cord clamping currently, but our family practice doctor was perfectly fine with our request to wait 3-5 minutes/until the cord stopped pulsing to clamp the cord. The research we did indicated that after 5 minutes the increased risk of jaundice outweighed the benefits (in our opinion).

The cord had stopped pulsing when he did clamp it and he asked my permission before doing it... the only "risk" in his opinion was jaundice, NOT blood loss, and I think he would have waited longer if I had insisted but we were still in the bathroom where I had delivered and at that point I wanted the baby to be detached

FWIW my husband is a pediatrician and had zero reservations about his child's cord clamping being "delayed" other than jaundice... which was mostly a hassle we didn't want to have to deal with having a breastfed baby in a hospital. (Our older daughter's cord was clamped right away and she had mild jaundice... this baby had none.)

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#12 of 40 Old 10-20-2010, 12:49 PM
 
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And some moms have heard the opposite from their OBs - that the baby will get too much blood. Well, which is it???

"Delayed" cord clamping is normal, it is what has occurred in cultures around the world for thousands of years. Clamping at birth is for the benefit of the doctor and the hospital methods which whished the baby away from mom at the moment of birth in order to clean them from all the mommy germs and such.

Here is an interesting article on a study done by pediatricians on the need for delaying with regards to the change in breathing - http://www.time.com/time/magazine/ar...830142,00.html
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#13 of 40 Old 10-20-2010, 01:00 PM
 
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And some moms have heard the opposite from their OBs - that the baby will get too much blood. Well, which is it???

"Delayed" cord clamping is normal, it is what has occurred in cultures around the world for thousands of years. Clamping at birth is for the benefit of the doctor and the hospital methods which whished the baby away from mom at the moment of birth in order to clean them from all the mommy germs and such.

Here is an interesting article on a study done by pediatricians on the need for delaying with regards to the change in breathing - http://www.time.com/time/magazine/ar...830142,00.html
Wow! That's a great mainstream article! (Cuz so many people will listen to TIME magazine over a midwife with 1000+ births.)

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#14 of 40 Old 10-20-2010, 07:31 PM
 
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In most mammals, the cord actually rips away from placenta during birth, before wharton's jelly has had time to form at all.
Wharton's jelly forms early in pregnancy. It holds the vessels together and protects them from compression while in utero. What are you talking about?
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#15 of 40 Old 10-20-2010, 09:08 PM - Thread Starter
 
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Here is an interesting article on a study done by pediatricians on the need for delaying with regards to the change in breathing - http://www.time.com/time/magazine/ar...830142,00.html
Holy Toledo! Did you notice that article is from 1963?! Seems it takes some doctors longer than 40 years to absorb information!

I'm truly blown away by your awesome (and sometimes sidesplitting) responses... I feel so supported by this incredible community -- thank you, everyone!

This doctor I saw is younger than I am, and she just resumed her practice after her own maternity leave, so I assumed she would be much more "with it" than she seemed. It's a total roll of the dice what doctor I get for the delivery, I think they draw from like a 5-hospital radius, so there's no way I can possibly meet them all beforehand, a stupid system that's set up totally for the efficiency and convenience of the insurer.

I'll soon be touring the two most likely hospitals I may deliver in, and you can bet I'll be asking way more than my share of questions, and reviewing my birth plan with their staff to try to find out in advance which of my requests will seem reasonable to them, and which I may have to fight for. Wish me luck!!
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#16 of 40 Old 10-20-2010, 09:19 PM
 
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The concern I have heard from health professionals here is that "skin-to-skin contact is not possible until after the cord is clamped" because the baby has to be kept below the level of the uterus in order to get all the blood. From what I have read, gravity does play a part in the blood flow at this point, but placing the baby on the mother gives the best of both worlds--the baby still gets some of the blood from the pulsing placenta but not so much that it increases the risk of jaundice.

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#17 of 40 Old 10-20-2010, 10:00 PM
 
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Holy Toledo! Did you notice that article is from 1963?! Seems it takes some doctors longer than 40 years to absorb information!
Oh, wow. No I hadn't noticed that. Yeah, not surprised that it is taking so long for changes.

I think my NICU baby could have been spared needing to be removed from me if they hadn't cut her cord. I understand why they did, because they were concerned about a possible heart defect and we had a NICU pedi team in the room at birth, but I think if they could have left it on just another minute or two until she was breathing on her own all the drama could have been done without.
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#18 of 40 Old 10-20-2010, 10:27 PM
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Just remember, mama, you don't need to consent to anything. Cord clamping is the kind of thing a doc or nurse will do very quickly-- so get yourself a good doula and go over which things you really want her to help you fight for. Have your partner and doula express your wishes clearly to all who will be present at the moment. Practice saying, "No, thank you" and especially "I do no consent" because those are the magic legal words. No matter what health system, you are still the one giving birth and they can't do something without consent (do not sign the blanket consent, or if they won't admit you without it, sign, and then give them a paper withdrawing it, if need be). It's good to educate yourself ahead of time about routines at the hospital, and just prepare your partner and doula, so you can relax and just birth.
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#19 of 40 Old 10-20-2010, 10:33 PM
 
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PPs have pretty much said it all. My first was clamped earlier than my second and my first had a little bit more jaundice - both were minor.

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And I don't know if it's my hormones or what, but I totally looked at this picture and said, Awww, look at those cute little placentas.

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#20 of 40 Old 10-20-2010, 10:34 PM
 
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Makes you wonder how our ancient ancestors survived after birth without sterile scissors and cord clamps handy, doesn't it?
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#21 of 40 Old 10-20-2010, 10:38 PM
 
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I managed (through great effort) to get my doctor to agree to delayed clamping as long as there were no contraindications during the birth.

When I arrived in the delivery room, I told the nurse on duty that I wanted delayed clamping and she told me it wouldn't be possible because there was meconium staining in the amniotic fluid, so my baby would need to be suctioned immediately by the NICU team.

She actually didn't call my doctor in time for the delivery, so the cord was clamped and the placenta was pulled out by the on-call doctor before my doctor even arrived.

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#22 of 40 Old 10-21-2010, 12:49 AM
 
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I managed (through great effort) to get my doctor to agree to delayed clamping as long as there were no contraindications during the birth.

When I arrived in the delivery room, I told the nurse on duty that I wanted delayed clamping and she told me it wouldn't be possible because there was meconium staining in the amniotic fluid, so my baby would need to be suctioned immediately by the NICU team.

She actually didn't call my doctor in time for the delivery, so the cord was clamped and the placenta was pulled out by the on-call doctor before my doctor even arrived.
why the hell do they need to cut the cord to suction! I had mec and they suctioned before cutting the cord. they are supposed to have the suctioning stuff in easy reach of the bed, so there's no reason to have to take the baby away from mom and no reason to need to clamp the cord. I'm not sure how long the doc on call actually delayed clamping the cord because everything was a blur, but she did wait until it has stopped pulsing according to her. I really wish I had had a Dula present, because DF and I were so wrapped up in other things neither of up was paying attention to what all she was doing down there at that point. I think she may have tugged to get the placenta out faster, it did feel like she was in a complete rush to be done with me.

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#23 of 40 Old 10-21-2010, 02:13 AM
 
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Ah, those amazing vampire placentas- they faithfully nourish the baby for 9 months, but the instant the baby is born, they suck the blood right out of him.


Nothing to add, since I have had 2 preemies and never really had a chance to think about what to do or not to do with the cord. I think I will discuss this with my MW at my next appt.

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#24 of 40 Old 10-21-2010, 02:30 AM
 
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mOxxie, if you can talk to the charge nurse on the L&D floors while you're touring, *her* reaction (and advice) when you tell her you'd like to delay cord clamping should give you a good feel for how supportive the nursing staff would be (which in many cases could be helpful if the random doctor who's caring for you is not so supportive).

When I knew I wanted delayed cord clamping and AAP procedures followed for dd2 for breastfeeding initiation (I didn't know as much about them with dd1, and assumed that's how hospitals did it, and when they didn't, with Ina, I figured that they must have had a reason. The reason was that I hadn't told them I wanted that, therefore they did what was most convenient for them, which was whisk baby away to do their thing with her immediately rather than letting me initiate breastfeeding skin-to-skin before she was bathed etc.). Anyway, the charge nurse there told me that OF COURSE they'd follow my birth plan, of course they do the AAP policy for breastfeeding, just be clear with the nurse about the birth plan and what we wanted when we arrived, etc. She acted offended that I even thought either would be an issue. So that reassured me; I knew I'd be bucking the norm but at least the charge nurse was supportive and knew what I was asking for was reasonable.

I've heard that at larger hospitals, the L&D nurses will often try to angle for their favorite type of patient - so a mother who is having a natural birth, or wants one, might get a nurse who is more supportive of that. Maybe. Worth letting them know clearly when you first arrive! People here can help with your birth plan, too, incidentally.

I'd also look into a doula, as pps have suggested.

ETA: In practice, however, we did have a little issue. My OB had to stop the nurse from coming in to give the pitocin for active management of third stage of labor (placental delivery) - which would have meant that I couldn't do delayed clamping of the cord. Our OB was awesome, he stopped her in her tracks, told her I didn't want pitocin, that I'd noted that in my birth plan, that he hadn't asked for it, and to take it out of the room to dispose of it and it had better not show up on my bill either. In her defense, I'd been at the hospital for about 20 minutes at that point and she hadn't really had time to look at my birth plan.

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#25 of 40 Old 10-21-2010, 10:45 AM
 
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Oh I didn't see you were with Kaiser. I switched to private insurance at 18 weeks. I initiated care in Hayward. But I heard the best things about the hospital in Redwood City (the Kaiser one close to Jefferson blvd). They have midwives on staff and the lowest c-section rate around.
Since the obgyn comes at the end only to catch the baby, I would distribute my birth plan to the nurses, put it up with Scotchtape to my room door, the wall, anywhere. Bring a doula and drill your partner to hover over the obgyn right at baby when born to enforce no cord clamping, cutting, milking etc.
Yes, there are nurses who like natural birth, request one once you come in (nicely, of course).
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#26 of 40 Old 10-21-2010, 05:14 PM
 
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The first time I heard about "vampire placentas" (love that term, BTW ) was from a surgeon last week. I have an anterior placenta and placenta previa (as of 3.5 weeks ago, anyway) and will need a c-section in 2 weeks if it doesn't clear. I assumed the potential of blood loss to the baby would be due to the placenta being cut and bleeding itself. Has anyone heard of that? I do wonder after reading this thread if instead he doesn't just have a misinformed position.

How surprising that article was from so long ago! I this quote though:
Quote:
The carefree manner in which the newly born infant is "disconnected" from his mother, concludes the report, "is in sharp contrast to the meticulous care with which the thoracic surgeon separates his patient from the heart-lung machine."

Karen love.gif James -- DS drum.gif (2/07) DD baby.gif (11/05/10) angel1.gif (9/05) (10/09)
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#27 of 40 Old 10-21-2010, 06:50 PM
 
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Suctioning shouldn't be done in the case of meconium stained amniotic fluid any how (unless baby is non-vigorous).
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#28 of 40 Old 10-22-2010, 06:46 PM
 
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Originally Posted by WifeofAnt View Post
Eh, I've only seen kittens born and they all came out in pretty much the same pattern. Kitten first, placenta about a minute or two later (still attached to the cord), repeat until all kittens are born. Then once they were all out she started eating the placenta and severing the cord. Maybe my cat was just odd but all 8 kittens followed the same pattern.
I used to breed dogs (have delivered about a hundred puppies) and this is about how it goes for them too, except the mom eats each placenta right after the pup is out (even if not all her pups have been born yet). My observations are that in dogs the cord stops pulsing quite soon after birth, which is good, since the cord usually gets severed pretty soon due to the placenta being eaten.

A few times I have seen the cord break during delivery, but this is rare and not a good thing (though not a disaster). The pup does lose some blood when this happens - not enough to be hazardous to an otherwise healthy pup, but I don't like to see it. Also, when this happens the placenta is often not delivered promptly - it can stay in the uterus and block the way of the next pup (I once saw a pup born with its sibling's placenta around its neck - fortunately it was ok but this did slow the delivery). Or the placenta might be retained entirely (fortunately not as dangerous in dogs as in humans).

All of which has absolutely nothing to do with human birth... I just find it interesting.
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#29 of 40 Old 10-23-2010, 07:44 AM
 
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After reading in this thread that in Germany delayed cord cutting is a norm I asked my midwife if it was so (I am seeing a group of MWs at birth center in Bremen, Germany) she said that it was and looked at me like I had two heads when I asked if it was a common practice in the hospitals here as well because in US hospitals people have to fight for it. She said that it was and there is absolutely no need to cut them right away and proceded to explain that they usually wait until cord stops pulsing and then cut it while the baby is still on moms chest nursing.
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#30 of 40 Old 10-23-2010, 10:01 PM
 
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Nature wouldn't hand us a widespread situation that has the capacity to destroy the species such as the baby 'bleeding back' and expect us to last very long.
Love this.

Jamie, DW to Jeff, birth and postpartum doula and Hypnobabies instructor.
4 years and 5 IVF cycles in the making, Elliott was born at home in water on 2/2/11.
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