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NHS cutting cord too early?

(116 Posts)
wifflepuss Sat 27-Apr-13 15:15:29

Just wondering what peoples thoughts were on this.

www.guardian.co.uk/society/2013/apr/25/cutting-cord-babies-risk-nhs

HettySunshine Sat 27-Apr-13 16:10:39

Having read a bit about the brnefits

HettySunshine Sat 27-Apr-13 16:14:47

Let's try that again! Having read about about the benefits of late clamping I was already planning on asking that the umbilical cord be left intact until it stopped pulsating. I think that it is becoming more and more common for people to ask for this. smile

Flisspaps Sat 27-Apr-13 16:15:26

I'd go for delayed cord clamping unless the baby needed to be resuscitated and this wasn't possible with the cord intact.

I thought it was now considered best practice to leave the cord until it had stopped pulsating?

tinierclanger Sat 27-Apr-13 16:16:42

Delayed clamping is policy in our trust now. smile

I'm also asking for delayed clamping.

wonderstuff Sat 27-Apr-13 16:23:33

I requested delayed clamping, no idea what the policy is, but midwives were happy to do as I asked wrt third stage. Both of mine were jaundice for just over two weeks and I think I remember something about that being linked.

I planned to ebf and that influenced my decision.

Fakebook Sat 27-Apr-13 16:24:44

My cord was left until it pulsated with both my babies and I didn't even ask for it. My dd was born in 2007 and ds in 2012. Maybe this is something that differs from hospital to hospital?

marthabear Sat 27-Apr-13 16:49:28

Many of the wiser midwives have known about this for a long time. I think immediate cord clamping became the norm due to the over- medicalisation of childbirth and the the hurried nature of delivery wards. It became unquestioned. However, their are also many midwives who are uncomfortable supporting mothers with a physiological third stage of labour as they are so inexperienced with it...even those with many years in the profession. I really welcome the publicity that this is getting, and hope it will bring about a change in the NICE guidelines as more mothers demand that their newborns are not deprived of their own blood at the time of birth.

marthabear Sat 27-Apr-13 16:59:31

Their is a trial at our hospital which involves the delayed cord clamping of preterm babies who would need resusitation. A kind of resusitaton station that can be used close to the mother is being used which allows resusitation measures to start while the cord remains intact, pulsing the oxygenated blood to the baby. I have really high hopes for this and actually think it will reduce the suffering of the most vunerable new babies. I just wonder why these trials weren't done years ago. When I was at a Neonatal Life Support Course about 5 years ago, I asked the facilitators ( neonatal consultants) about the possibilty of leaving the cord intact during resusitation so the baby can be receiving oxygen via the cord while it is struggling to breathe for itself. They looked at me like I was from another planet.

marthabear Sat 27-Apr-13 17:01:05

there*

chattychattyboomba Sat 27-Apr-13 17:18:36

Never had the option- they didn't even read my birth plan which included delayed clamping and DH to cut the cord. Pretty sure they just chucked it in the bin.

IneedAsockamnesty Sat 27-Apr-13 17:20:17

I'm pretty sure that all my children ( being born since 1993) have had delayed clamping.

higgle Sat 27-Apr-13 17:58:31

I asked for delayed clamping and DH to cut cord, plus natural third stage and this was OK in private hospital with DS1 and at home with DS2.

perfectstorm Sat 27-Apr-13 18:16:57

I was at the Rosie at Addenbrookes, NHS hospital. The midwives were pleased I wanted delayed clamping/natural 3rd stage as they were aware research showed that as possibly a bit better for the baby. This was in 2008. It wasn't any kind of a big deal (and the placenta delivery was painless, too, which may be akin to the difference between induced/accelerated labours and natural? No idea but would make sense).

MaybeAMayBaby Sat 27-Apr-13 18:26:13

Marthabear, would you mind me asking which hospital?
I delivered a preterm baby (29 weeks) a couple of months ago and the immediate aftermath of the emergency section is still confusing. The cord wasn't clamped. But the neonatologists didn't realise and the baby lost a lot of blood back into the placenta-needed a transfusion. The details are still sketchy but it was implied that the doctor doing the delivery was from a different hospital and was used to different practise!
So, if left too long, does it make sense that the blood flows the opposite way? From baby to placenta? I have a debrief appointment coming up and would love someone who knows more about this to give me some advice.

Longdistance Sat 27-Apr-13 18:41:39

I wouldn't have had a choice with dd1 as the umbilical cord was only 15cm long, and snapped on delivery.

Dd2's was cut straight away, and she was jaundiced for weeks. Maybe that had something to do with it?

duchesse Sat 27-Apr-13 18:49:34

It's always made perfect sense as the biological norm to me. Along with the oxygen support until breathing is established, the benefits of blood supply evening out both sides of the navel were pretty compelling to me. Having read up extensively about this before the birth of my 3 oldest, I requested it for their births in 1993, 1995, and 1997.

In the event DS's labour was augmented (which is a contraindication as it can force too much blood into the baby apparently). He was rather badly jaundiced. DDs 1 & 2 were home births with delayed cutting. Absolutely fine. DD3 was born as a crash CS so not sure what happened but she did get slightly jaundiced. I had been on syntocinon and she was pretty ill so fairly unlikely they delayed clamping. I really must get around to going for a debrief some time.

A friend had a hb and delayed cord clamping with an independent very laid-back midwife. Even her midwife was getting pretty worried and getting ready to take my friend to hospital when the placenta hadn't appeared after 7 hours (everything else was fine) and the cord still had a pulse. As my friend stood up to walk to the ambulance, the placenta plopped out.

MissHinky Sat 27-Apr-13 18:51:41

I'm not sure what is best practice in our health trust but I'm going to ask for delayed cord clamping as well.

Going to check out the situation with my midwife on the next appointment.

duchesse Sat 27-Apr-13 18:52:06

Longdistance, 15cm?? shock Was she a CS? Can't imagine she'd have made it out any other way. Was she very calm in utero?

VivaLeBeaver Sat 27-Apr-13 18:53:37

Its been policy at our hospital for about a year as well.

duchesse Sat 27-Apr-13 18:54:44

Maybe, did you have ergometrine to expel the placenta? You need an unmanaged third stage for delayed clamping. As far as I remember you're more likely to bleed from the site of the placenta with an early birth as the placenta isn't "ripe" and ready to come away as much.

Does anyone know if you can have a managed third stage as well as delayed cord clamping?

Oops duchesse just answered my question!

5madthings Sat 27-Apr-13 18:56:29

I asked for delayed clamping with mine and yes there is now a special.resusitation station that can be used to enable babies needing resucitation to leave cord intact.

Littlefish Sat 27-Apr-13 18:58:21

I had delayed cord clamping with dd, but she was still jaundiced.

duchesse Sat 27-Apr-13 18:58:59

martha, I think there is an enormous amount of evidence to show that the placenta keeps functioning until the baby starts breathing properly and its circulation is rerouted away from the umbilicus to its lungs. It's like life support for babies struggling to breathe. I'm aghast they appeared not to know this. shock

4yoniD Sat 27-Apr-13 18:59:07

Something I read on BBC News suggested that if you delayed clamping until the pulsating stopped then you couldn't have the injection to speed up delivery of the placenta. Is that right?

duchesse Sat 27-Apr-13 19:02:20

That is correct. Healthy women rarely have problems and births are managed in a much sensitive way than they used to be so PPH is rarer than it used to. Active management of the 3rd stage was introduced to reduce deaths and illness from PPH. Unfortunately it's difficult to predict (beyond the standard risk factors) which women are more likely to haemorrhage, and it very quickly becomes a life or death situation if you do.

VivaLeBeaver Sat 27-Apr-13 19:14:25

We do managed third stage and delayed clamping. I'm sure years ago I read some research saying this wasn't best practice due to the syndrometrine causing too large a shunt of blood through the cord and to the baby.

Then our hospital started doing this and I queried this but was told it was now deemed ok. I've looked for evidence and haven't found any. The stuff I've read on delayed clamping doesn't mention about not been able to have ergometrine/syntometrine I suppose.

lurcherlover Sat 27-Apr-13 19:19:16

My SIL is an obstetrician and whilst in favour of delayed clamping, did tell me it tends to make babies more jaundiced as they can end up temporarily with "too much" blood.

LauraPashley Sat 27-Apr-13 19:29:51

I asked for delayed clamping and natural 3rd stage with both babies and had no problem getting either each time. Noone seemed surprised that I'd asked or anything. I think I had read about it pre birth on here tbh, it certainly wasn't mentioned in midwife appointments or anything while I was pg.

bicyclebuiltforfour Sat 27-Apr-13 19:49:05

lurcher - that is exactly what happened with DS.

DD we delayed clamping (St Thomas', London) - no issues.

DS we also delayed clamping (US hospital) - done without question. He was a good healthy weight, and we went home the next day. At his first pediatrician's app though (5 days old) they suspected jaundice, ran a blood test and sent us straight to the ER where he was admitted.

He'd lost almost 10% body weight and needed phototherapy for 24hrs. He was totally fine afterwards (and put the weight on very quickly) so no long-term harm, but obviously an overnight stay in the hospital wasn't what we wanted.

We were later told that his red blood cell count at birth (not sure if they monitor this in the UK?) was sky-high due to leaving the cord to pulsate. His body wasn't able to deal with the huge amount of extra blood and so he developed jaundice.

I'm still pretty angry that nobody mentioned this to us as a possible complication: no doctor, midwife or doula in either pregnancy. Not sure it would have changed our choices, but we'd have been on the look-out for jaundice and maybe stayed the extra night in hospital immediately after birth to be sure he wasn't developing it.

As an aside, I was under a lot of pressure to FF once he was admitted (since, as I said, he needed a lot of fluid). I'd BF DD for 12m so was confident in how to feed and in my body's ability to make milk so resisted them, but a first time mother or someone less confident in BF may well have agreed and never established feeding. As it was I spent most of those 24hrs either offering the breast or hooked up to a pump...

So there are benefits, but also complications.

Flisspaps Sat 27-Apr-13 19:51:10

There is no reason why delayed cord clamping can't take place and then syntometrine be given - it doesn't have to be given at the moment of birth.

I had delayed cord clamping with both and a managed third stage both times.

jchocchip Sat 27-Apr-13 19:55:01

I had delayed with my first and third. Can have the injection after a delay and switch back to active management if necessary for blood loss but I understood that syntrometrine shouldn't be given until cord was clamped. With my first cord wasn't clamped until stopped pulsating and was completely white. Didn't have an injection, it was hospital practice at the time.

5madthings Sat 27-Apr-13 19:55:30

I had syntometrine with four of my five and still did delayed clamping.

Only one of mine had jaundice and it wasnt enough to be an issue, i just bfed and let him get sunlight, aug born so easy to put him.by the window etc.

My friend had a homebirth, baby needec resucitation and they left the cord intact whilst they did the resucitation.

bicyclebuiltforfour Sat 27-Apr-13 20:10:17

I also had managed third stage with both so it seems it can be done, although Viva's comment is very interesting about it possibly 'shunting' too much blood through.

mylittlepuds Sat 27-Apr-13 20:14:06

I asked for it this time but my wishes were simply ignored.

Cinacina Sat 27-Apr-13 20:58:26

I am a massive advocate of delayed cord clamping. Dc4 didn't breath for 12 mins when he was born at home. The whole time he was being resuscitated, he was receiving oxygen via the cord. If the cord had been clamped on birth (which is what would have happened in hospital), his only oxygen supply (via me) would have been cut off.
Delayed cord clamping provides essential blood and oxygen to the baby and helps assist in there birth recovery. Why this isn't standard practice defies belief.

BoffinMum Sat 27-Apr-13 20:59:52

I've had delayed clamping with at least 3 of mine (can't remember what happened with DD). I reckoned if nature had invented it, there was no reason to faff about and change things unless there was some medical reason.

VivaLeBeaver Sat 27-Apr-13 21:21:14

Our hospital is adamant that syndrometrine if its been used is still given with the anterior shoulder, so as to reduce pph rates.

5madthings Sat 27-Apr-13 21:31:46

Really viva the hospital.i had mine in were happy to give it after delivery, you dont notie it if they do it at the delivery tho!

But i was given the choice, well i asked and they were happy to do it the way i wanted unless circumstances dictated otherwise medically.

That was the midwives were fine with it, the consultants i saw made it sound like i was risking imminent death, ditto with going more than ten days overdue and ignoring their suggestion of a planned c section for no apparent reason apart from me being shory and dp being tall...

Funny how policies vary according to hospitals ans what differing views different drs and midwives can have!

VivaLeBeaver Sat 27-Apr-13 21:47:57

I believe rcog and nice guidance is fairly clear with syntometrine, that it should be given immediately if been used.

MNBlackpoolandFylde Sat 27-Apr-13 21:51:17

DDs was clamped right away and she developed severe jaundice, not sure about what they were discussing on the tv though about leaving it attached for ten DAYS shock

marthabear Sat 27-Apr-13 22:05:03

This- http://www.youtube.com/watch?v=cX-zD8jKne0 is the first of four lectures about the physiology of delayed cord clamping for anyone who is really interested.

Maybeababy- How is your baby now Maybe? I believe there is some degree of two way blood flow between the placenta and baby as the cord pulses, slowly balancing out and leaving baby with the optimal blood volume as the cord stops pulsing. The YouTube piece above explains it I think and also makes the point that too much blood doesn't flow back to the placenta unless the baby happens to be held quite a distance above it which is unlikely to happen in real life. Check out the video to make sure my details are correct as it's been months since i've watched them all. I don't want to out myself but the study I mentioned is taking place in the Midlands. There may be other trials going on elsewhere. I can't really make sense of what happened at the birth of your baby Maybe. Surely the paed was aware that the cord was cut as it would be usual to cut and clamp straight away and transfer the baby to a resus area away from the operating table. Could it be that the cord was cut and clamped quickly but the clamp wasn't closed properly?

Bicycle- What a distressing experience for you. Obviously I don't know your case but I wonder if your baby would have been re admitted if the same scenario had happened in the UK as I understand that obstetrics/ neonates is more medicalised in the US? And I wonder if the sky high result was actually more normal than thought as the thresholds for the blood results would likely be based on babies that had immediate clamping and were deprived of their optimal blood volume at birth?These are just some thoughts i had when I read your story- I obviuosly have no idea about your baby. I believe that there is evidence that delayed cord clamping and physiological third stage does slightly increase jaundice in some babies, but that it is the type of jaundice that is not problematic and clears easily. I think the YouTube clip talks about this too.

marthabear Sat 27-Apr-13 22:07:20

Oh dear. That link didn't work. Hope the clip can be found from it.

bicyclebuiltforfour Sat 27-Apr-13 23:38:06

Thanks martha - it was pretty horrid, particularly as it happened on the day the baby blues hit hard: I was in tears over nothing before I'd even got to the ER!

You raise some interesting points: the head of paeds (accompanied by fawning med students) at the hospital didn't seem at all concerned when he did his rounds the morning after we'd been admitted (when we'd been there about 15hrs), saying something like "He'd seen considerably worse when everything was fine in the end", so quite likely that the situation wasn't as dire as we'd been led to believe. And yes, much more medicalised over here: I'm developing a worrying scepticism about what tests are actually necessary and which are being done to cover arses/get money from insurance companies...

And the point about the reference levels for bloods is also interesting: I hadn't thought of that. Bit like weight gain in BF babies being incorrectly tracked alongside FF babies.

We're hoping to have #3 but probably not before we move back to the UK in the next few years. Hopefully some of these issues will have been cleared up by then, otherwise my midwives will face a lot of questions!!

Requested it with DD2 and DS. The request was ignored once and complied with once. Both were slightly jaundiced; neither needed treatment. I have known there was evidence for the benefits of delayed clamping since about 2004 (did an undergraduate module that covered it). Really glad to hear that it is becoming more acceptable in SOP.

MrsPennyapple Sun 28-Apr-13 00:00:06

I had delayed clamping with a managed third stage with DD (July 2011), but I'm pretty sure the injection was given after the cord had been clamped and cut.

I'll be asking for delayed clamping again when this baby is born, but am considering whether to have a natural third stage this time.

NaturalBaby Sun 28-Apr-13 00:10:40

My plan all along was I didn't want any intervention and rushing if I didn't need it, so I was left to my own devices and delivered the placenta within 1/2 hour. The only benefit I could see of speeding things up was that the mw's would have left a bit earlier.
I've never heard of any complications or issues before reading this thread.

MaybeAMayBaby Sun 28-Apr-13 00:13:06

Thanks, Martha. I'm midlands too...
Baby was delivered to the neonatal team in her amniotic sac. I think this is where the confusion happened-but I need to check at the debrief. I don't think that was standard practise at the hospital (I wasn't at my own hospital but transferred) but the obstetrian was also from elsewhere?
Baby is very well. Finally home.
I will have a look for that film. Thank you.

Longdistance Sun 28-Apr-13 03:48:26

duchese she was anatural delivery. I remember her not kicking much during pg. Could feel her hiccuping lots, and some glitters. Just thought cos I'm chunky, the movements weren't great. When pg with dd, she used to beat my tummy like mad, and could see her hands, feet, legs when she moved.

As a result of the cord breaking, the placenta was retained. But, eventually came out with synocotyn (sp)

It'd a miracle she's here, as she could have been smotheredin the birth canal sad
The mw was flapping loads, as she'd never seen anything like it, and could donate the cord fir stem cell research.

sparklekitty Sun 28-Apr-13 10:08:32

I wanted to delay the cord clamping and possible natural 3rd stage (depending on how I was feeling after delivery) but in the end my DD birth was so traumatic that I didn't have a choice. Cord cut asap as she has shoulder dysocia (sp?) and they had to check she was paralysed, then I had the injection, they tols me as they were giving to me. However, I think I'd have opted for it anyway after that birth.

I think its a great idea but I guess its not always possible. My friend had it while her DS was being assisted to breath for 8 mins shock I guess it possibly saved his life?

olympicvibes Sun 28-Apr-13 10:21:59

I had requested delayed chord clamping too but when he emerged after a very traumatic time, the chord was wrapped around my ds 's neck twice so had to be cut free there and then by the doctor.

He is now a week old and doing well smile

littleducks Sun 28-Apr-13 10:38:01

I'm a bit confused by all this and unsure what to do in this pregnancy.

DD was born in a birth centre, very natural (but quick active stage) labour, midwife didn't really touch me. DD was born, I bfed with cord intact until after placenta was delivered then cord cut. Roughly an hour.

DS was a BBA at home with paramedics. Quick labour, bit hectic and crazy but not traumatic. I beeged for the syntocin, no idea why now....I'm assuming I just wanted it over quick and they didn't have gas and air. Paramedics were calm and soothing and delivered baby and immediately cut cord. Placenta delvered naturally fairly quickly, when midwife arrived they explained they don't give syntocin unless a midwife is present or there appear to be complications.

This baby I was assuming I would go for delayed clamping and no syntocin, hoping for a calm birth like dd's. However at booking they said they strongly recommend me having the injection as the risks are higher due to it being my third.

5madthings Sun 28-Apr-13 10:43:03

littlethey said the same to me for no 3, 4 and 5 but it was fine. Did you bleed heavily with your others.

There is a study to show that in healthy mums in places with good healthcare is the UK,Europe etc that being a 'multipareous' mother does NOT raise your risk of having a pph. It was linked on another thread recently.

wonderstuff Sun 28-Apr-13 10:47:33

I had delayed clamping but after had the injection, that was what I requested, I had no idea that was not guidelines, why is syntocin not recommended after delayed clamping?

FirstVix Sun 28-Apr-13 11:55:12

I was told that it had to be given within a certain time frame after delivery or the drug would pass into me (I think - I may be mis-remembering). I also wanted delayed clamping but was advised against after delivery (although I did manage to hold them off for about a minute which is when I was told about the time frame).

bohoec Sun 28-Apr-13 12:48:24

I wanted to delay cord clamping, and said so in my birth plan but somehow at the final stages of labour I agreed to having the injection to speed up delivery if the placenta (and therefore cord had to be clamped). There were no complications, and no clear reason why my midwife felt this had to happen. I regret agreeing to it and wish I'd have stuck to my original plans. I'm sure the common practice of cord clamping is just about convenience and speeding up third stage labour!

Bue Sun 28-Apr-13 12:55:39

Viva do you have two midwives at a birth? Because otherwise it's impossible to give syntometrine with the anterior shoulder! Most of what I have read says there's no evidence that giving it with the shoulder or immediately afterwards has an effect on PPH rates, but I will look again. Also I too have never found any research regarding this supposed 'shunt' of blood from synt. With my current mentor we tend to wait a minute, clamp and cut, then give the jab but some other midwives give it, then wait to clamp and cut. I can't decide yet what my usual practice should be.

TurquoiseTranquility Sun 28-Apr-13 13:42:59

no idea what happened with DS (DH can't remember either) but he was born on an MLU and I had a physio 3rd stage - does that mean his cord would have been left pulsating?

He was lightly jaundiced but I'd already read up on it so wasn't worried. We were told to leave him by the (closed) window as much as possible (so as to "sunbathe" him but not in direct sunlight) and that sorted things pretty quickly.

Probably having a homebirth this time round and will ask for delayed clamping.

As far as I'm aware, it's quite common for newborns to be lightly jaundiced, and if properly managed that's not a problem at all, and not a good enough reason to clamp the cord immediately.

A friend's first-born was a bit jaundiced, and some idiot of a midwife told her not to breastfeed! As a first time mum, she went along with that and was sorry later.

5madthings Sun 28-Apr-13 14:14:41

If you had a natural thitd stage i would think they would have done delayed clamping.

Whrn i gave birth they called a second midwifd for delivery but she literally stuck her head round the door as i delivered, not involved at all and barely in the room for a minute!

PearlyWhites Sun 28-Apr-13 21:37:05

My ds had delayed cord clamping he was later found to have severe jaundice made worse by the delayed cord clamping but we were not told that could happen.

Flisspaps Mon 29-Apr-13 07:39:15

There's research by Prof. Cecily Begley, Trinity College Dublin, which says that there is no risk to waiting to administer syntometrine and to wait to see if it's needed as it is effective within seconds. There is also a suggestion that syntometrine given prophylactically may make it less effective in the future - so if you give it to a woman 'just in case' at birth the first time, then a dose given when she has a second or subsequent baby may not work so well.

Info from AIMS also seems to back up that there's no reason why syntometrine cannot be given later, if it is needed, rather than prophylactically. It's ok to try a physiological third stage and then have syntometrine later on if the placenta doesn't appear or if PPH does occur.

5madthings Mon 29-Apr-13 09:57:53

fliss that was my understanding as well and is what my midwives said to me.

gnushoes Mon 29-Apr-13 10:13:30

Had mine at home and natural third stage both times. I know I asked for delay with dc3 nine years ago and midwife was fine about it but don't remember a huge rush to clamp and cut with dc1 and 2.

Bramshott Mon 29-Apr-13 11:55:01

DD2 was born in the car and everyone seemed OBSESSED about whether we'd cut the cord or not - it was the first thing the rapid responder, ambulance staff, hospital staff etc asked us. TBH it never occurred to us to cut it (what with??), rather the opposite, that there were very real benefits to NOT cutting it until we were somewhere warmer and more stable.

duchesse Mon 29-Apr-13 13:03:56

Bramshott they may been more worried about the risk of neonatal tetanus from cutting the cord with an unsterilised instrument.

rrreow Mon 29-Apr-13 13:12:26

How long does it take for it to stop pulsating? I thought I had delayed clamping with DS's birth. He was put on my chest as soon as he was born (still attached) and no one touched the umbilical cord for quite a while. But reading duchesse's comment now I'm not sure, as I did have the injection to speed up delivery of the placenta.

marthabear Mon 29-Apr-13 13:15:29

Fliss- There is also a suggestion that syntometrine given prophylactically may make it less effective in the future - so if you give it to a woman 'just in case' at birth the first time, then a dose given when she has a second or subsequent baby may not work so well. - That is so interesting. I must try to find the research.

squirrel996 Mon 29-Apr-13 13:51:16

My dd was born blue and not breathing, the midwife bless her didn't clamp the cord properly in her haste to resuscitate my baby and as she cue at the cord a load of blood came pumping out, my feet were sitting in blood up to my ankles sad
It was horrible but she successfully got her breathing and she was (and still is) absolutely fine. However she did get very jaundiced afterwards and we had to stay in hospital on a phototherapy bed and had to have a cannula put into her tiny little hand.

recall Mon 29-Apr-13 14:21:25

I requested that my baby's cord clamping was delayed, and regretted it.
She went on to develop AOB incompatibility jaundiced, and spent a week in the neonatal unit. She was nursed with double UV lights, and had cannula fitted and was fed via a nasogastric tube. The paediatrician said that the delayed cord clamping contributed to the severity of the jaundice.

I asked for DS's cord clamping to be delayed when he was born 17 years ago. The midwives weren't terribly keen because they wanted to give me the injection to deliver the placenta, but they 'humoured' me until the cord stoped pulsating, which took IIRC, about five minutes

lottieandmia Mon 29-Apr-13 14:37:43

I had physiological 3rd stages with dds 2 and 3. But they are very quick to try to give you the injection to expel the placenta without asking you.

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.

Flisspaps Mon 29-Apr-13 15:13:34

martha I'll look at home to see if I saved the links somewhere on my PC - am on phone at the moment.

duchesse Mon 29-Apr-13 15:51:23

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.

IdaClair Mon 29-Apr-13 16:25:29

DD's cord was never actually clamped, it was tied then cut about 90 minutes after birth after the placenta was out and examined.

MrsWooster Mon 29-Apr-13 21:34:30

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.

duchesse Mon 29-Apr-13 22:17:52

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?

5madthings Mon 29-Apr-13 22:21:47

We left it to stop pulsating, which I think is what is recommended?

AussieDollar Mon 29-Apr-13 23:19:15

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. grin

themidwife Tue 30-Apr-13 01:32:44

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.

themidwife Tue 30-Apr-13 01:35:13

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!

AussieDollar Tue 30-Apr-13 03:53:02

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.

themidwife Tue 30-Apr-13 07:10:43

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.

chattychattyboomba Tue 30-Apr-13 07:16:36

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?

Meringue33 Tue 30-Apr-13 07:27:21

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.

kefybaby Tue 30-Apr-13 08:05:43

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.

Chunkamatic Tue 30-Apr-13 10:16:51

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 angry

themidwife Tue 30-Apr-13 11:54:20

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 grin

Bramshott Tue 30-Apr-13 12:13:51

Ah yes, maybe Duchesse.

duchesse Tue 30-Apr-13 14:07:19

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.

Shiraztastic Tue 30-Apr-13 18:30:01

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.

grants1000 Tue 30-Apr-13 21:51:55

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!

grants1000 Tue 30-Apr-13 21:54:07

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.

5madthings Tue 30-Apr-13 21:59:25

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.

5madthings Tue 30-Apr-13 22:05:36

www.inditherm.com/default.asp?langid=1&contentid=1366

Here equipment like this and there is another thread I found on mnet where I got this link.

5madthings Tue 30-Apr-13 22:06:29
Shiraztastic Tue 30-Apr-13 22:54:30

Er, well, let's see.... When the baby is inside their blood flows to and from the placenta via the umbilical cord. At any one time, a proportion (25% from memory) of the baby's own blood is in the cord/ placenta. At birth the system is designed to work so that the placental flow shuts down son after birth, and as it does so, more of the blood out of the cord transfers back into the baby. Clamp it off before that happens, and the baby is missing a proportion of their blood. There is good research that shows that early cord clamping leads to worse iron status at 6-9 months.

5madthings Tue 30-Apr-13 23:04:30

A bad who has the cord clamped early can loose out on 59% of their red blood cells, massively important for oxygenation. By delaying clamping you ensure they get this, makes a massive difference esp to premature babies who then are less likely to need blood transfusions.

For a baby who is not breathing the umbilical cord whilst pulsating is a lifeline, literally providing oxygen. Hence the equipment to enable resuscitation without clamping the cord.

Yes, I had a managed third stage with delayed clamping.

Actually, thinking about it....baby was delivered, straight onto my chest, I lay there for a bit, cord stopped pulsing within about 3-5 minutes, cord clamped and cut by OH, injection given, placenta out.

I expected the cord to pulse for a lot longer. My LO never suffered from jaundice, and had an APGAR of 9, 9, 9 :D

grants1000 Wed 01-May-13 14:10:29

As I said it seems so important at birth and stresses those out who won't have the option and at the end of the day it does not make much difference when they are older, even if they are iron defficient at 6-8 months. I don't like scare mongering as if it is the B-all and end-all! If you don't do this, it's all over, not at all.

5madthings Wed 01-May-13 14:19:04

No its not the be all BUT it gives benefits particularly to premature babies who are then less likely to need invasive treatments and blood transfusions etc. That's why its being recommended.

The iron levels are a small thing but the fact that it gives premature babies a higher chance of a positive outcome is important.

Flisspaps Wed 01-May-13 18:29:06

I didn't have the option - two instrumental births with PPH.

I'd have preferred delayed clamping. But it certainly isn't the be all and end all, as you're making it out to be. It's like ALL preferences for labour and birth.

themidwife Wed 01-May-13 19:33:24

Absolutely I agree - if you have complications you need to go down the managed route & it isn't the only thing that matters. The thing that matters too is that you are safe.

gillybeandramaqueen Thu 02-May-13 08:50:05

This is brilliant. Thanks so much for sharing this... I had no idea about this and am glad that I now know. The article certainly makes a great deal of sense.

Well said Flisspaps.

Flisspaps Fri 03-May-13 08:30:29

Sorry, my point was aimed at grants1000 (just to be clear)

MaybeAMayBaby Fri 03-May-13 08:47:57

I'm even more confused now.
5madthings, if delayed clamping is benefitial to preemies, why did it all go wrong for mine? Don't know if you read my post earlier in the thread, but DD2 was born at 29 weeks and I have been told a 'mistake' meant her cord wasn't clamped at delivery. She was delivered in her bag (does it make a difference is the placenta isn't attached to me?) and needed up losing blood back into the placenta. She needed a transfusion straight away.
After 7 pretty uneventful weeks on the NNU, she is now home. I like to think she'll have no lasting affects from this, but people are advising me to complain. Are you saying that she should have benefited from this and was just unlucky?

5madthings Fri 03-May-13 09:27:23

maybd the evidence shows that yes it helps prem banies..if you leabe tje cord.to.stop pulsaring eventually he flow.equalises.amd the baby ends up with the blood it needd.

I have nevrr hesrd of too much bloof going back into the placenta and that is not what the studies say.

Maybe it wasnt explained very well to you or maybe your dd experienced an anomoly, i would ask for further explanation as it doesny make sense tbh!

Ultimately the health if mum amd baby are priority and delayed clamping isnt always posdible but for a long time the cord has been clamped immediately just because when actually the evidence is that it is better to have delayed clamping
as lonh as circumstances permit that.

And yed thr placenta not being attached to you may have made a difference, did the placenta abrupt?

MaybeAMayBaby Sat 04-May-13 00:45:15

Thanks 5.
It IS confusing and thankfully I have a debrief appt soon. All the doctors have been very cagey about the details like they are trying to protect themselves and their colleagues tbh. I got a few more details every time I asked in those first few days after (I then transferred hospitals). I've just been told she was delivered in her sac to the neonatal
Team (in next room). (I've assumed the placenta is in the sac-is it not? ) and that the neonatal doctors then discovered while resuscitating her that she hadn't had her cord clamped an she'd bled out back into the placenta. I remember the midwife rushing back in a calling another over to her and whispering urgently about it. I though she said placenta previa-but that makes no sense? I was later told that the obstetrician doing the csection was from a different hospital who have different policies. She needed an urgent transfusion but touch wood, has had no ill affects.
All the new medical team at the next hospital were amazed and shocked it happened-like it was a major routine thing to miss.

If it is not related to the delayed clamping as discussed on this thread (It certainly wasn't meant to happen) then I'll come back on and update. I don't want to necessarily scare people off something that could potentially be so positive to preemies. Incidentally, my DD has made fantastic progress throughout her short life. I'm constantly told she shouldn't be doing half the things she is. Maybe she did benefit?

BoffinMum Sat 04-May-13 09:22:16

I think the reality is we know delayed clamping is good for most babies (although there is a slightly increased risk of PPH for their mothers) but we don't have enough evidence to know whether it is good for premature babies, or those born by cs, or in what circumstances.

lisad123everybodydancenow Sat 04-May-13 09:37:10

Message withdrawn at poster's request.

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