Delayed cord clamping rebuttal from OB

2749 Views 34 Replies 25 Participants Last post by billikengirl, Mar 6, 2010

KGB

Discussion Starter · Feb 23, 2010

My wife and I have researched the benefits of delayed cord clamping and are planning to do it when our first child is born. We mentioned it to our OB today, and although she's very open to it and has had other couples ask to have it done, she said she doesn't really see a benefit to it. She said that when a baby is placed on the mother's chest, gravity would end up forcing the blood in the cord from the baby back to the mother.

I didn't really understand this since it's basically a closed system -- not like raising one end of a garden hose and allowing water to drain out the other end. Plus, the cord is still pulsating, which means it will still be circulating the blood to the baby, right?

Why would she think that simply having the baby on top of the mother would keep the blood flow from reaching the baby? Is she right?

1 - 20 of 35 Posts

MamaJen

· #2 · Feb 23, 2010

Most research shows that delaying cord may lead to lower levels of anemia several months after the birth.
http://aapgrandrounds.aappublication...xtract/16/3/31
I have never heard that about the gravity forcing the blood down. I mean, if the cord is pulsing, it should be pushing the blood up, right? Just like your pulse pushes blood through your body? It's not like all the blood drains out of your head when you're standing upright.

MegBoz

· #3 · Feb 23, 2010

4

Quote:

Originally Posted by *MamaJen*

View Post

Just like your pulse pushes blood through your body? It's not like all the blood drains out of your head when you're standing upright.

Exactly what I was going to say! That is just,

, I mean,

, I dunno.

See less See more

mambera

· #4 · Feb 23, 2010

I think the argument is totally pointless. If there are study-demonstrated benefits to delayed clamping (I haven't researched this myself but I'm taking your word for it) then that's the end of the story, regardless of what the OB or anyone else says about blood flow.

That said, it's not crazy that gravity should affect blood flow in the cord.
Biological tissues are expandable (unlike a garden hose) so fluid can pool in the lower tissues if there isn't sufficient force to push it up.

Quote:

Originally Posted by *MamaJen*

View Post

I mean, if the cord is pulsing, it should be pushing the blood up, right? Just like your pulse pushes blood through your body? It's not like all the blood drains out of your head when you're standing upright.

That is because most veins are specially constructed with valves that prevent backflow.

See less See more

MsBlack

· #5 · Feb 23, 2010

If you're OB really believes that, then she needs to go back and take a basic Maternal-Fetal Anat and Physiology course again. That is just plain stupid, particularly coming from the mouth of one who is highly paid to 'know it all' about maternity.

The blood flows back to the mother????

Jeez!

Sheryl1678

· #6 · Feb 23, 2010

I insisted on a lotus birth with my OB even for a cesarean. I did not actually want a lotus birth but did not trust any hospital birth attendant to respect wishes/instructions to delay. I figured I would just cut the cord myself after a few hours.

My first midwife agreed to delay cutting and then cut it within seconds. They are so resistant to the idea.

I ended up having a planned UC and it was the best way to ensure that nobody touched my daughter's cord without my consent.

JorgieGirl

· #7 · Feb 23, 2010

This is the lamest argument. I mean, our blood doesn't just all pool at our feet. The body (which includes the temporary organ placenta with the umbilical) is designed to work under normal, and even many not normal, circumstances.

Ditto, she needs to go back to school.

mwherbs

· #8 · Feb 23, 2010

I find that really amazing that the baby is up at your belly level all the time and the cord/and placenta are perfused thanks to a beating heart- and yet after the birth that same heart can no longer pump blood though that same system. even though putting the baby up on mom's chest or belly is pretty close to the position it was just in-- I have been attending births since the 80's and would say that I/we have rarely cut the cord before 5 minutes- probably easier to say most often the placenta is delivered before we cut the cord-
here would be my question for the doctor-- so if it is gravity and there is no force in there then why do we need to have cord clamps? also unless your doc is a family practice doc I doubt that it would be in his/her scope to know about long term infant well being.
It use to be believed that as soon as the baby took a breath the cord stopped functioning, even though they also knew that some degree of patient circulation continued, which is part of why cord clamps are used because the baby's circulation stays or can stay open to a degree. so there is circulation that goes out to the placental bed and circulation that comes in from the placental bed- it is now thought that the outgoing circulation shunts first with incoming later-
as medical folks have shown us over the years that yes for the most part babies can survive all sorts of things that we do to them- but this is not something that HAS TO be done in seconds after the birth it could be minutes to hours and the baby will be fine - one thing is that the minute the cord is cut then the doctor hands off responsibility of the baby to another professional- and babies are not really the OB's patient so they want then handed over and those few minutes delay is now not what that doc is use to makes them nervous
---------------------------------------------
you know they could probably use a vascular ultrasound and see what an unclamped cord is doing -

See less See more

Kidzaplenty

· #9 · Feb 23, 2010

See less See more

MamaJen

· #10 · Feb 23, 2010

So I did a little more research -- it looks like there was some kind of shoddy small scale research studies done in the 1950s to suggest that it was dangerous to leave the cord connected. That's where the blood pooling back into the placenta myth comes in.
There is, apparently, a slightly elevated risk of jaundice with delayed cord cutting? But it's minor, and balanced out against the risk of anemia that occurs with cord cutting.
Also, I'm a pretty big fan of evolution. And I'm pretty certain that up until 50 years ago, our human and pre-human ancestors weren't cutting the cord within 10 seconds of birth.

mambera

· #11 · Feb 23, 2010

Quote:

Originally Posted by mwherbs

View Post

here would be my question for the doctor-- so if it is gravity and there is no force in there then why do we need to have cord clamps?

Bc if you cut an unclamped vessel all the blood really will fall out of the baby regardless of the pulse pressure.

Btw it's not about 'no force.' The pressure in every vessel falls during diastole and if you add gravity to that without a valve system to compensate you could still get pooling.

I can't say the scenario sounds likely to me but it isn't impossible either.

See less See more

CallMeMommy

· #12 · Feb 23, 2010

Quote:

Originally Posted by KGB

View Post

She said that when a baby is placed on the mother's chest, gravity would end up forcing the blood in the cord from the baby back to the mother.

If that were true, every. single. case. of placenta previa would result in a dead baby. Placenta's lower than the baby, right?

See less See more

mwherbs

· #13 · Feb 24, 2010

I am looking for some pictures for examples- because the hospital generally clamps and cuts and those cords look like plumbed out fat full of blood- and are underpressure- usually when a cord is cut after a delay it sort of trickles out and looks more like white limp pasta, it is even hard to visualized the arteries and vein. So for instance something that is a bit more measurable we have had moms who wanted to do cord blood banking if possible but still wanted to do delayed cord clamping- and we put babies up on mom- don't hold them lower , in any case even with a touch early clamping we were not able to get enough blood for banking at least for the places that had a minimum - I think now there are some places that don't impose a minimum amount- but then they were wanting 80-90gms and we could only get around 40...

rainbowmoon

· #14 · Feb 24, 2010

2

um, how would one have a lotus birth during a cesarean Wouldn't you bleed to death?

Quote:

Originally Posted by Sheryl1678

View Post

I insisted on a lotus birth with my OB even for a cesarean.

See less See more

Romana

· #15 · Feb 24, 2010

She is incorrect. Placing the baby on the mother's abdomen will mean the blood goes into the baby more slowly than if the baby was below the level of the placenta or level with it, but ultimately the total blood volume received will be about the same.

I researched this recently due to a similarly ridiculous comment made by a midwife. I found recent, decent research (but don't have links and aren't looking it up again). Some of the studies were on premature babies they were trying to help give a better head start (by making sure they got their cord blood).

Gena 22

· #16 · Feb 24, 2010

I've heard your OB's comment before from other OBs, including my own. It sounds bizarrely and medievally stupid. But I hadn't thought about valves in veins that prevent gravity from affecting bodies, so maybe it is possible if these valves are not present in cords.

But the gravity theory is just an unsubstantiated theory pulled out of someone's a$$. Just like human gestation being 40 weeks. That docs not only believe but practice and voice these theories in the face of contradictory evidence is one of the reasons I went running for a HB MW at 30 weeks along.

Beccasteve03

· #17 · Feb 24, 2010

3

Quote:

Originally Posted by KGB

View Post

She said that when a baby is placed on the mother's chest, gravity would end up forcing the blood in the cord from the baby back to the mother?

HAHA! That's exactly what my OB told me last time around! I think they say that because they don't want to wait.

One more reason I'm so glad I've found my wonderful midwife!!!

See less See more

katelove

· #18 · Feb 24, 2010

To echo most of the PPs, your OB is incorrect. When I was writing my birth plan I looked into the latest research on this subject too. Some studies do suggest that there is a slightly increased risk of jaundice with delayed cord clamping but, IMO, this risk is outweighed by the benefits. And, being aware of the potential means that you can take steps to prevent it such as frequent feeding, daily sun exposure etc.

The umbilical vein does contain valves like other veins to prevent backflow of blood and the blood pressure will be sufficient to sustain normal flow in most circumstances. The one possible exception to this is if the baby is held high above the abdomen for a sustained period. For example, during a c/s the baby is sometimes lifted up and held up high while the cord is untangled, parents have a look etc. Some back flow *could* occur then. It won't occur if the baby is kept at about the level of the placenta, ie on mum's chest.

mamabadger

· #19 · Feb 24, 2010

Local OB's oppose delayed cord clamping on two opposite grounds.

1) The OP's doctor's argument that blood would drain from the baby back into the placenta;

2) The blood would drain from the placenta into the baby, causing an excess of blood in the baby's body.

mwherbs

· #20 · Feb 25, 2010

so I tried to trace down the roots of this belief well atleast to a degree- Alice Yao a Dr of Peds, for over 50 years now, published in 1968-69 in the Lancet a paper on the effects of infant position and placental transfusion - now here is what she says in regards to relative position - I would also like to point out that in recent years she has co-authored/published studies on benefits of delayed cord clamping for premies and there is an open clinical trial on laying a baby on mom's tummy. any case the info on position is if the baby is held 50 to 60 cm above the placenta no benefit- a baby on a mom's tummy is at the level of the placenta- her chest-if the cord will reach that far is not 50 cm above that--
here is a nice quote from a presentation given discussing changing common practice of quick clamp and cut-to delayed in 3rd world countries because the difference to those infants is profound- and can make or break survival in the long "In addition to the timing of cord clamping, three other birth-related factors might influence the amount of placental transfusion at birth:
(1)the position of the baby in relation to the placenta;
(2)the method of delivery (vaginal vs caesarean section); and
(3) uterine contractions during the third stage
The rate of placental transfusion is markedly influenced by the position of the
delivered infant. An infant held 50-60 cm above the placenta will not receive
any blood from the placenta. At 10 cm above or 10 cm below the level of the
placenta, infants receive the maximum possible amount within 3 minutes of
birth."

See less See more

1 - 20 of 35 Posts

This is an older thread, you may not receive a response, and could be reviving an old thread. Please consider creating a new thread.