//
Delayed Cord Clamping, Interventions, Neonatal transition, Physiological birth, Placental transfusion

How delayed clamping may protect babies from trauma

Premature clamping and cutting of the umbilical cord can be highly traumatic

Studies show that premature cord clamping can cause:

  • significant blood loss for the baby (loss of 15 to 30%, and up to  40% -50% in more extreme cases of fetal distress and cord compression prior to clamping) (1)
  • loss of red blood cells (up to 50%) (2)
  • loss of stem cells (2)
  • loss of support from placental circulation, to receive oxygen and transfer accumulated acids, before the lungs are functioning adequately (3)
  • anaemia and iron-deficiency (4)
  • interference with clearing of fluid from the lungs (2).

This last point is important, because suctioning of fluid can be traumatic for the baby too.

Many people believe all babies require suctioning at birth – and there is a good chance this ‘need’ is partly due to the effects of immediate cord clamping.

This is because the normal increase in blood volume in the minutes or so after birth (without cord clamping) has a role in the baby’s lung transitioning from a small, fluid filled organ to the ‘dry’ organ of efficient respiratory exchange (2).

After a baby is born, the blood vessels in the air sacs of the lungs are filled for the first time. This increased blood supply though the lungs is an important mechanism for fluid to be drawn out of the lungs (into the baby’s circulation) (2).

The lack of comfort and attention to the baby’s distress is evident in this video, along with the volume of blood clamped off within the cord–depriving the infant. Sadly, many fathers are asked to participate in this “ritual”. *Warning–may be distressing for many viewers*

Suctioning can be trauma

Routine suctioning of the baby – the oropharynx and stomach – was adopted without evidence in the same manner as immediate cord clamping (2).

Suctioning at birth has been performed on a vast number of babies and is still routinely done by some providers/ institutions.

Studies that have examined this practice (after it was already routine) found no differences in lung function between the groups of babies that were suctioned versus the group not suctioned (2). Instead, the studies found risks associated with bradycardia (slowed heart rate) and cardiac rhythm disturbances (2). Suctioning can also be painful and interfere with breastfeeding. (6)

In the video below you can see a baby that is already crying and vigorous at birth being suctioned, and you can clearly see the baby gag and cry in distress.

The experience of premature cord clamping and suctioning for the infant *warning–this video may be highly distressing for many viewers* The baby cries relentlessly for 8 minutes while it is suctioned, injected, handled and temperature taken rectally – with no attempt to calm or comfort the distraught baby.

How to avoid trauma

To protect your baby from unnecessary trauma, please give careful consideration to how you can protect your baby’s umbilical cord and normal placental transfusion.

Your baby is a placental-mammal and as such, is designed to transition from placental circulation to pulmonary circulation (5) – without the need for clamping, suctioning, painful rubbing with towels and separation of mother and baby.

Delayed clamping, gentle handling, even a gentle approach to neonatal resuscitation is possible – parents need to be aware of their options to increase the likelihood their baby will avoid immediate cord clamping(6).

Delayed clamping (or ‘cord milking’) with no suctioning or separation is achievable in more than just natural birth. It can also be possible in:

  • medicated birth,
  • induced or augmented birth,
  • after forceps or vacuum birth,
  • after shoulder dystocia and other forms of temporarily constricted cord (like tight nuchal cord),
  • twin birth,
  • cesarean section birth.

It is important to learn about the physiology of the third stage of labour, discuss your preferences with your care providers, and communicate your choices in very clear terms.

For example, “refusing to consent to the umbilical cord being touched, clamped or cut without verbal consent” (state in writing too) is likely to be much more effective than “asking for delayed cord cutting”.

It is important to be aware how use of equipment in the birthing space can lead to unwanted and premature clamping of the cord.

Planning ahead and discussing birth without clamping with your providers may improve your chances of the cord being intact for assessment, support and perhaps even resuscitation. (This PDF regarding the B.A.S.I.C.S. trolley provides further explanation about bedside neonatal support)

Worse than premature cord clamping?

In some instances, pre-birth and premature cord clamping can be fatal.

The immediate clamping of a volume-deplete and compromised infant can inflict a catastrophic hemorrhage, resulting in global developmental delay, cerebral palsy or death . (Please refer to the references in this article)

There are other rare complications and accidents that can be associated with untimely clamping the cord at birth, for example:

The plastic umbilical clamp is inappropriately applied too close to the baby, and appears to have pinched the baby’s skin. *Warning–images and infant distress may be upsetting many viewers*

Supportive birth practices

There are many routine practices that are disruptive and harmful to the mother and baby at the time of birth. Parents may need to be very clear in negotiating supportive birth practices for their babies. (6)

Supportive birth practices can include:

  • allowing time for the baby’s shoulders to rotate during birth (without applying traction),
  • somersault manoeuvre if cord is tight around the neck,
  • allowing fluids to clear without suctioning,
  • leaving the cord intact and not clamping,
  • using gravity to assist with placental transfusion if necessary,
  • resuscitating with the cord intact or milking the cord before clamping (6).

While a provider may argue some of these practices are not based on outcomes from random controlled trials, neither is traction for rapid delivery of the shoulders, immediate cord clamping, routine suctioning, or the routine and premature amputation of pre-term, full term, vigorous or depressed newborns from the placenta prior to full transition to pulmonary circulation!

Supportive birth practices protect and preserve the normal anatomy and physiology of birth

The more parents demand this type of care, the less infants will experience unnecessary shock, trauma, blood loss and mother-baby separation at birth.

4208918716_8cbed7e409

Image by Jonty Fisher

Video showing birth without harmful clamping

Jamie shared her video with this site a few months ago, which compares her experience of natural ‘Bradley’ style birth to a hospital birth where her baby had instant cord clamping. The Bradley style birth is very safe and gentle, but please be aware this video contains distressing scenes of immediate cord clamping, significant infant blood loss and suctioning.

References:

(1) Yao, A.C., Moinian, M., & Lind, J. (1969). Distribution of blood between infant and placenta after birth. Lancet 2 (7626):871-873

(2) Mercer, J., Skovgaard, R., & Erickson-Owens, D. (2008). Fetal to neonatal transition: first, do no harm. In Downe, S. (Ed.) Normal Birth: Evidence and Debate (pp. 149-174). Elsevier Limited

(3) Farrar, D., Airey, R., Law, G. R., Tuffnell, D., Cattle, B., & Duley, L. (2011). Measuring placental transfusion for term births: weighing babies with cord intact. BJOG : an international journal of obstetrics and gynaecology, 118(1), 70-75. doi: 10.1111/j.1471-0528.2010.02781.x

(4) Chaparro, C. M. (2011). Timing of umbilical cord clamping: effect on iron endowment of the newborn and later iron status.  Nutrition reviews, 69 Suppl 1, S30-36. doi: 10.1111/j.1753-4887.2011.00430.x

(5) Hutchon, D. J. (2010). Why do obstetricians and midwives still rush to clamp the cord?  BMJ, 341, c5447. doi: 10.1136/bmj.c5447

(6) Mercer, J., & Erickson-Owens, D. (2010). Evidence for Neonatal Transition and the First Hour of Life. In Walsh, D., & Downe, S. (Eds.) Essential Midwifery Practice: Intrapartum Care (pp. 81-104). United Kingdom: Blackwell Publishing

Please note this page does not constitute medical advice.
This site is for information sharing and discussion only – the web host assumes no responsibility for any loss/injury/damage arising related to any use of the content contained in, or linked to this website. It is up to the individual, in collaboration with their clinical care provider, to determine the appropriate course of action, treatment and management.
About these ads

About Kate Emerson

Kate Emerson, BA (sociology/politics) / graduate student Kate is a graduate student pursuing her particular interest in neonatal transitional physiology and clinical cord clamping practices. She produces articles and popular media to increase the level of awareness about delayed cord clamping, for parents, students and interested practitioners. Please visit www.cord-clamping.com to read more.

Discussion

12 Responses to “How delayed clamping may protect babies from trauma”

  1. Wonderful, comprehensive articulation of these concepts Kate. I agree 100% with your analysis. I have seen the difference between those babies who’ve had their cord amputated immediately at birth and those who’ve been ‘allowed’ to transition to newborn life at their required pace.

    Over the last couple of decades we have discovered that much of what we have done ‘routinely’ as maternity care professionals has been wrong and damaging. For the mother – routine shaves, enemas, per rectum cervical exams, starvation in labour, ‘confinement’ to bed, episiotomies (to avoid a tear – go figure!) restricted times and duration of breastfeeding in the first four days of the infant’s life – the breast engorgement was horrific and more. For the newborn, rough towel rubbing, slapping, holding upside down, suctioning (vigorous), separation from mother, nursery care, per rectum temperature recording, heel pricks, sugar drinks after intragastric tube, washing with toxic substances etc.

    My personal observation is that the blood loss associated with premature cord amputation and resulting interference in normal cellular shifts with the transition to newborn life is behind a lot of lung and brain ‘glitches’.

    This practice is another one that will make everyone go ‘we did what?’ in a few more years.

    All health professionals as well as childbearing families should read this post and reflect on the innate sense of what you are saying. Thanks for writing this crucial overview.

    Posted by Carolyn Hastie | July 9, 2012, 7:10 am
  2. Great article! The only thing you are missing is a video of a baby’s first few moments when clamping is delayed. There really is a big difference!

    Posted by jessiquebrown | July 10, 2012, 9:39 am
    • Thanks Jessique – I have now added Janie’s video, which she made to show a natural birth and placental birth and compare with the experience of immediate cord clamping and hospital routines. Her ‘Bradley style’ birth was so gentle and normal in comparison.

      Posted by GiftedBirth | July 10, 2012, 11:09 pm
      • It great to have facts and citations. Thank you for sharing this. I will share with other groups that I am part of blessings, Shafia

        Posted by Shafia | July 11, 2012, 3:33 pm
  3. It’s hard to find knowledgeable people on this topic, but you sound like you know what you’re talking about! Thanks

    Posted by get fast pregnant | July 27, 2012, 7:15 pm
  4. We {as moms…as couples} have to care enough to learn the Evidence. We have to Expect more from providers. It starts with us. :)

    Posted by Sarah | August 2, 2012, 1:56 am
  5. I have recently just stumbled across this information so excuse my lack of knowledge, but what does it mean by “resuscitating with the cord intact” resuscitating the infant? like to make it start breathing? how is this a good thing if you have to then resuscitate your baby after? I read about all the benefits, so I get that, but this part I don’t understand.

    Posted by CJ | April 7, 2013, 4:07 pm
    • Hi CJ,
      When an infant is born and is not vigorous/does not commence breathing fairly quickly, it is not possible for the care providers to know if the infant is in primary or secondary apnea. For this reason, resuscitative efforts usually commence within 30 s of birth – however some circumstances or practices may result in resuscitation beginning even quicker. Unfortunately, the space and equipment designed for neonatal resuscitation is usually well away from the mother and involves rapid clamping and cutting of the cord. The issue for the compromised infant is that this clamping and cutting may leave the baby with insufficient blood volume/blood pressure/ red blood cells to support resuscitative measures (expand lungs and commence gas exchange) and for adequate perfusion and oxygenation of the brain.
      Advocates of resuscitation with the cord intact are striving for clinical practices/ investments in technology/ training to address the possibilities to assess the newborn below level of the placenta, consider the infants blood volume and commence initial resuscitation with the cord intact.
      I hope this explanation helps?
      Kate

      Posted by Kate Emerson | April 24, 2013, 11:29 am

Trackbacks/Pingbacks

  1. Pingback: How delayed clamping may protect babies from trauma « Delayed … | ChildBirth 101 - July 9, 2012

  2. Pingback: Cord clamping and obstetric violence *graphic* « Delayed Cord Clamping - July 10, 2012

  3. Pingback: Birth plan for delayed cord clamping « Delayed Cord Clamping - July 13, 2012

  4. Pingback: Cord Blood Collection: confessions of a vampire-midwife | Midwife Thinking - July 23, 2012

Leave a Reply to get fast pregnant Cancel reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Follow

Get every new post delivered to your Inbox.

Join 97 other followers

%d bloggers like this: