"delayed cord clamping" - Mothering Forums

 
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#1 of 7 Old 03-25-2005, 12:38 AM - Thread Starter
 
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Has anyone had any experience of other hospitals, especially tertiary/teaching hospitals moving toward "delayed" cord clamping = at least 30-45 seconds? Our neonatology department is suggesting this as a new practice parameter, but trying to convince the OB department is really comical. I think it is truly 10-15 years away yet given the current situation.
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#2 of 7 Old 03-25-2005, 05:06 AM
 
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Good luck. Even the current studies, which show so much benefit, the delay is only like you mentioned - 30sec or so. Most docs I hear start freaking about polycythemia and jaundice.

What is interesting is in the four years that I've done delayed cord clamping, I've seen very little jaundice. Every once in awhile, I'll see some yellow faces on day three, but then it resolves quickly.

I wish there were more studies about babies born to moms who had meds during labor and delayed cord clamping. On the one hand, I'd imagine they'd see more jaundice just from the liver trying to not only process the red blood cells, but also the meds, but I would bet that the rates of babies needing extra stimulation/O2 would decrease alot.

What is the opposition from the OBs? It seems to me that if the neonatologists have evidence to show it benefits babies, what is the reasoning from the OBs? Maybe showing some studies (are there any??) about how delayed cord clamping actually helps facilitate a smoother birth of the placenta (it shears off the uterine wall more cleanly due to the decreased blood volume) and less PPH.....
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#3 of 7 Old 03-25-2005, 09:58 AM
 
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I'm a doula, but I went to a workshop taught by Anne Frye about delayed cord clamping (that was geared towards MWs). It was so enlightening. She went into great detail about how the maternal/child transfusion is supposed to work when left unhampered with. Amazing how biology works when you dont mess with it.

But the sad thing is that at the births I attend, the Drs act all supportive of delaying the cord clamping, but literally seconds after the baby is born, they seem so antsy. Telling the mom that its done pulsing and she is going to clamp it, etc. It's almost as if there is this huge rush to separate that baby from the mama. Sad.

Good luck getting the change passed through your hospital.

Jenn, perpetually tired mom to DS(9): DD(4.5): DD(2) :
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#4 of 7 Old 03-25-2005, 10:41 AM
 
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I would agree with Pam's observations what I have seen in over 22 years of delayed clamping is less jaundice.

I looked on line and found that there are some hospital protocols that include delayed clamping atleast for premees. Also to there are about 60 abstracts findable on pub med. Here is a recent abstrat that supports the reduced jaundice.

Trop Doct. 2004 Oct;34(4):218-22.

The early effects of delayed cord clamping in term infants born to Libyan
mothers.

Emhamed MO, van Rheenen P, Brabin BJ.

Child and Reproductive Health Group, ********* School of Tropical Medicine,
*********, UK.

This study was conducted to evaluate the haematological effects of the timing of
umbilical cord clamping in term infants 24 h after birth in Libya. Mother-infant
pairs were randomly assigned to early cord clamping (within 10s after delivery)
or delayed clamping (after the cord stopped pulsating). Maternal haematological
status was assessed on admission in the delivery room. Infant haematological
status was evaluated in cord blood and 24 h after birth. Bilirubin concentration
was assessed at 24 h. 104 mother-infant pairs were randomized to delayed (n=58)
or early cord clamping (n=46). At baseline the groups had similar demographic
and biomedical characteristics, except for a difference in maternal haemoglobin,
which was significantly higher in the early clamping group (11.7 g/dL, SD 1.3
g/dL versus 10.9 g/dL, SD 1.6 g/dL; P=0.0035). Twenty-four hours after delivery
the mean infant haemoglobin level was significantly higher in the delayed
clamping group (18.5 g/dL versus 17.1 g/dL; P=0.0005). No significant
differences were found in clinical jaundice or plethora. Surprisingly, blood
analysis showed that two babies in the early clamping group had total serum
bilirubin levels (> 15 mg/dL) that necessitated phototherapy. There were no
babies in the late clamping group who required phototherapy. Three infants in
the delayed clamping group had polycythaemia without symptoms, for which no
partial exchange transfusion was necessary. Delaying cord clamping until the
pulsations stop increases the red cell mass in term infants. It is a safe,
simple and low cost delivery procedure that should be incorporated in integrated
programmes aimed at reducing iron deficiency anaemia in infants in developing
countries.
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#5 of 7 Old 03-25-2005, 12:01 PM
 
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Quote:
Originally Posted by BensMom

But the sad thing is that at the births I attend, the Drs act all supportive of delaying the cord clamping, but literally seconds after the baby is born, they seem so antsy. Telling the mom that its done pulsing and she is going to clamp it, etc. It's almost as if there is this huge rush to separate that baby from the mama. Sad.

Good luck getting the change passed through your hospital.
There is a huge rush. Once the baby is born, liability wise, the baby becomes the "responsability" of Neonatology/Pediatrics. The OB has nothing more to do with the baby, cannot attend the baby, will not be held responsable for the baby. The hospital looks at it as, the OB is caring for a "patient" out of the scope of his/her practice. : Better to hand the baby over sooner rather than later than deal with 2 patients. :
So, like everything else they want to justify, they make up medical excuses for liability issues.
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#6 of 7 Old 03-25-2005, 12:18 PM - Thread Starter
 
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Of the larger studies reviewed none showed increased bilirubin, so trash that argument. None showed lower temperature on admission of the baby. Only a few cases of polycythemia (Hct >65) were noted but none of the babies were symptomatic like a baby that had prolonged period of high hct due to disease process. Of all the studies, good ones, bad ones, mediocre ones, none showed a negative impact on babies, all were neutral or supportive.

These OB were concerned with 1. Liability, with all other things being the "usual" standard of care and they do one thing differently then there is potential for that to be blamed for a problem.
2. then they were concerned about c/sec mom's having longer period where there is bleeding, we countered this argument with supposedly they let the placenta separate naturally anyway so they would be waiting anyways.
3. they were concerned that not all of the pediatric team would be on board with this plan and give them a hard time, especially on premies etc.

I think it is exciting to even see the topic be seen from a positive perspective from the MD side though, rather than a bunch of ha-ha granola/hippie talk.
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#7 of 7 Old 03-25-2005, 02:29 PM
 
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I actually had an intern tell a mom that if they didn't cut the cord right away the heart valve wouldn't close and the blood wouldn't circulate through the lungs! Can you believe it! and he knew she was a nurse!! I wonder if he was just trying to scare her by telling her an out an out lie or if that's what he really thought!
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