Wednesday, May 26, 2010

Wait to Cut Umbilical Cord, Study Says

Another study says that delayed cord clamping is a good idea!


A review article from the most recent issue of the Journal of Cellular and Molecular Medicine was cited in the following MSNBC article [all emphasis mine]: 


Wait to cut umbilical cord, study says
Baby may benefit from not clamping until cord quits pulsing

Usually within the first minute of birth, the umbilical cord running between mother and infant is clamped. But this may be too fast, researchers say.

Waiting until the cord stops pulsing could give the newborn significant health benefits, suggests a review article in the most recent issue of the Journal of Cellular and Molecular Medicine. 

"Ob-gyns and parents should think about giving the cord blood to the baby," said lead researcher Paul Sanberg of the University of South Florida. "It only takes a few minutes." 

The umbilical cord carries nutrients and oxygen from mom-to-be's placenta to the developing infant's abdomen. (It leaves a life-long impression in the form of the belly button.) When the practice of immediate cord clamping first began about a half century ago, the value of cord blood, especially its stem cells, which can develop into a suite of other cells, was not known. But now we know that stem cells have many therapeutic properties, Sanberg told LiveScience. 

"It is not just regular blood going in," he said. "It is nature's first stem cell transplant.

Common problems in newborns are usually related to their underdeveloped organs, which might be helped by the regenerative properties of stem cells, Sanberg theorized. 

After reviewing the majority of research in the field, Sanberg and his colleagues concluded that delaying cord clamping could reduce the infant's risk of many illnesses, including respiratory distress, chronic lung disease, brain hemorrhages, anemia, sepsis and eye disease. 

The risk of such problems, and thus the potential benefit of delaying cord clamping, is particularly significant for premature babies and those born malnourished or suffering from other complications.
Still, the researchers suggest delaying cord clamping may be beneficial for healthy, full-term babies as well — after all, it may be what we have evolved to do. 

"Evolutionarily, there is clearly value for this," Sanberg said, explaining that all mammals, including most humans through history, allow the maternal blood to finish being transferred before severing the cord. The squatting birthing position, only recently out of vogue in the West, may have even facilitated this transfer by harnessing gravity. 

"Only in the last half century or so has mankind started cutting the cord early," Sanberg said.

Evidence-based medicine, people! :) 

This makes me curious as to why doctors even began immediate clamping. I know there is the argument that not clamping the cord may deprive the baby of oxygen, but was lack of oxygen happening in such a way that doctors thought the cord was the connection? It seems like it may have just been more for convenience... if we disconnect mom and baby ASAP, the faster we can whisk baby away from mom to do our newborn checks, and the faster we can get on with our lives (or for legit emergencies). I guess it caught on because it didn't seem to have negative effects on the baby (babies still live, after all, despite quick clamping and cutting). But now that we know it an have positive effects, it is worth changing practices!

9 comments:

Eric said...

I see where this is going - but I think the clamping and severing of the cord so quickly is mainly so that the baby can be quickly aspirated, checked for any disorders, and quickly given to the mother so that she could see her healthy newborn child ASAP before she gets a chance to ask "is everything ok?" You can't exactly do that if the placenta is still inside of her while connected to the baby. Even if you wait for the afterbirth, you could image how awkward that would be,

"here's your baby - now hold this placenta and don't let it fall!"

So good to hear from you Emily - keep in touch and good luck with everything!

Eric

Emily, Anthro Doula said...

Hi Eric! Thanks for stopping by! :)

In actuality, all that CAN be done while the placenta is still inside of her and connected to the baby. I've heard of it, seen it in videos, and seen it with my own eyes.

Baby is placed on mom's tummy immediately after birth, if the baby was not in some sort of pre-determined distress, if the hospital staff does this as the norm, or if the staff respects her wishes that she would like this done. Baby is aspirated like crazy in the hospital setting (which, btw, is not always -necessary- but almost always done as precaution) and looked over while on mom's chest. Mom doesn't need to ask "is everything ok" if she sees the baby first with her own two eyes and hands. Baby can have temperature taken and be looked over while on mom's chest, which is warmer than the hospital warmer and less stressful for the newborn.

The cord is generally long enough to allow this to happen. I have seen instances where the cord has been short, but usually baby can still be lifted to at least the stomach.

You may not know this, but the placenta takes quite a while to come out. Its not "woosh - baby! woosh - placenta!" It takes a few minutes (generally if this stage is 'managed' where the caretaker pulls on the cord, which I'm not a fan of - potential problems) or even over an hour. If it takes longer than a half hour in a hospital setting, the staff flip out, give you pitocin (if you don't already have that running through your veins) and may potentially go in and yank it out. They worry about hemorrhage here. In reality, the placenta can take up to two hours to come out safely and the woman is perfectly fine. So there's no baby/placenta juggling going on!

:)

Scrappy said...

It's worth reiterating: When baby is placed skin to skin with mother immediately after birth, mum has no need to ask if everything is okay, as she can observe this for herself. Apgar scores immediately following birth can be done with baby on the mother's chest, as well as most other routine checks.

Interestingly, routine suctioning after the birth of the head is currently under scrutiny, and is no longer practiced at our hosp. Also studies have shown evidence that even gastric suctioning to prevent the aspiration of meconium is not only not beneficial (!!!), but that it interferes with feeding in the first hours after birth.

Funny how we are consistently seeing that in birth, and in the absence of clear pathology, the more we sit on our hands the better things go.

Emily, I really enjoy your blog! All the best.

Emily, Anthro Doula said...

Thanks Scrappy!!

Desiree Fawn said...

At my homebirth we definitely waited to clamp until they cord was done pulsing, and it pulsed for quite a while! All of those safety checks can certainly be done while everything is still attached, no problem at all.

Stem cell said...

Yes, I think this is right, and also from this cord we can get cord blood which is very much rich in stem cells.

Cord Blood said...

Wow. Thanks for sharing your story. I've heard that preemies can benefit the MOST from delayed clamping/cutting. Unfortunately there are still lots of old school doctors and nurses out there that like to do things the old fashioned way: Cut the cord ASAP, wipe the kid down, place under heat lamp or in nursery, forget about Mom. Luckily our hospital was pretty progressive and had changed their ways within the last 5 years or so. They realize that natural is better and having the child on Mom's chest with the cord intact eases the transition considerably from the womb to the world. Natural is always better and we as parents need to learn to trust our instincts more than old generation doctors that don't want to change their ways.

Anonymous said...

Delayed Cord Clamping Grand Rounds
Dr Nicholas S Fogelson MD
http://academicobgyn.com/2011/01/30/delayed-cord-clamping-grand-rounds/

erinmidwife said...

Love the perspective! I am a midwife and my husband is an evolutionary anthropologist by schooling.

I'm curious about the image used here. Is it stock? I'm looking for a limp cord shot for a piece I am writing on the same subject.

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