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NHS cutting cord too early?(116 Posts)
Just wondering what peoples thoughts were on this.
A couple of weeks ago I was being treated for threatened pre-term labour at 27 weeks and was approached to be part of a trial looking at the immediate and long-term effects of deferred cord clamping in very premature babies. We asked a lot of questions and in the end decided that we couldn't be part of the trial and risk being in the control group who would have immediate cord clamping. What they would do for such a premmie is make the mother's bed higher to be a touch higher than the resuscitaire and with the cord still in tact, start to treat the baby (primarily intubate and ventilate) then after at least two minutes clamp and cut the cord. They could clamp and cut at any point if it was deemed medically necessary for me or the baby. I asked to have the third stage drugs after the cord was cut (as I've had a previous PPH and retained placenta) and they were happy with that. I felt bad not taking part in the trial but at only 27 weeks we felt it would be reckless to choose anything else when there is already building evidence that very premmie babies need less blood transfusions and are less likely to have an intra-ventricular haemorrhage if they have had deferred cord clamping.
martha I'll look at home to see if I saved the links somewhere on my PC - am on phone at the moment.
As I understand it, as long as the placenta and cord are healthy still, the cord will keep pulsating and the placenta stay attached and delivering oxygen for as long as the baby's circulation has not re-routed away from the umbilicus. There are massive changes within the baby at birth caused by it taking its first breaths, including direction of blood circulation, which is why some heart defects aren't a problem until the baby is born. For instance it's normal for babies in utero to have a "hole in the heart". This is normally covered at birth by a valve that activates when the circulation changes direction when the baby starts breathing. So the circulation will not re-route away from the umbilicus until the baby has established breathing, and in theory the placenta and circulation through the cord should continue until that happens. So until the baby's circulation has turned into that of a born baby rather than a foetus, the cord will keep pulsating. In healthy adapted babies, this only usually takes a few minutes, although in the case of my friend it did take 7 hours.
DD's cord was never actually clamped, it was tied then cut about 90 minutes after birth after the placenta was out and examined.
haven't read whole thread but I wonder whether there might be some implications for certain kids: DD was VERY pink after the delayed clamping that we had wanted and there was a big concern that she may have too many red blood cells (polycythemic?) , which can have serious problems associated. Because I had gest. diabetes, she was a bit prone to this any way so the combination of these things, AND the vit K injection which encourages clotting led to some very worrying days after she was born. Just a thought - I have no medical bg so there may be no connection at all.
There's delayed clamping (ie picking a random moment to cut the cord but not at birth) and there's waiting for the cord to stop pulsating. There is a difference. Depending on which moment staff choose to cut when the cord is still pulsating, the baby could be left with more or less blood. And a few ml makes a huge difference to a tiny newborn. This might be behind problems experienced by people having delayed clamping and cutting. The normal physiological process hasn't had time to even out blood supply between infact and placenta. There is clearly enough blood in utero to supply both baby and cord + placenta (ie more than enough for the baby alone), no reason at all for anaemia to be a problem. Left alone, with circulation gradually ceasing through the cord, amounts should equalise on either side of the umbilicus. Staff seem (anecdotally from posts on here) reluctant to leave the cord alone long enough for it to stop pulsating- maybe that is where problems arise?
We left it to stop pulsating, which I think is what is recommended?
My first 2 DCs born in the UK had immediate clamping. My third DC was born in Australia in an MLU, I had a fast water birth and was offered physiological management for the first time. The cord took about 20 mins to stop pulsing and was then clamped. The placenta wouldn't budge though, they tried getting me into all sorts of positions but I was too tired to push it out. Eventually I lay on the bed and the MW pushed my abdomen which required gas and air but no joy. She then had a feel and I thought she'd got it out, but it was actually an enormous clot. So the decision was made to give me the injection and immediately afterwards I delivered the placenta. I probably didn't need it though, the clot may have been blocking its path.
The discussions about jaundice are interesting. My first 2 DCs were quite jaundiced after birth, where as DC3 was not jaundiced at all. He did have a bruised head after a slightly too rapid descent down the birth canal.
Many of us have always recommended a true physiological 3rd stage of labour if all is normal where the cord isn't clamped & cut until after the placenta has delivered by maternal effort. Also resus guidelines now recommend where possible that babies that need resuscitation at birth also have their cords left intact as long as possible, (i.e. resuscitate next to mum) to allow an asphyxiated infant to still receive oxygenated blood through the cord.
It should now be routine practice to delay cord clamping for at least 2 minutes even if you opt for syntometrine to expel the placenta.
And if you clamp a cord before the placenta is expelled in a physiological 3rd stage the placenta is less likely to come out! I have observed this over many years!
That's interesting themidwife. I wonder why mine was clamped before I'd tried to push it out, I just assumed it was standard practice.
I think some midwives find it too awkward to leave mum & baby attached maybe? Especially if you need her to squat to deliver the placenta.
Themidwife- finally- a viable reason why mine had to be removed in theatre. I had to squat to give birth- but what difference would it make to cutting the chord? You can't do that until the baby is out anyway right?
I had delayed clamping, was given the choice as they are in favour at that hospital. After an hour placenta had not come out and I had no urge to push so midwife told me to push otherwise she said they'd have to give me a jab. Baby was lying on my tummy all this time as cord was too short to reach my boobs, so we didn't get to try the breast crawl. I'd be interested to know if this had anything to do with the fact his latch is v poor and bf took ages to establish. He also had prolonged jaundice.
I also had the injection after the cord stopped pulsating. I would have preferred a physiological third stage but the midwife started getting worried that the placenta would be retained. I did not want the complication of a retained placenta (surgery would have been needed) and as by that point I had had my lovely baby safely in my arms I was happy for my birth plan not to be executed to perfection!
Unfortunately I then had the same experience as bicycle: DD had a high red cell count and we needed to spend the night at the hospital. DD had a lot of blood tests and I was also put under a lot of pressure to FF to hydrate her and "dilute" the blood. This was in the UK, at a leading hospital. I became very upset as I was worried that this would interfere with establishing BF but the only other option that I was offered (having also spoken to the senior paediatrician) was to feed DD formula through a tube to her stomach through her mouth.
Luckily the red cell count dropped after a few hours and we could go home the following day without any further complications.
Had it with my first as they were great and had read my birth plan.
For my 2nd I too believe they stuck it in the bin and his cord was clamped and chopped (in a terrible fashion, his belly button is all wrong!) before I'd caught my breath. In fact the whole birth experience with my DS2 makes me feel stabby
Yes tricky with a very short cord!
If its long enough & the baby is kept up at chest level there shouldn't be over transfusion of blood to the baby causing polycythaemia & then subsequent jaundice. The thing with birth (& life in general) is that there are always variations & what works for some doesn't for others but I personally see that cord as a life line & hesitate to cut it until absolutely necessary ie after the placenta has delivered unless there are risk factors. But then, I'm a "hippy" community midwife
Yeay for hippy community midwives! I had the same lovely one for the births of DDs 1 & 2 -both times she was technically off-duty but insisted on doing my births as she was my community midwife. She said my sort of birth was why she'd decided to be a midwife and that they were the only sort that kept her in midwifery.
I had one managed third stage (and even in that the cord was not cut instantaneously) and then three physiological third stages, where the cord had long since stopped pulsating before it was cut (10 mins plus each time -more like half an hour after dc2). One baby had very slight jaundice, no treatment needed. The others not at all.
The bit that I find terrifying is the difference in iron status at 6-9 months in premature (I.e. immediate) versus NORMAL (I.e. delayed) cord clamping. Babies who don't get that cord blood are missing a good volume of blood that they should have.
I can't fathom the logistics of this, both my children born 2002 - 5 weeks early and 2007 - 3 weeks early, had to go on the peads heat table thing (sorry can't remember what it's called) with a bevvy of nurses and consultants, which was across the other side of the room, but even if it was next to me can't see how it would owrk, cord not long enough, different height of bed and unit etc. Also both children have never been iron poor, I would have rather they were looked at ASAP due to their early arrival than left until the cord had stopped pulsating, both needed help with their breathing/lack of oxygen, cord blood oxygen being insufficient, is more important I feel.
Both are now healthy, tall, happy boys aged 6 and 10. I'd never even heard of this until now, but I think it is just one of those things that seem very important to do at the time but really don't have any impact in later life. Like skin to skin and all that jazz, total fear mongering nonsense that if you don't do it ASAP you will have no bond with your child, utter rubbish.
In the end you have your baby the way you have your baby!
Babies can't 'be missing the blood they should have' medically impossible, they have the blood they need and make their own, which is based on yours and the cord blood already received. Nothing to be 'terrified' about Shiraztastic.
grants they now have a special table for resus warming etc which adjusts and is mobiles do they can leave the cord uncut whilst working on the baby.
The blood in the placenta will natural stop flowing, only when it does that does thebaby have all,the blood it should have.
the evidence ius that premature babies do much better if there is delayed cord clamping, they continue to get vital oxygen and are much less likely to need blood transfusions etc after the birth.
There is a post on this thread that explains the benefits to premature babies and on another thread there was a link to the special resusitaire table/warmer that they use.
Here equipment like this and there is another thread I found on mnet where I got this link.
The other thread discussing this
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