What's normally done with the cord?

[FrettyBetty]

We are thinking of saving the cord blood, but I actually have a different question. What is normally done with the cord? I have never given birth before, so no idea. Do they clamp it straight away? My mum said that when I was born they cut it about 2 inches long and tied a knot close to the belly. She reckons the blood from the cord went into the baby from those couple of inches. What do they do now? And for that matter, if anyone knows what they do when they collect cord blood, that would be a useful comparison.

Thank you!

They use a clip rather than tying the cord now. Other than that, I don't know. I presumed they went to the incinerator at the crematorium with all the amputated legs and tonsils etc.

You actually have a choice about what they do with the cord. By default they will cut it straightaway, however you can ask for "delayed cord clamping", this means that the cord isn't cut until it stops pulsing, which means all the blood from the placenta has a chance to diffuse back into your baby. There is quite a lot of blood in the placenta and it is thought that it benefits the baby to have it back. It is now known that the placenta can support the baby for quite a while after the birth, and perhaps cutting it off asap isn't necessarily the best thing.

You might find this interesting midwifethinking.com/2010/08/26/the-placenta-essential-resuscitation-equipment/
midwifethinking.com/2011/02/10/cord-blood-collection-confessions-of-a-vampire-midwife/

When they do cut it, the remainder is knotted, and it dries out over the first week or so, before falling off naturally.

Cheers, do you know if they clip it straight away?

Thanks FNO, love the name btw! Stupid question, I know, but how long is the remainder? Also, isn't the placenta blood the same one the baby would be getting throughout the 9 months, ie. the last few pumps of it should not make much difference if they'd been getting it all along. Also, this means that we had all grown up without the delayed cord clamping, doesn't it?

Completely up to you.

Cord blood is definitely a misleading name to give what you are discussing though. The cord itself is just the carrier of blood that travels from the placenta to the baby.

You can use sterile thread, rubber bands or plastic clamps I believe. May need to discuss this with your midwives in advance though, especially if giving birth with NHS healthcare who are generally less flexible at delivering outside the template.

1.) Delayed cord clamping has many documented benefits that you can easily look up if interested (it basically insures that your baby is given every last drop of blood from the placenta before it's connection and reliance on it is severed).

2.) Immediate cord clamping is what I guess you'd get if you requested to bank or donate the blood that is still travelling from the placenta to your baby.

3.) You could also request a lotus birth, whereby the cord and placenta remains intact and connected to baby until it dries and falls off a few days later.

4.) You could cut the cord at your chosen time and take cord and placenta home in a tupperware, to maybe plant under a special fruit tree as a memorial to the birth, or even cook eat it (not for me, but great for some people!)

There are many options as yuo can see, that you make when deciding when (if ever) to clamp the cord, what you'd rather use for this and what you then wish to do with the placenta and cord. The choice is yours!

Yeah, I read up a bit more now so am a bit more up to speed. But was curious really what would be the most common route, and it sounds to me like in most cases they would clamp the cord straight away, unless you request otherwise. And this is probably what they did when we were all born.

Frankly, all these choices are confusing me!

From what I've read in various places, it's pretty common now to ask for delayed cord clamping, that is, waiting til it stops pulsing before cutting it (not witnessed it myself but I don't think it takes that long, not more than a few minutes?)

The added benefit of this is that, all things being well and healthy, you get to have your newborn in your arms right away as he/she is pretty much still attached to you so nobody can take it away.

This is what I'm planning to do. Sounds to me like the best of all options, with the baby taking what it needs from the placenta (oxygenated blood) while it learns to take its first breaths. Seems to me that the immediate cord-cutting of yesteryears was more for the doctors/nurses convenience (so they could whisk the baby away and weigh it, etc.) rather than for the baby or the mother. As far as I'm concerned, having my (healthy) baby in my arms right away is more important than weighing and measuring, so if waiting to cut the cord helps me achieve that, I'm all for it.

The cord left behind is about an inch or so, it shrivels up to a scabby thing about the size of a grape I guess.

The blood in the placenta doesn't have some magic factor that it passes on by being in the baby's body, you are absolutely correct that it has been circulating around the baby during pregnancy, quite simply it is your baby's blood, I think the MW thinking blog puts it best:
"I wonder how many parents would consent to someone coming onto the postnatal ward and sticking a needle into their baby to collect around a third of their blood volume? It?s the same thing? only the needle is in the baby not the umbilical cord."
It really is a substantial volume, not just a few pumps, although waiting just 2 minutes (which is what they do in a natural CS) makes quite a difference.

Also when you do DCC, the baby has the support of the placenta while they are getting their lungs working, as the placenta will still be attached to you, providing him with your oxygen. It's another of those cunning things nature does which sadly seems to have been overlooked for the sake of convenience. Another handy thing is that while the baby is attached to you, they can't take them off you, so it's a bit of an insurance policy for your skin to skin.

With DCC the placenta will also come out a fair bit smaller, as it will be drained of its blood

This blogpost suggests that the thing with the baby getting extra oxygen from the placenta in dcc is bollocks

I'm a bit confused - if the placenta is part of the baby's bloodflow system then surely if it is left attached, blood will be flowing from the baby to the placenta as well as from the placenta to the baby? Would the baby not end up with too much blood if the contents of the entire system went into it's body rather than being split between the placenta and body as it had been for several months?

[http://skepticalob.blogspot.com/2011/03/watch-how-and-why-homebirth-increases.html Here]] is a different view on the resuscitation thing NannyOgg posted, mostly on the video of Inga's birth linked to in the blogpost.

WidowWadman - from what I've read, both here and previously, Amy Tuteur is a prime example of a "Skeptical Obstetrician" (her own words) who has no faith or confidence in MWs to be anything other than a surgeon's handmaiden. She does not seem to have any respect for midwifery as a related, but independent, profession and is very close minded to anything that was not standard practice in American Obstetrics 30 years ago. I disagree with her position in general and I disagree with much of what she says in specific, but I don't think this is the place to go into detail.

IMO it is worth noting that, even in areas of America (where Amy Tutuer trained and worked), it is becoming common practice to wait to clamp the cord for at least a few minutes (as discussed here).

The blog post FutureNannyOgg linked to may be seen to eulogize DCC. IMO the post made by Amy Tuteur is at least as extreme, just coming from the other direction.

Cattleprod - look at it another way. Homo sapiens has evolved over thousands of years. For only the last 30 years, give or take, has immediate cord clamping been standard practice. There is very little evidence to suggest that immediate cord clamping has any benefit to either mother or baby, an increasing body of evidence to suggest it may be detrimental - and very little research into the long term effects of this practice. If the baby was going to wind up with too much blood if the cord was not clamped immediately, wouldn't we have evolved a mechanism whereby this blood did not, if left for just 120 seconds, wind up in the baby?

FrettyBetty "Frankly, all these choices are confusing me!"
Welcome to motherhood :o

Tangle - I agree that Tuteur is at the opposite of the extreme, and I don't always agree with her tone, and not all of her views (I'm against circumcision for example). For what it's worth, she's writing about a different healthcare system with different types of midwives and her main beef seems to be with those which are trained to a inferior standard/and the lack of standards. That's a different discussion though.

Showing videos of floppy blue babies and claiming that this is normal/evidence for the placenta being a resus system struck me as wrong even before reading Tuteur's views on this.

The bit about that resuscitaires are only for evil doctors' convenience, and not needed as long as there is a placenta attached is pretty bonkers

I'm not sure anyone is saying resuscitation is obselete with DCC, that would be ridiculous. I think the important point is that resus is not always necessary, and prioritising the cutting of the cord so that the baby can be taken away and measured, over keeping the baby close to the mother and allowing them to receive their placental blood isn't very sensible either. I'm also not convinced that cutting the cord so as to collect stem cells that may or may not help treat an illness your child may or may not get is good prioritising either, but that is more personal, the cynic in me wonders whether cord blood banking is just making money from worried parents. I'm sorry if my post wasn't clear, I'm certainly not advocating refusing resuscitation on a newborn, that would be horrendous.

There are studies that suggest that not cutting the cord and carrying out resus might be a good thing, but resuscitaires aren't designed that way so it only happens outside of modern hospitals.

It's not all about oxygen from the placenta (there are studies to support this) it is also about the blood count, once the blood is in the baby's system, their body can use it. Those blood cells will be around in the baby's system for weeks. The transfer is clearly supposed to happen, because it happens in all mammals. Babies manage without it, adults also manage after losing 3 pints of blood, but it doesn't mean it's the best option if you have the choice (and of course, not all cases do, I didn't with my DS, he's doing absolutely fine, it's not the end of the world, but if I could have had DCC I would have, and will aim to do so for future DCs)

I think it is pertinent to consider that Tuteur is commenting on the American system, especially when considering the second link. It's quite clear that the risk she is talking about is due to midwives not being equipped or trained to resuscitate a newborn, which is simply not the case over here. It is widely understood that HB safety in the UK and US are not comparable. I actually think that's a pretty shocking article to bring to the attention of a nervous mum-to-be who isn't considering HB, let along HB in the US.

Yes, it is a pretty shocking article, but so were the ones you posted - the second link was specific to a case in your first link - so I can't see anything wrong with posting the other side of the story.

So far the consensus seems to be that delayed cord clamping in the majority of cases probably doesn't make much difference either way. Your links were the ones who brought up the "placenta as resus system"

The article does not suggest relying on the placenta alone as you imply, in fact it specifically mentions resuscitating the baby if the baby does not start to breathe when given stimulation (and AFAIK it is usual for MW to rub baby down etc to stimulate breathing before going into full blown resus). It might be misleading as she does describe the placenta as "resus equipment", however she very clearly states that "The placenta not only helps the baby to transition, but assists with resuscitation if needed" then "Anything that needs to be done can be done with back-up from the placenta, and the involvement of the mother."

In other words she is not condoning less support for the baby, but more.

Can I rewind back a bit? I thought Cattle raised a good question: does the blood really end up in the baby? Ie, if the placenta and the baby are still attached as a system, is it the case that the blood would simply continue circulating until the cord is eventually clamped, rather than all the blood ending up in the baby?

FrettyBetty - Short version: Yes, the blood really ends up in the baby.

There's an image here that shows how the baby's blood volume per unit weight changes if the cord is left unclamped for 3 minutes (haven't got a clue how they measure that, and haven't managed to access any more of the article to try and find out).

We didn't clamp DD1's cord until it had stopped pulsating. Immediately after birth it was quite fat and you could see purple blood inside it. By the time it was cut it was pretty flat and much whiter.

The blood ceases to circulate as the shunts that allow the blood into/out of the umbilicus (should and usually do) close shortly after the birth as the lungs inflate. Once those shunts are closed, the baby's circulation is operating as a unit independent of the umbilicus/placenta. But the technical side of it is horribly complicated and I don't pretend to understand it at anything more than a very superficial level!