I’m a little afraid to even mention this in case it disappears. Shhhhhh. . . don’t tell anyone but there’s a doctor talking about leaving the baby’s precious backup oxygen supply (the umbilical cord) alone to do its physiological job. He’s calling it “delayed cord clamping” which is a ridiculous description but, as long as babies get to enjoy some cord time, I’m not going to quibble about semantics. Perhaps we’ll see an end to this kind of violation of a newborn baby who is trying desperately to protect herself from the bulb syringe and the clamps/scissors that are stopping her oxygen supply.
You can read all about his research and insights at Academic ObGyn
I’m going to paste in here the comment by Gail Hart, midwife from Portland, Oregon because she has an interesting view of the history and physiology involved in leaving the cord to pulse.
December 6, 2009 at 9:29 am
Gail Hart comment
“The large body of research over 5 decades shows benefits from delayed clamping of the umbilical cord, but there are conflicting reports of potential rise in rates of jaundice. I believe the conflict in these reports is a result of the variations in conduct of third stage. The practice of delayed cord-clamping does not mix well with oxytocics given as part of “active third stage management”.
Under normal physiologic conditions, the uterus remains in quiet tone for a few minutes while the baby receives the “correct” amount of blood remaining in the placental circulation.
If oxytocics are given with delivery, the early uterine contractions may result in an over-infusion of blood to the baby, polycythemia, and elevated risk of jaundice. In my region, the understanding of the association of increased risk of jaundice with the practice of “pitocin with the shoulders” was the major reason for the abandonment of this routine in the 1980s.I think a wise policy is to allow normal third-stage umbilical transfusion by clamping after the cord goes flat under most circumstances. But when pitocin is used then the cord should be clamped within 30 seconds.
Midwives and doctors who follow this policy report rare incidences of neonatal jaundice, and extremely rare need for phototherapy.
Regarding ‘what to do with the baby while waiting”… Let MOM deal with the baby!
In almost all cases, the cord is long enough to allow the baby to be held on mom’s abdomen (and in her arms). There is no need to keep the baby at the level of the introitus: in fact, this is not physiological. It is normal instinctive behavior for mothers to want to hold their babies at birth; in evolutionary terms, this means mothers hold babies while the cord is still intact!
The maternal abdomen may be considered to be close enough to the level of the placenta that gravity is not likely to impact either under-infusion or over-infusion, unless the woman has given birth while standing (and this is unusual in our culture)
(On a personal note: I’ve been a midwife for almost 40 years and can attest that babies do extremely well with a policy of delayed cord-clamping! I think they transition to extra-uterine life more easily, and breathe more quickly and deeply with a lower incidence of “gunky lungs” or TTN (transient tachypnea of the newborn). Also, their intact cord allows them an additional life-line in the rare instance when they require assistance.
Immediate cord-clamping is a very new development in human history. The routine evolved as a method to reduce the neonatal load of maternal medication when births were conducted under general anesthetic.
Those days are LONG past, but this old routine still remains!
We’re having a heck of a time getting rid of the silly thing!
see: JAMA. 2007 Mar 21;297(11):1241-52.
Late vs. early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials.
Hutton EK, Hassan ES.
CONCLUSIONS: Delaying clamping of the umbilical cord in full-term neonates for a minimum of 2 minutes following birth is beneficial to the newborn, extending into infancy. Although there was an increase in polycythemia among infants in who cord clamping was delayed, this condition appeared to be benign.
(note nearly a 1000 babies in late-clamping study)
also check out PMID: 16567393
PMID: 18624002 — describes additional benefit of increased alveoli perfusion and recommends a minimum of 3 minutes delay
end of Gail’s comment.