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THIS FIRST SECTION IS REFERENCED FROM THIS WEBSITE: http://www.empoweredchildbirth.com/articles/birth/cord.html
There is no rush to cut an umbilical cord in nature. It is vital that the cord be left intact until the child is breathing well on hir own. Oxygen supplied by the placenta makes the transition from the watery womb to dry land much easier on tiny lungs. The "clamping upon emergence" protocol followed in many modern hospitals is nothing less than an assault on the newborn child.
In a normal birth, the child emerges and utilizes the oxygen flowing through the umbilical cord for the transition period after birth. A nursling at the breast is one of Nature's cues to shut down the placenta and empty the womb but this isn't always possible when the cord is short.
Ideally, the placenta will be out and in a bowl beside the beside the baby before the cord is cut. There is typically no hurry to cut the cord and, in fact, many of the standard problems (bleeding, infection, etc.) decrease with each passing hour. If you wait long enough, you might not require a clamp at all as the site "clamps" itself from the inside. Some women report that letting the cord wait for several hours and cutting without clamping results in a cord stump that curls itself into a round button shape. There are baby books out there with the baby's "belly button" proudly displayed in them. :)
Some families choose not to cut the cord at all and allow the placenta and child to separate themselves (Lotus birthing). They may view cord cutting as a form of violence against the child and its "little mother" (placenta) as such practices usually require a great deal of spiritual discipline. Needless to say, this idea appeals to few families today but it is an option.
If the cord needs to be cut before the placenta is delivered it must be tied off to prevent the baby from bleeding out of the wound. Umbilical tape, dental tape (not floss) or even braided embroidery flosses have made excellent "cord clamps" for many babies.
There is blood pulsing through the umbilical cord until it expires. Cutting the cord while it still pulses is common in a hospital setting but it is a last-resort, one-in-a-million intervention in most home births. Preserving that lifeline is an important part of birthing normally.
If the cord is cut before it expires, plastic cord clamps or hemostats are required to quickly and effectively clamp off the blood flow to and from the baby's placenta. Embroidery floss won't hack it in an emergency. If you're the type who wants to prepare for every last possible birth problem you could invest in a pair of plastic cord clamps. The chances that you'll need them are pretty darn slim though. The most common reason cords are clamped early in homebirths is "umbilical cord wrapped around neck and impeding birth". The umbilical cord is commonly wrapped around the neck during birth (it's a "good place" for it) but it rarely impedes the birth. Only one in a million mothers will need those cord clamps.
Metal-handled scissors can be boiled to sterilize or swabbed liberally with alcohol just before cutting the cord. The idea of clamping in two places and cutting between the clamps is prudent when the placenta hasn't delivered but isn't required once it too is Earthside. Some parents choose to do it anyway to prevent leakage from the placenta side.
If you choose to clamp (or tie) do it about an inch or so from the baby's belly and cut close to it so the stump isn't so long it catches on things.
There are several things you can put on your baby's umbilical stump but all it really requires is air and sunshine. Most mothers are warned to keep the stump dry in the US but mothers around the world bathe with their infants and don't give it another thought. If the stump looks red or weepy, the best "remedy" is breastmilk. Breastmilk is a natural, safe, free product with well documented anti-bacterial properties. (You can use it for those yucky newborn eye discharges too. :)
THIS NEXT SECTION IS REFERENCED FROM THIS WEBSITE AND NOTE IT IS BASED FROM A DISCUSSION BETWEEN DOCTORS:
http://healthwise-everythinghealth.blogspot.com/2007/07/umbilical-cord-dont-rush-to-cut.html
If you or someone you know is pregnant, a recent study from JAMA is something you should know about. It has to do with when to cut the umbilical cord. That is probably something you never thought about, right?
The placenta and umbilical cord contain up to 60% of the fetal blood red cells and this blood is rich in stem cells. We are just learning how important these precious stem cells are in preventing blood disorders and diseases later in life. There has been controversy among obstetricians about the optimal time to clamp the umbilical cord in a normal childbirth. Early clamping is considered up to one minute after delivery. Late clamping is leaving the cord attached with blood flowing from placenta to infant for at least 2 minutes.
The researchers carefully reviewed all of the world's literature on this subject and compared studies. They found that delaying clamping of the umbilical cord for at least 2 minutes after birth consistently improved both the short- and long-term blood and iron status of full term infants and this benefit lasted for months. This benefit would be even more important in developing countries where the mothers are often anemic and infant anemia is widespread.
If you think about childbirth in nature, there would not be a rush to cut the cord. The infant is tethered to the mother for several minutes during birth and there is likely a selection advantage for this. We are entering a new era in medicine as we study best practices and use this evidence in care of patients. This is called "evidenced-based" medicine, as opposed to much of how we care for patients which is anecdotal and varies depending on where the physician is trained. Any time we can know what the current evidence shows and use that evidence to practice in the best way, patients all over the world benefit.
The evidence is clear...don't clamp the umbilical cord for at least 2 minutes so the infant can receive all of the important blood components from the placenta and cord.
Posted by Toni Brayer MD at 8:44 AM
Brad Cohn, MD said...
Good article. Not new. Pulsation of the cord lasts at least 2 minutes and on ending is a good measure of when to cut. An exception to the two minute wait is maternofetal blood incompatibility (Rh or ABO) where you want to reduce the transfusion of sensitized cells pursuant to less hyperbilirubinemia and no erythroblastosis. Brad Cohn, MD
K said...
My understanding of what Brad wrote was that it's better to cut the cord earlier rather than later if the mother's blood type is incompatible with the baby's. Because of the problems that occur when someone receives incompatible blood, and also because babies are kinda delicate when first born, it's best to limit their exposure to their mother's blood.
Unfortunately all I could do to help with what hyperbilirubinemia and erythroblastosis are would be to google them for you. I do remember bilirubin and blastocysts from biological anthropology class, though. Basically, though, the things he mentions are blood disorders.
July 16, 2007 2:15 PM
Toni Brayer MD said...
K, it looks like you were listening in anthroplogy! That college tuition was worth it. Now you can interpret health blogs. You translated Brad very well.
Erythroblastosis is too many red cells and hyperbiliruinemia is too much bilirubin. Newborns with excess bilirubin can have serious complications. We know ahead when there is the rare case of maternal-fetal incompatibiity so in all other cases...let that cord blood flow.
FOR MOTHERS HOME BIRTHING HERE IS ALSO A COUPLE OF HOW TO WEBSITES AND A COUPLE OF THE SITES HAS ACTUAL VIDEO FOOTAGE OF HOW TO DO THIS:
http://www.ehow.com/how_2087364_cut-umbilical-cord.html
http://pregnancy.about.com/cs/laborbasics/ht/cutcord.htm << HAS VIDEO
http://www.operationalmedicine.org/Videos/ClampCutUmbilicalCord.htm << HAS VIDEO
THIS SECTION IS ALSO REFERENCED FROM ANOTHER WEBSITE AND SOURCED: Rabe, H., The Cochrane Collaboration, October 2004. Health Behavior News Service WHICH INVOLVES CUTTIN OF THE UMBILICOL CORD AND PREMATURE INFANTS:
http://www.webmd.com/parenting/news/20041018/when-to-cut-umbilical-cord
Slight Delay Could Reduce Transfusions in Premature Babies
By Miranda Hitti
WebMD Health NewsOct. 18, 2004 -- Premature babies may be less likely to need blood transfusions if their umbilical cords are cut a bit later than normal.
Waiting 30 seconds to 2 minutes before cutting the umbilical cord could make the difference, say researchers including Heike Rabe, MD, PhD, of Brighton and Sussex University Hospitals in Brighton, England.
The umbilical cord connects the baby to the mother's placenta, delivering oxygen-rich blood to the infant.
After the baby is born and before the placenta is delivered, the umbilical cord is clamped in two places and cut between the clamps.
There are no official standards about exactly when the umbilical cord should be clamped and cut.
Rabe and colleagues recently reviewed seven studies on the clamping and cutting of umbilical cords. The data are based on almost 300 babies, all of whom were born early (before the end of 37 weeks of pregnancy). Their study appears in the October issue of the journal The Cochrane Collaboration.
When to Separate Baby From Umbilical Cord
Delaying umbilical cord clamping by 30 to 120 seconds, rather than early clamping, seems to be associated with less need for transfusion and less bleeding in the infant's brain, according to the researchers.
Early clamping was defined as clamping in less than 30 seconds.
The extra time lets the baby get a little more blood from the placenta, which could reduce the need for a blood transfusion.
However, the strategy could have risks.
For instance, many premature babies need resuscitation, which is typically performed away from the mother. In those cases, the umbilical cord must be cut quickly to save the baby's life.
Waiting too long could also allow an excess of red blood cells to thicken a baby's blood, possibly stressing the newborn's heart and breathing or even prompting jaundice or brain damage, according to news reports.
The study did not address the practice of "milking" the umbilical cord before cutting it, a method used by some practitioners to coax placental blood in the umbilical cord into the baby.
The researchers also did not weigh in on whether it helps to hold the baby below the placenta, as some believe.
A longer-term study of umbilical cord clamping times in premature babies is under way.
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| Posted by Jennifer on 01/23/2009 11:19 PM
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