All over the western world, every day with every birth midwives and doctors alike are clamping the cord immediately after the baby has been born. They are pumping women full of artificial oxytocin (which knocks off the natural production) and they are pulling out the placenta. But Why?
They are taught this is the best way to deliver the third stage. Birthing is no longer thought of as a natural event. Without help the mother would bleed to death and the baby become ill.
I have heard an Obstetrician say, if you don’t cut the cord then all the blood will run out of the baby back into the placenta and it will become anaemic. I’ve also heard them say, if you don’t cut the cord the baby will be polycythemic( too many red blood cells). The lack of knowledge on the physiology of birthing makes my head spin. Is it truly possible that Obstetricians do not understand how the body works?
After the birth of the baby the cord continues to pump in and out of the baby for a few pumps. If the cord is cut on the out pump then the baby is quite devoid of the amount of blood they require.
There is lots of research out there on cord clamping which is all very boring but easily found on google, (saves me putting it all here), Here is the cochrane recommendation. (significant obstetric data base)
Effect of timing of umbilical cord clamping at birth of term infants on mother and baby outcomes
At the time of birth, the infant is still attached to the mother via the umbilical cord, which is part of the placenta. The infant is usually separated from the placenta by clamping the cord. The timing of this clamping is one part of the third stage of labour (the time from birth until delivery of the placenta) which can vary according to clinical policy and practice. Early cord clamping is believed to lead to a reduced risk of bleeding after birth (postpartum haemorrhage). This review of 11 trials showed no significant difference in postpartum haemorrhage rates when early and late cord clamping were compared. For neonatal outcomes it is important to weigh the growing evidence that delayed cord clamping confers improved iron status in infants up to six months after birth, with a possible additional risk of jaundice that requires phototherapy.
basically early cord clamping is a totally crappy thing to do to a mother and a baby.
The golden rules,
- Don’t wake the mother
- Don’t touch the baby
- Don’t cut the cord.
Any interference in the natural process creates more risk. As the mothers chest gets ready to receive the baby the vessels open and the skin is warmer than the rest of her body. Receiving the baby to her chest keeps the oxytocin high helping the mother to contract for the process of birthing the 3rd stage and helping the baby up it’s oxytocin ready to stimulate suckling.
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If mother and baby are left, her uterus will start to contract after a while and she will push out the placenta. Only then should the cord be cut. There are far fewer risks to mother and baby if the process remains untouched.Cutting of the cord before the process has finished creates a higher risk of bleeding. This is the normal physiological process, drugs such as synthetic oxytocin (syntocinon) should only be used in an emergency.
The trouble is, many midwives have NEVER seen a completely physiological third stage they are afraid of normal blood loss and are not able to make a good assessment of what is normal because they have no experience of it.
The fear of jaundice also seems to be unsubstantiated. I have never experienced pathological jaundice in a birth with a totally physiological third stage. Phototherapy has long been assumed to be a positive thing when it comes to a jaundice baby but there is very interesting research that shows that some jaundice can be important in the oxidant/antioxidant defense system in newborn infants, exposing them to potent oxidative stress. It is totally possible that physiological jaundice with a natural third stage is a normal part of developing a healthy system.
Only rarely have I experienced a post partum bleed of significant amount. It is far more common that the interference of pharmacology and human hand impedes the process causing bleeding.
There are lots more posts on the third stage.
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Couldn’t agree with you more. The huge majority of my births have been physiological third stages and the only problems I’ve ever had with heavy bleeds and retained placentas have been the ones with active management (usually after additional interventions such as induction or epidurals). I HATE the feeling of pulling on a cord – so unnatural.
Have just become a homebirth midwife in Canada by the way – lovely to be back at births!
LEAVE THEM ALONE!!!
I am a student midwife and sitting in on prenatals with a Dr (no midwives here). One mom asked about delayed cord clamping for her birth plan. Now this Dr is pretty open but he said with this baby expected to be pretty big he doesn’t recommend it because “extra blood on a 4 kg baby might cause jaundice”. What I don’t understand is formulating it as “extra blood” instead of “normal amount of blood the baby would get”. Did we have doctors around to clamp cords thousands of years ago? No. Mothers took care of cords (or not) when they had spent some time with their babies first. So it’s really about the language. It’s not giving the baby “extra”.
With all due respect to Ms Barrett, if you want a little more balanced view, may I suggest reading for yourselves:
http://emedicine.medscape.com/article/275304-overview
In many cases delayed cord clamping will be a great idea, and I have no issue with this. However, in high risk situations, and even in some lower risk settings, there is much evidence to suggest that active management of the third stage of labour prevents serious post partum bleeding.
Seeing as this is world-wide probably the single largest cause of maternal mortality and morbidity, it makes sense on a population scale that any reasonable measures that can be instituted to prevent this will save lives and save complications, hence why you will find most Obstetricians recommending active management of 3rd stage. Why risk it?
Prevention is better than cure!
Please explain these high risk situations to us and we’d love the evidence, as long as it isn’t the Bristol trial or the hinchingbrooke trial. ( which in fact I have first hand knowledge of) Good health is the main prevention of post partum bleeding along with patience and understanding of the physiology. Activity in the third stage should be reserved for necessity. Interfering unnecessarily with potentially compromising the baby for no actual reason cannot possibly be justified. What if just by chance the escalation of cancer is because we are depriving babies of stem cells that are vital? In the retrospective look at homebirth and hospital birth in SA, when they looked at the haemorrhage rate it was the same as the hospital rate AFTER they had removed all the things like extended episiotomy, instrumental birth, snapped cord blah blah. The were surprised with the results, they couldn’t believe that the haemorrhage rate at home was so low. So much so they even said that very thing in the report. The balanced view is do nothing unless you have reason to interfere. White western healthy women with good hb and no underlying liver issues just don’t spontaneously bleed to death for no reason.
This is directed toward AP. Wow! Pretty scary article… I am sure there are many more where that come from. The medical community likes to scare the poopy out of people. I think you said it was in the prevention. Maybe to prevent this we should not have babies at all… It is like taking out an organ because it may get cancer. When I talk about prevention, I am talking about taking care of yourself not checking to see if anything is wrong and then treating the problem. Then we get into defining high risk and what is “low risk”. I have know a couple people who have fallen and bumped their head and DIED!!?? Do we stop walking or strap ourselves to a wheelchair because there is a “risk” involved.
If you have been indoctrinated “brainwashed” through medicine, you may not see it.
So who can a mother believe, it we have all these medical articles telling us how bad birth “could” be (which is what happen in a hospital) when having a baby.
Check the stats and not the ones from the hospital.
Here is one article and I am sure you can google more stats on homebirths.
http://www.compleatmother.com/homebirth/hb_safety.htm
I had 3 unassisted homebirths 19, 16, and 13 years ago. My husband did not let me read ANYTHING negative (at that time we could only get things from the library) or watch any bad birthing videos. That did not leave me with much. I did watch my dog have puppies 2 months before my first due date and she had never given birth before. I figured if she didn’t need any training nor did I. Ha ha.
I had read about 100 homebirth stories and highlighted things that had happened in the births that I thought was pushing the envelope… like crowning for a long period of time…cord wrapped around the neck… placenta being born 11 hours later… having sex during labor… tearing and healing naturally…
So, when I was in labor I would remember all these different out of the box situations and allow mine to be mine.
This past summer I had a friend call because he and his wife had just an unassisted homebirth. It had been 8 hours and she still had not delivered the plancenta and he wanted to know what I thought. I told him I remember reading 20 years ago that the longest I had heard was 11 hrs. He called later to tell me that her placenta was born 12 hours after the birth. Both she and the baby were healthy.
I am with Miki on this one “Please- to all midwives out there- see that things can go wrong and be prepared! And to all the obsetricians- if we have a normal pregnancy with no risk factors, please let us birth alone and save us if we need to be saved. No mother would make an informed choice to harm their baby.”
AP, for the record, ‘active’ management of the third stage led to my post partum haemorrhage.
So I bled heavily and continuously for four hours while they waited for it to stop, before they decided the retatined placenta wasn’t going anywhere.
Which led to me being wheeled away to an operating theatre after having to sign the paper acknowledging that they might have to give me a hysterectomy or that I might die…
I looked at my husband and child and wondered what the hell they would do without me.
Luckily I woke up. I was groggy and had missed several of my daughter’s first hours, but at least I was alie and whole.
All this because an impatient attendant ‘actively’ manged the third stage of my labour by trying to pull the placenta out by the cord within 20 minutes of my daughter’s birth. (We were low risk, she came out beautifully and had started to nurse, I had an intervention free birth, and was lying in a hospital in case anything went wrong. I now believe I would have been FAR better off at home)
Thank you for yet another good discussion of this Lisa…passing it on to all the mamas I know
Fantastic post Lisa. And I do remember the 3 ‘golden rules’ from my valuable experience with you, amongst lots of other info.
Thank you so much….I too have never seen a physiological third stage, as a 3rd yr MID student!! x
It isn’t ‘extra’ blood at all! This summer I learned from Barbara Harper that the baby actually sends some of its blood into the placenta before birth, in order to be as small as possible for the birth. Then, after the birth, this blood is returned to the baby’s body through the cord. I had previously learned that the difference in blood volume for the baby is between 33% and 40%! NOT receiving this blood does NOT help the baby!
In the hospital picture, what is that grey thing with the blue cord?
Just curious.
I bled too much after my hospital births, when I had “controlled cord traction.” As soon as I stayed home and the placenta and cord were not messed with, no problem.
However, there was one time that 45 minutes after the birth, the placenta had still not separated and was still actively pumping. I called my doctor (who didn’t come to the births but was available for consultation and would come later and examine me and the baby) and asked him what to do, and he said go ahead and cut and the back pressure would separate the placenta. It happened as he said. How long do you think we should have waited with the baby still in fetal circulation? The baby appeared fine, was already nursing. Nor was I bleeding too much.
But I sort of wanted to be done at that point.
Susan Peterson
My 3rd stage was actively managed, it was presented to me as necessary because of the other interventions I’d had (epidural). Cord was so short I couldn’t hold baby until the cord was cut; I wouldn’t let them do that until it stopped pulsing. The delay in holding him is still felt to me as a pain in my heart. When they finally told me it was ‘time to delver the placenta’ (after a short time nursing) I wouldn’t let them pull it out; I was convinced it was still attached as I hadn’t felt any contractions. So there I was unable to hold baby and feeling frantic about letting go of the only bit of baby I was still holding. this was very distressing for me. Point I’m making: the issue of management of the 3rd stage isn’t just about protecting physical health, the treatment of mum and bub in this time has deep psychological significance too.
I personally had both sides of the story- a hospital birth and a homebirth with delayed clamping of the cord. I have trusted the experienced midwife completely to help me make safe decisions. I have weighed up the risks and benefits and as much as I was aiming for a beautiful birth experience (that I had), I was prepared for nature to have something else in mind for me! I would not have risked the life of my baby- and my life- however, after researching the information around the delivery of the placenta, I believed the delayed clamping is the way to go- not leaving the placenta on until it drops off (since the cord has stopped pulsating- so what is the n=benefit?). Could you not still give Syntocinon if the mother actually starts bleeding- which- as far as I know- is not the norm?
) and I often look into the animal world to see how they do things and what works for them. They hide somewhere to have babies and they eventually chew the cord and eat the placenta (very nutritious- but I could not eat it and luckily dont have to with all the food around us!) That is natural. Did you know that acupuncture works on animals? That is proof for me.They dont judge, they do not know who the obstetrician and who the midwive is. It would be great, in an ideal world, if midwives and obstetricians could develop enough respect for each others work that they can sit down and work on a solution that actually benefits the mother and the baby.
)- and isnt it safer in that case to leave the mum?- just a thought.
I really think that obstetricians are often only called to serious complications of a labour and therefore have not experienced many uncomplicated labours- whereas the midwives are often at the other end of the spectrum. Obstetricians are needed and are doing a fantastic job saving the life of babies and their mums!. But there are some (most) that do not need intervention, since birth is natural (painful but natural
Please- to all midwives out there- please also see that things can go wrong and be prepared! And to all the obsetricians- if we have a normal pregnancy with no risk factors, please let us birth alone and save us if we need to be saved. No mother would make an informed choice to harm their baby, please work out a plan together and then inform us- it is all so confusing!!!!
By the way-
I have read the medical study suggested- here the summary: “The period following delivery of the baby is a time of relief and joy for all involved; however, this period holds great potential danger for the mother. Complications of the third stage, especially PPH, account for much maternal mortality and morbidity. Compelling evidence suggests that active management of the third stage results in a decrease in complications and morbidity. The practice of prophylactic oxytocin administration with delivery of the baby and CCT with countertraction when the uterus is well contracted is strongly advocated. Caregivers must be prepared to diagnose and manage the complications that arise in the third stage in a timely and systematic manner.” – can the haemorrage not be caused by pulling on the cord by an unexperienced resident, for example (just to talk in real life terms
With the critical analysis of the two main trials on an active third stage, there is very little compelling evidence on third stage. However I agree that being prepared is important and why you have a care provider at your birth.
of all the research I have read (quite a lot), the only one i remember best is the one done in Australia published just this year I believe and they had done something no other research did – they separated the mothers into risk groups. If a mother was in a high post partum bleeding risk group – the outcomes were better with active management. But if the mother was in a low risk group – active management INCREASED her chance of extensive blood loss. And it does make sense, since you can get severe bleeding if you pull on the cord too hard and too soon. And it also proves that it is possible to predict which women can benefit from active 3rd stage and which should be left in peace and just observed.
I also have a question – what do you believe is the difference between clamping and cutting after the cord stops pulsating and cutting only after delivery of placenta?
P.S. I was also thinking about those stem cells that we so desperately try to preserve in freezers at high cost. But if we do not freeze them, we do not let the baby get them and just throw them out. Does not make sense. I wanted my baby to have them all from the start. and he had jaundice, so what – that is why we have the sun and mother’s milk to get rid of it.
the cord does not, from my reading and observation, completely stop pulsing until after the placenta is born. Hence, “delayed” clamping that is done before the placenta is out is of debatable use and can easily result in the baby having either too much or too little blood When the uterus is clamping down on the placenta, it is putting pressure on the blood to flow toward the baby, when the contraction is over but the placenta is still inside the blood would flow from the baby back toward the placenta… depending on which direction blood is flowing would result in the baby having too much or too little of its birthright of blood. Waiting until the placenta is born and the cord TRULY stops pulsing lets the blood equalize between the baby and the placenta in the way nature intended. That is my non-medically-trained interpretation of the evidence from extensive reading and three births. My first son had a short cord, the CNM clamped and cut it though I could have just hunched to let him have access to the breast if I could have been in a position other than on my back but I had birthed sitting upright on the edge of a hospital bed and could not roll to my side to take the baby in such a narrow space and felt a little too floppy to trust my arms without support, especially with how high off the ground I was. She didn’t cut it the instant it was available but it was still pretty quick even though I had specified I wanted it delayed (it was maybe a couple minutes after he was born so by mainstream standards, “delayed”). His bili level went to 19.5, he was YELLOW head to toe and whites of his eyes, and he spent 40 hours under lights even though nursing was going fantastically (he latched as soon as he was able to reach a boob, within 10min of birth, and my milk came in before he was 48hrs old with enough supply to have been feeding twins – I have oversupply problems). My 2nd and 3rd were born at home with a direct-entry midwife who is also an RN. Their cords weren’t touched until the placenta had been out for about 10min or so and had definitely stopped pulsing. Neither of them had their bili levels go into the double digits. They were/are also fantastic nursers (2nd son weaned during my 3rd pregnancy, 3rd son still nursing at 10.5mo). I firmly believe it was the too-soon cord cutting that triggered my eldeest’s jaundice, that the cord was clamped when the blood was on the out-flow to him from the still-internal placenta and he got too much blood without being able to equalize it. He was also very RED before the jaundice set in, enough that my MIL said he looked like a sweet potato when she saw the pictures.
interesting. My baby similar story, short cord so we cut because I couldn’t even pick him up it was so short (and the hospital bed layout so impossible to manouvre on). and yes, day 3 sleepy as, jaundiced and losing weight.
That postnatal admission was a nightmare.
I still can’t pass a week without regretting setting foot inside that hospital.
I adore you and your blog! <3 This information seems like common sense in theory, but it isn't which is a tradgedy. I was ignorant enough to believe that having a CNM attend my daughter's birth in a hospital would make me immune to the systems of a hospital. A completely different "med"wife assisted the delivery and as soon as my daughter was out and on my abdomen (short cord) I reiterated that I wanted to practice delayed cord clamping. I was in my own little world while my daughter and I fell in love with each other so I didn't realize until I watched the video that her cord was clamped *maybe* 3 minutes after she was born. This may be delayed by hospital protocol but I cringe when I look at pictures of the still robust cord clamped off in 2 spaces. I'm sure she applied traction to detach the placenta as well, seeing as how the it was out and discarded (sadly) within about 10 mintes after birth.
Hi Lisa. This is my first comment on your web site, and I have read alot of your articles with interest, as you sound a very passionate woman when it comes to home birth and what I see as issues countries have with ‘informed choice and consent’: Women need the reserached based information in which to make informed decisions upon. I am a midwife in New Zealand, and have been for 18 years. I am a rural self employed midwife and catch babies at our local birthing unit or at home. In New Zealand, our New Zealand College of Midwives has a Consensus Statement (which is meant to guide midwives and women with informed choice and consent) about the third stage of labour. It says that women who have a physiological labour and birth should be expected to have a physiological third stage. This document has research which supports it and this is also supported by the New Zealand Ministry of Health. Active management of the third stage is indicated when there are active management of labour and birth. So for me it is simple, and my 6+ birthing women per month understand and accept that they will have a physiological third stage unless indicated. I have a very low ratio of complications due to this guideline. Lots of skin to skin with mothers where there is no seperation from their baby for a minimum of one hour, surges the natural oxytocins which makes my job so much more simple. This year I have had one pph but only very mild (600mls). No retained placentas. I cut the cord as per the guideline, which is often after the placenta has come out, and I leave a long cord which we find drys out so much better and quicker. Within the first hour after a birth, the placenta may come out, the baby will find the breast and feed, and the skin to skin regulates the babies breathing and heart rate. Only after a baby had fed well (usually over an hour) will the baby be checked and weighed. I have found from my own statistics, which has mirrored researchers, that seperation of the baby from it’s mother in the first hour of birth can increase the rate of pph, retained placenta, breast feeding failure. I barely need to use any oxytocin injections for women unless they are under a specialist having intervention for complications, and the best thing is that the women fall in love with their babies in such a wonderful way: Lying down, snuggling and relaxing. And during this, the placenta comes out. I love it!! Have recently even supported a woman to have identical home birth water birth twins, all physiological and with a blood loss of 150 mls. So I feel that informed choice and consent is one of the key to outcomes. Choosing place of birth is another, as phycological preparation affects outcomes. And keeping strong and focussed in ones choices is essential.
Question for you Karen..under your guidelines, would I have been recommended a physiological third stage even though I’d had an epidural? Just curious whether the managed 3rd stage I had was actually necessary or not.
It is difficult question Meg, I’ll be interested in Karen’s reply. I think that it is possible to have a physiological 3rd stage with an epidural but the risks are far higher.
How can we expect that the first and second stage are not physiological (epidural, augmentation, induction etc) then expect the body to miraculously kick in to a physiological third stage. It’s all the other interventions that probably weren’t necessary that created the need to manage the end of the birth too.
With any augmentation (drip of synto) the artificial drug knocks of the body’s naturally produced hormone making it difficult for the body to do the right thing without continued assistance.
thanks Lisa : )
If it helps with the answer…the only intervention I had was the epi. there was no augmentation.
I guess I’ll never know whether the epi was “necessary” or what the outcome would have been had I made a different choice. It was a decision I made for myself to transfer from home to hospital and get the pain relief. After feeling like I was in ‘transition’ for hours, I started to feel very tired/worried and asked for an exam…it was found I had a huge anterior cervical lip and I met some pretty strong fear (or at the time, I felt it was an intuition) that if I didn’t get a rest I’d have no energy for the push. After the epi (which I hated) I finished dialating pretty fast then took 2 hours of full on pushing to birth, so maybe my intiution was right on that one.
If I ever have another babe, I will be less naive about being able to walk into a hospital and pick which intervention I’m going to have. Once you’re there it’s like a tide that just sweeps you along…
anyhoo it would give me a lot of peace to know how necessary it was.
Meg
ok….correction I did get synto…via drip and exactly 1 min after baby emerged. I just got hold of my notes today. so what you are saying is that once the synto was in there, there was no way I was going to push it out alone. It was going to have to get yanked out? thanks Lisa : )
If a mom is left alone and a lotus birth is realized the baby will get exactly what it needs. The baby will take in what is needed in the right amount that is needed and the excess will be left within the placenta.
After Ohio attacked homebirth midwives my midwives were unable to assist at my birth. I didn’t want to birth at home alone with only my husband who knows a lot but not enough. We went with my back up Midwife/CNM and OB/GYN. Despite being moved to the ‘hospital’ from the ‘natural birthing area’ I still had a full lotus birth DESPITE strangers bursting into the room while naked and just birthed my babe demanding to take her because we weren’t immediatly cutting the cord.
My ob/gyn is my hero(sounds odd…but I call him my undercover midwife). He stood up for us as we unfortunently wasn’t enough when childrens’ services is being involved. We had our full lotus birth. Her,our daughters, bili count was practically nonexistant…no jaundice here! She and I stayed naked and skin to skin. They were also amazed a newborn could sustain her own temperature when naked against moms chest… Other dr’s and residents and nurses were amazed and wanted to see. She seperated from her placenta on day 3. She’s incredibly strong, smart, seldom sick… She was also the first full lotus birth in an Ohio hospital and from all our midwife friends the first lotus birth we know of in Ohio at all.
Some tried to prevent us from allowing our daughter to be born safe and how she wanted to be born. Others stood up and declared NO with us. Not the norm and not from where you’d guess but like there are medically minded midwives there are natural minded ob/gyns.
Why even mention cord cutting unless its a true emergency? Lotus birth…allow the babe to do his job and know what is extra.
Also, I know a short cord is hard…but could you sit ‘indian style’ and hold your bub in your lap? It’s lovely you waited for the cord to stop pulsating before you cut though. That gives some definite benefits and blessings to the baby.
By the way…I love your site…off to subscribe and I’m following you at twitter. Sorry you lost. Australia and the birth movement has been in our prayers along with the birth movement here in the states.
Happy Birthing Mommas!
Honey
http://www.mondorfment.blogspot.com
When Mon(tessori) (Wal)dorf (and Attach)ment Parenting meet in our home.
Hi Honey
that is great you were able to get what you wanted for your lotus birth! this is something for which we shouldn’t have to fight.
I would have loved to sit indian-style and have my baby in my lap. but I was stuck on all 4s holding on to the bed and couldn’t move without falling off. No-one bothered moving to help me, just said “pick him up” and all I could manage to get out in my state of shock was “I can’t”. Actually when the cord was finally cut and I moved to turn over I nearlly DID fall off the damn bed, so just as well I didn’t try with baby still attached!!! I remember hearing my midwife (who was no longer able to act as my midwife thanks to hospital ‘policy’) yelling “for god’s sake, would somebody HELP HER!” and then finally a hospital midwife grabbed me. Unfortunately I can never go back, and will never have another child so it is what it is. All I can do is tell what happened to us so others *might* be better prepared.
All of these personal stories are lovely, and it makes me feel warm that those ladies leaving comments after positive experiences have had such nice experiences.
However, if you are going to judge an intervention or a way of doing something (such as active management or leaving for a lotus birth) you need trials with lots and lots of women to examine outcomes across a population.
In rural India, lotus birthing is common, and the rates of neonatal infection and death are high. The placenta is a fabulous medium for bugs to grow on, and then climb up straight into the baby creating blood poisioning and death. For me, it makes no sense to recommend this to women knowing this kind of risk.
Perhaps as time goes on, and further evidence becomes available, we will realise more about the “benefits” of physiological third stage and not administering oxytocic medication and allowing the “natural” oxytocic from the mother to work. I would be delighted if this evidence becomes available in larger trials, as it would mean more hands off for me as an obstetric doctor, and less interference in a women’s beautiful birthing experience.
But while ever the current evidence (which I have sighted earlier) suggests that active management improves outcomes, I will recommend this to women, especially those who are high risk of a post partum bleed.
I think the situation regarding delayed cord clamping is starting to gain more acceptance as the evidence becomes more favourable, and hence, I have no problem with this and would even encourage a low risk woman to delay cord clamping. In fact, I believe that with the current evidence for low risk women, delayed cord clamping should probably be the norm, rather than the exception, especially in third world settings, and some cultural groups, such as indigenous Austalians who may struggle to get enough iron.
Dr Pesce, I’m sure you appreciate that cutting the cord after the birth of the placenta is just a completely physiological third stage and not the same as a lotus birth where the placenta is left attached until it drys off.
I facilitate many lotus births as I have lots of clients who want this. As you suggest it is a first world country with very little chance of tetany. I would not chose this for myself as I don’t share the spiritual belief that surrounds it. However I have no ownership of the birth and when women want this I am happy to help.
I do definitely believe that a physiological third stage is the normal and that means NO cutting of the cord until the 3rd stage is complete unless there is a sign that intervention is necessary. I am a British midwife and was working in the East of England at the time of the Hinchingbroke trial. I was there at the result point and for the presentation of the findings. They don’t really reflect what the trial now seems to stand for. You are also right about a randomised controlled trial being the only acceptable way to judge in the modern world. This doesn’t however make it the only way or the correct way.
Appreciate your thoughts Lisa. I enjoy learning more about the reasons for a woman’s choice (even if I disagree with them)
BTW, I am not Dr Andrew Pesce from the AMA.
I am all for delayed cord clamping! I am still disappointed that my first son’s cord was cut before I could say “Stop!” in a birth center. My next two, born at home, did not have their cords cut until they had stopped pulsing and turned white, one just before the placenta birthed, and one just after. A friend who is a childbirth educator gave me the best explanation I’ve heard for immediate cord clamping. She said as soon as the cord is severed, the OB is no longer responsible for the baby; the pediatrician is! This makes perfect sense to me. This is just one more interference common in modern obstetrics that harms the baby and mother, yet continues unabated anyway.
Most people have no clue how safe and healthy an un-interfered with birth is. It is best in all ways. Sure, complications and emergencies can happen, but they are very rare if the mother is left alone to do what she innately knows to do. Almost all complications in the hospital are caused by the interferences! “Active management” of ANY part of labor and birth, except in a true emergency, CAUSES problems, not solve them.
Christy,
I agree with you regarding delayed cord clamping, there is some good evidence that this is beneficial, and this practice should probably become routine where no or minimal intervention has occured, and perhaps even in higher risk settings.
But please stop there. Your logical thereafter is flawed. To suggest there is harm in cutting the cord early is not supported by any evidence. If this were the case, then 95+% of babies who have this done as current practice would be “harmed” – this is simply not true. The vast majority are happily growing up around the Australia oblivious to the fact that their cord was cut “early”.
As I have posted earlier, if you want to look at the evidence for the benefits of active management, have a read: http://emedicine.medscape.com/article/275304-overview
It does have a reasonably amount of medical terminology, but you should still be able to understand if you are not a medical person.
In particular a good summary paragraph is:
“Several large, randomized, controlled trials have addressed the question of whether physiological management or active management is preferable. These trials have consistently shown that active management leads to several benefits compared to physiological management. These trials use 1 of 3 uterotonic agents: ergonovine, oxytocin, or Syntometrine, (a combination of ergometrine and oxytocin). Five trials have been the subject of a meta-analysis in the Cochrane Library”
Ironically there is some truth in your suggestion that once the cord is cut, the responsibility lies with the Paediatrician – this is correct, however, the REASON to cut the cord is NOT so that responsibility for the baby can be quickly transferred to the paediatrician. In some cases in the public or private setting the Obstetrician will need to manage a neonatal resuscitation because no paediatrician is around at the time, but you are correct in implying that their main concern is with the delivery and mother.
I would love it if a birth I am involved with goes naturally with little or no intervention! Fantastic for the mother and baby. I totally agree this is a wonderful experience for all parties involved, and I have had my fair share of involvement with these type of births as an obstetric doctor.
But I get disappointed, frustrated, annoyed, and saddened when I see the medical profession attacked again and again for intervening in labour. Even to the point where the accusation is that Obstetric doctors are stupid, naive and don’t know how to manage a real pregnancy. Nothing could be further from the truth. Granted that there will be timing when a doctors intervention could be deemed unnecessary, and there are some doctors who are bad in this area, but the vast majority are intervening to PREVENT problems, not cause them, and mostly this is backed up by the latest evidence.
I will acknowledge that sometimes the medical profession moves slowly to make changes, and you may find that with growing acceptance of delayed cord clamping, the practice becomes much more common and routine in hospitals. I for one would support this happening because of the benefits of doing so (increase iron stores, less anaemia etc), but not because of the perceived “harm” of active management that you suggest, which is not evidence based.
Hi Lisa, I’m a midwife at a rural hospital in NSW and am constantly trying to educate the rest of the staff about early cord clamping and the negative effects on the baby, especially those babies that need a few extra moments to get going. I was doing some research about this the other day, to hand out at work and stumbled across an interesting article. The research had been done quite some time ago, however it showed a possible link between jaundice and the use of syntocinon during third stage. I thought this was very interesting,however there has never been any further research about this from what I can see. I thought that this could be an interesting research study for someone wanting to do a PHD perhaps? xx
About the picture, and maybe a tip for the blog? How About keeping the suction bulb FAR away from tha baby’s nose and mouth.. who ever thought that would be necessary to use that.. it’s disturbing to the child and will probably cause an over stimulation of the gagging reflex.. Nature har it’s own way.. and that’s baby breathing, sneezing in addition to the squeezing of the torso when the baby’s head i s born..
Leave the healthy baby to breath undisturbed..
Suction is for babies in trouble…!!!
I’m not sure what you mean, obviously that was an american hospital shot and nothing to do with the births on my blog. It was to illistrate crap practice. I hope you weren’t thinking that I would use that. If on the odd occasion I have seen anything that needed removing I have sucked it out with my mouth gently no trauma, no airway spasm and no worry. It has only ever been a few times. I does however feel yuck and you have to spit pretty soon after.
A bit unrelated- Is it true that babies tend to cry when the cord is cut? If so- Is there any possibility that they can feel it? I mean, can they feel pain while the cord is cut?
I’ve been reading birth related books, blogs etc, for quite a while and never came across any reference concerning that matter.
Thanks, Naama
I don’t really know the answer but once the placenta is born cutting the cord seems to be quietly achieved without much fuss.
5 weeks ago I recently achieved a HBA2C – which was amazing in itself to me. I didn’t realise it was real until his head was crowning (i didn’t feel him move down or anything and he had no moulding). I didn’t really discuss what would happen if I actually achieved my natural birth but the one thing I do remember is telling everyone to just wait for his cord to stop pulsing (they were going to do that anyway).
Why would you prematurely remove the “life line” that has been your babies for the last 9-ish months? Why can’t we remember that a little patience (you know that virtue that some never have!) is so important.
I feel that waiting for the cord to stop pulsing was like the last part of my body’s way of telling the baby that this chapter in the journey of a vaginal birth is now complete.
**Sorry if I offend anyone but we never got this chance before with our other children being born via c-section and it was such a beautiful ending for our HBA2C journey.
Naama- One reason for the crying when the cord is clamped or cut is that Fetal aortic and carotid chemoreceptors are stimulated by cord clamping. The Oxygen in the baby’s system decreases, CO2 increases, and PH decreases. These changes result in the baby wanting to breath. Oxygen does not make us breath…it’s the build up of CO2 that stimulates breathing. Our bodies want to get rid of the CO2 so we are forced to exhale and then we subsequently inhale. Same type of response for the infant and crying is very instrumental in the much needed air exchange. I can’t comment if there is any pain or not associated with the clamping and cutting.
Where do I start? With cord cutting or pph? they are two separate but related issues.
1st, it is my practice to NEVER cut the cord before:
a) baby is breathing well on it’s own, as an autotransfusion would be a prudent step in resus, if such is needed.
b) placenta is out, therefore no longer a functioning organ.
c) parents want (request for) it to be cut. Lotus is fine w me too.
2nd, If a still functioning cord is cut, it is technically a surgical procedure, if it is clearly non-functioning, it is not… more like cutting hair or fingernails.
3rd – about the “active mgmt” of 3rd stage. I’ve read the lit. & worldwide, it could make sense, at least for certain populations, but…
My version of “active mgmt” is to:
a) preach the good news of green leafy veges (vit K) in the diet prenatally.
b) get baby on breast immediately! or other nipple stim, if cord to short.
c) start herbal remedies if there is more than 2 c blood seen, or fundus rising prior to placenta coming.
d) there is a reason animals eat their placenta! if there are early real indications of a pph (not just, a “gee, it might happen!”) a small piece of bucchal placenta has always done the trick for me… so far, knock on wood!
c) NEVER pull on an undetached placenta! (On the other hand, if its detached, sitting on cx like a stopper, I do pull, if mom doesn’t want to get up & push.)
Following those guidelines, I rarely see a pph! Even rarer one that needs pit or transport!
4th, It was very interesting to note that someone said they do see infection w lotus births. I never heard of that. I would think that infection could set in one cord is cut, but since it starts out a closed sterile system, infection would be much greater once it is severed. Didn’t think about the other end of the placenta being open, but that is something to consider too. I usually leave a long cord when I cut. Reasoning 2 advantages: if germs do find their way into the end of the cord, the further it has to travel to reach an active blood supply, the less likely it is to reach it at all. And it’d easier to keep it out of the diaper when it’s longer.
Now @ Honey: Very interesting you mentioned:
“After Ohio attacked homebirth midwives my midwives were unable to assist at my birth.” Since I do homebirths all over southern OH, I was shocked to hear this! Who in OH attacked homebirth midwives? Are you reffering to the Levier case? If so, they did not attack midwives at all, just a Blankety blank officer who doesn’t approve of homebirth throwing his wt around, causing lots of expensive & heart rending trouble for that poor innocent family, but the midwife was never “in trouble”, just scared enough to stop practicing, unfortunately. It is a real loss to the midwifery community! I do a good number of births between Dayton & Cinci, so how was I unaware that we were under attack? And, if you wanted a homebirth, there are lots of midwives around, besides the one in Dayton who quit and the one in KY who moved. I think you got fed a bunch of goods! What you describe does not follow what is/was really happening in OH! I’ve been involved in OMA’s the legislative efforts for many yrs now. I am deeply saddened by the rift that has occurred between the pro- & anti- licensure factions. TBP people have distorted the truth and spread fear & distrust among the populace. I wish we could all just be sisters again!