Good news on pulsing umbilical cords

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.

violation of the newborn

You can read all about his research and insights at Academic ObGyn

http://academicobgyn.com/2009/12/03/delayed-cord-clamping-should-be-standard-practice-in-obstetrics/

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.

PMID: 17374818

(note nearly a 1000 babies in late-clamping study)

also check out PMID: 16567393

PMID: 15510946

PMID: 18624002 — describes additional benefit of increased alveoli perfusion and recommends a minimum of 3 minutes delay

PMID: 11783688

end of Gail’s comment.

About gloria

I live and work in Vancouver BC Canada. I've been in the childbirth business for 30 years. I teach midwifery and doula courses both online and in person.
This entry was posted in Intact umbilical cord, Newborn care. Bookmark the permalink.

17 Responses to Good news on pulsing umbilical cords

  1. Amy says:

    very interesting as usual. but what about raising the baby higher than the placenta after a water birth? Im assuming this isnt an real problem since all the waterbirths Ive seen (mine included) have ended up with the mother holding her baby on her chest immediately after birth, but Gail’s comment seemed to imply that it was only ok for the mother to hold the baby with the cord intact if the mom was lying down. is this really true?

    anyway, yay doctors for discovering this cool trick of not cutting off the baby’s oxygen in order to improve outcomes! what would we ever do without science?

  2. gloria says:

    The umbilical cord has one (large) vein and 2 arteries. Blood in the umbilical cord circulates just like blood to the legs i.e. it goes in and out and there is no pooling anywhere there shouldn’t be. It wouldn’t matter what position the mother is in or the location the baby is placed, the circulation would continue as long as needed. I was looking at a friend’s belly the other day–she’s in her final weeks of pregnancy and her belly button is really pushed out. I showed her partner the large brown dot where her umbilical vein had been and the two smaller dots where the arteries were. We carry those spots all our lives but mostly don’t see/notice them. Gloria

    • Adel says:

      Gloria, it’s very interesting to hear you say that position doesn’t matter because this has been something I’ve wanted to know more about ever since my son was born 18 months ago. I planned a home birth but had some complications. The doctors were willing to delay cord clamping but came up with this absurd thing about holding the baby below my perineum so the blood wouldn’t “flow back into the placenta”. I asked for them to show me some research about this and they had nothing, just said it was “physiological”. In all the documents I read regarding the benefits of delayed cord clamping, I only found a couple references to the gravity issue, and they were all equally without support. It really irritated me that there was nothing more out there! A little thing to some, maybe, but to me it was important to delay cord clamping AND to have baby skin to skin immediately! In the end, my doctor “delayed” cord clamping for about half a minute, and my son was put on my belly immediately. DEFINITELY hoping to be home with a midwife for this next one!!!

  3. I want it all! I want leave the cord intact until the placenta stops functioning. It is still a live (alive) organ after birthing from the womb. What are it’s many functions that we don’t even know about? I challenge people to see 1 min, 3 min “delayed cord clamping” for what it is … a very, very small concession meant only to cajole people to be quiet. Cord clamping was contraindicated when birth moved to hospital and was done mostly because of ether and other drug use. Research done recently to show that 3 minutes is good was done on NON-consenting, non-informed BABIES … some in immediate cord clamping group, some in one-minute group, and some in three-minute group. Here’s link to one that randomized babies into 1 and 3 minute groups. http://www.medscape.com/viewarticle/708616_2
    NON-CONSENTING, INFORMED BABIES who get to live with the consequences of not getting to be in their mother’s arms, not having her protection and knowledge of when THE BABY’S SYSTEM is ready to be separated. This outrageous treatment of a baby when historically it’s been known and shown that the baby needs it’s cord blood. Doesn’t anyone else see this research as wrong? And, whoopeee… they found that the 3 minute group has measurable outcomes better than the others. Would you accept a partial circumcision? If not, if you don’t think it’s ok to study circumcision by cutting babies differently, then don’t accept this “delayed cord clamping” that is subjective and totally under the control of the medical caregiver to do whatever fits his/her agenda.

    When a woman says no to cord clamping her baby, no means no. No arguing. No more of this bull shit of prying her hands away to cut the cord anyway and no more use threats of “your baby could die if we don’t cut the cord” as was told to a local woman here recently. NO MORE!! Birthing parents have the right to say no! to cord clamping and the research and the law are on their side.
    … See More
    Study listed says: “Although some studies and many midwives use the cessation of cord pulsing as a marker for when the cord should be clamped, there is no standard measure for this, either. It is unclear whether this means waiting until there is no pulse left at all or waiting for the pulse to become weak, which is both variable and subjective.”

    Mark my words, it won’t be long, I hope, until we know about the placenta what we now know about the breast milk. Some of knew breast was best for our babies even when DOCTORS and scientists told us it was defective compared to formula. Same science, same doctors … NOW we know every day some amazing new thing about the benefits of breast milk. It will be the same for the placenta. The placenta continues to be a functional organ for a period of time .. how long, and what it does, we don’t know yet, but we will. And this research done by MEDICAL PROFESSION to arbitrarily establish a number, to be imposed upon every baby, is meant only to establish control through one more protocol … one that has zero to do with what the baby and mama-baby dyad need.

  4. Lizz says:

    Keep up the good work. Spread the word, care for the mamas and babies and heal the world. You rock!

    I can vouch for Greek women being good birthers. Loved that story.

  5. Amy says:

    thank you, gloria, for answering my question. it makes sense that of course it wouldnt matter whether the baby was up high or down low, blood circulates both upward and downward normally! I wonder where this idea about keeping the placenta up high so it could “drain” into the babay came from? anyway, I will continue to feel good about holding my kid after it’s born! lol

    Janel, you are absolutely right. it’s sickening to think of how many women and babies submit themselves to being treated like lab rats by birthing in hospitals. even women who arent part of an official study are still part of a massive “experiment” in misogyny imo. Ive had one hospital birth and one “birth centre” water birth, and both of them treated me and my newborn like crap. you’ll never catch me birthing near a hospital or a hospital-in-thin-disguise ever again. I wish that women would learn their lesson after their first births and march en masse away from ob’s and hospitals. it’s incomprehensible and sad that they dont.

    -37.5 weeks with baby #3 and freebirth #1!!

  6. Jessica says:

    As a new homebirth midwife, I am surprised at how many midwives are bothered by the idea of not cutting the cord until after the placenta is birthed. Why? It seems to me there is no reason to rush in most cases. It feels perfectly natural to me to leave the cord alone, completely!

  7. Paulina says:

    Gloria,
    I am currently pregnant with my second baby boy, my first born was c-section, and I am hopeful for a natural birth this time, I have a great Midwife that I trust, and so far everything is going great, except for one thing that I think about everyday.
    Exactly this, the delayed cord clamping, I want to do it so bad and I am having conflicts because my first born has Autism, and I have seen so many kids with this condition to get so much better with a Cord blood stem cell treatment, and I’ve been told that when the cells are from a family member (a brother/sister) that it is even more beneficial to him.
    So here is my problem, I want my first born to have his brother’s cells to get better, and I also want to leave the umbilical cord on his baby brother until it stops pulsing, I feel terrible about reading all this, and I feel selfish for wanting to take that precious blood for my first born… can you give me your opinion?

  8. gloria says:

    Paulina, I had never heard of this theory of cord blood cells for autism so I did a quick Google search. Don’t be fooled by what is on the internet. All of the info on this is a sales pitch for a business. What a world we live in where profit would be made on parents’ desperation to help their children!

    You would be wise to read the cord blood banking statement of the British Royal College of Obstetricians and Gynecologists http://www.rcog.org.uk/womens-health/clinical-guidance/cord-blood-banking-information-parents

    Clamping your baby’s cord too quickly could, in fact, lead to autism:

    Early cord clamping in relation to autism

    Tue Sep 16, 2008 12:33 pm (PDT)

    “Immediate clamping of the umbilical cord at birth has become a
    standard procedure during the past two decades. This merits
    investigation as the cause of increased incidence of autism.
    Clamping of the umbilical cord before the lungs function induces a
    period of total asphyxia and produces severe hypovolemia by
    preventing placental transfusion – a 30% to 50% loss of blood
    volume – resulting in a hypoxic, ischemic neonate at risk for brain
    damage.

    As in circulatory arrest and other factors that disrupt aerobic
    metabolism, damage of brainstem nuclei and the cerebellum can result.

    Visible damage seen in some cases of autism also involves brainstem
    nuclei and the cerebellum. The brainstem auditory pathway is
    especially vulnerable to brief total asphyxia. Impairment of the
    auditory system can be linked to verbal auditory agnosia, which
    underlies the language disorder in some children with autism.

    Due to blood loss into the placenta, the immediately clamped
    neonate is very prone to develop infant anemia that has been widely
    correlated with mental deficiency and learning / behavior disorders
    that become evident in grade school.

    We propose that increased incidence of autism, infant anemia,
    childhood mental disorders and hypoxic ischemic brain damage, all
    originate at birth from one cause – immediate umbilical cord
    clamping.

    This deserves to be investigated as extensively as genetics or
    exposure to toxic substances as an etiological factor for autism.
    Normal cord closure, with placental oxygenation and transfusion,
    prevents asphyxia and ischemia.

    Allowing physiological cord closure at every delivery could at least
    reduce the incidence of birth brain injuries.”

    “Immediate clamping of the umbilical cord before the child has
    breathed (ICC) has been condemned in obstetrical literature for over
    200 years. [1] [2] In the 1970s, primate research [A][3][4] using
    ICC to produce neonatal asphyxia resulted in brain lesions similar
    to those of human neonatal asphyxia.”

    http://www.cordclam p.com

    The trauma of being asphyxiated at birth after losing half your
    blood to the placenta can only be imagined.

    3) “In 1975, the College Entrance Examination Board commissioned an
    advisory panel to examine the possible reasons for an alarming
    continuing decline in the scores of high school students on the
    Scholastic Aptitude Tests or, “SAT’s,” a decline which had started
    with the 18-year-olds born in 1945 and thereafter.

    From 1963 to 1977, the score average on the verbal part of the SAT’s
    fell 49 points. The mathematical scores declined 31 points. (1)
    (…)
    “The SAT is designed to be an unchanging measurement. Considerable
    effort has been made to keep the test a sufficiently constant
    measure so that any particular score received on a current test
    indicates the same level of ability to do college work that the same
    score did 36 or 20 or 5 or 2 years ago. The SAT measures individual
    students’ capacities not only in comparison with their peers in the
    particular group but also in comparison with those who took the test
    in earlier years …. The SAT score decline does not result from
    changes in the test or in the methods of scoring it.” (2) (…)

    “What happened around 1945 that might have contributed to declining
    academic performance in the United States in the years that
    followed? Consider this brief history: According to figures from the
    National Center for Health Statistics, hospitals were the setting
    for only 36.9% of American births in 1936. By 1945 that figure had
    more than doubled to 78.8%. In 1950, 88% of Americans were born in
    hospitals. In 1960 the figure was 96.6% and in 1970, 99.4%. (…)

    “A reading of the obstetric literature indicates that there had
    always been philosophic differences among doctors regarding normal
    childbirth. There were those who felt it was best to allow nature to
    take its course and there were those who felt that intervention was
    better. In the years following the 40s and under the stresses of the
    population explosion, there was a tremendous acceleration of
    intervention in obstetric care. Instead of adapting to the time-
    consuming demands of normal childbirth, the obstetric community
    (with very few exceptions) changed normal childbirth to conform to
    the comfort of the mothers and the convenience of the doctors,
    hospital staffs and hospital routines — all at the expense of the
    fetus and newborn.”

    Excerpted from a letter by Rich Winkel, a mathematician at the mathematics department of the University of Missouri, of Columbia, MO

  9. Paulina says:

    As a mother who investigates every single day, anything that can help my son’s condition, I came across this stem cell treatment which is very expensive, I am in contact with one of the recovered children’s dad, his name is Daniel Faiella (You can look him up, he has been in the news and even wrote a book). His son received four transfers of stem cells plus hyperbaric oxygen treatment and he has miraculously recovered to a level that one can only dream it will happen to their kid.

    After reading the information that you have provided me though, I am not willing to risk my second born to help his brother, and I think that when we can finally afford it we can use donated cord blood stem cells instead.

    Thank you so much for your advice Gloria, it is much appreciated.

  10. Brigida says:

    Hi Gloria ,
    I went to my 33 week pregnancy check up and was talking to my doctor about wanting to wait for the umbilical cord to stop pulsating before he clamps it and he said that though it could be advantageous because the baby will receive more Red blood cells there are also some disadvantages. For example, the blood could start…… leaving the baby’s body back into the placenta hence he recommends that it be clamped within the first five minutes of giving birth. What do you think about his thoughts?

  11. Sigismond says:

    Indeed , Gloria, “delayed cord clamping” does not resist to “natural clamping”.

  12. Sigismond says:

    Free consent should be required for non-natural clamping.

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  14. Trisha says:

    Brigida, I realize that it’s past your due date now, but I wanted to give some info on why that just can’t happen. When the baby is born, shunts in it’s heart close and fetal circulation changes to pump blood to the lungs instead of to the placenta. The idea that we need intervention (cord clamping) to save us from nature’s divine design (leaving it alone) is preposterous. That would imply that if a woman had her baby all alone with no way to clamp and cut the cord that her baby’s blood would drain back into the placenta after birth and the baby would what? die? That’s ludicrous. Baby and placenta work together after birth so that baby gets only as much blood as baby needs—AND keeps it.

  15. bernice raabis says:

    I know this is old but I just have to say for my own sake…. BRIGIDA get a new doctor!!! If he truly believes this can happen he has never really paid attention (or possibly has never experienced) a cord that was left alone until the placenta was delivered. I have had 2 unassisted births (4 births in total) and what always astounds people most was that I (we) dealt with the cord/placenta on our own. Far from being superheros we just left things be and followed very simple intuition. I had my baby, I went to the bed and cuddled her, cried, called in the kids, talked to our new angel and bonded as a family… the placenta and cord silently do their work putting baby blood where baby blood goes and mama blood where mama blood goes. The cord begins to go more and more limp eventually clotting. I then (both times) was signaled by my body that it was time for the placenta to come…. it is not rocket science, I felt a feeling of heaviness in my vagina, I felt slightly irritated, I wanted the cord gone so I could continue to bond and not have to worry about it… well as if by design (tongue in cheek) this was because my placenta had detached and was right there at my opening ready to come out. One quick tiny push and it plopped out. By this time the cord is mostly white, limp and has many little clots in it. We tied a piece of boiled home-made rope (monks cord made from embroidery floss) for good measure an inch and a half from her belly button and just cut the cord… it didn’t even bleed because there is very little blood let in the cord and what is still there has begun to clot. Seriously there is such a big deal made of the whole thing and having experienced it 4 times and 2 on my own I can tell you it is a non issue and very intuitive… I wish for all womyn to have this amazingly empowering experience, to know that their bodies are so well designed to give birth, and that the process itself is simple…. So simple in fact the most beings on this planet navigate it without the aid of attendants or fancy devices… imagine that.

  16. We had midwives for all four of our children’s births. My third child’s cord pulsed for an hour! She was happily nursing and we all were amazed to see how long it took for her to get all her blood. When we took her to the doctor for her first checkup (it was a homebirth), the doctor was amazed at how red our baby was. We explained that this was how much blood she had and needed, and the doctor was amazed. Our daughter had none of the supposed problems of delayed cord clamping, like high bilirubin levels. She was just fine.

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