Umbilical cord clamping/cutting

[charleypops]

I have been reading some articles recently about the benefits of leaving the umbilical cord to shut down on its own before cutting (and no need for clamping) - a delay after the baby's born of from 30 seconds onwards.

Apparently the placenta should ideally be above the level of the baby so the placental blood can drain into him. If the placenta is below the baby, blood can drain the other way which wouldn't be good.

All this stuff makes complete sense to me and I feel strongly about it, so I am going to do my best to insist that my baby's cord is not cut too soon. But I'm worrying that the staff around me would find this too much hassle - especially if the placenta remains inside for a while. It would also mean not having the baby immediately placed on my chest - I would want him next to me or somehow slightly below me (if the cord is long enough), if the cord isn't long enough I would want him to remain near my hips until the cord can be cut or the placenta comes out, which I would then want elevating.

I want to know if anyone has had this type of discussion with their midwives or obstetricians and what happened at the birth.

Or do midwives wait to cut the cord as a matter of course these days? (this is my first baby due in June).

Thanks!!

IME midwives cut the cord immediately unless you state otherwise (as with my DD1). With DD2 we waited for the cord to stop pulsing before DH cut it. It wsn't quite long enough to allow us to breastfeed which was something we wanted to establish immediately after the birth, so this was partially why we cut it before the placenta was detatched. I didn't have syntometrine or traction to deliver the placenta. It came of its own accord...initialising breastfeeding and skin to skin contact stimulates oxytocin (our natural version of syntometrine) which was why the breastfeeding / skin to skin aspect was important to me. I had disliked the way the placenta I shared with DD1 was 'removed' from me following her birth, so really wanted to encourage my oxytocin to do its stuff in an effort to avooid intervention!
We had a homebirth and our community midwives were as keen to avoid intervention as we were, which was extremely good! I did find that unless I was clear and concise about what I wanted for my birth plan, and could explain my reasons for my decisions they were a little uncomfortable about some points. Anyway \link{http://www.mumsnet.com/Talk?topicid=1370&threadid=35937\here's} my birth story if you're interested .
Congratulations on your pregnancy!

It is standard procedure to clamp and cut once the cord has stopped pulsating (this is later than it used to be). Once the cord had stopped pulsating the baby is no longer dependent on your blood supply and it is safe to cut.

You can ask for it - NOT A PROBLEM... some hospitals are very much into clamping quickly but please make your point early on in labour.

Do keep an open mind as if the labour didn't go according to plan your 3rd stage may need to be managed.

Have you looked into lotus birth where the cord is never cut.... much more hippie

As a doula most of my clients try to have a physiological 3rd stage and to leave the cord uncut for quite a while.... this isn't always possible for medical reason but not because the staff is against it.

Levanna what a lovely story! And congratulations! I love the idea of a homebirth myself, but as this is my first, I'm not going to take any chances. I'm glad it's not necessary to have delivered the placenta for the cord to shut down, I was wondering about that. You've also underlined for me importance of a clear birth plan. Thanks!

Dophus, I wonder why they need to clamp if it's stopped pulsating? It's good to hear that waiting is standard procedure (at least in some places) though - I didn't want to be perceived as some weirdo by medics who'd not heard of it and couldn't understand the reasoning.

Pupuce - it was reading a thread somewhere here (originally about placenta eating I think) which mentioned Lotus Birth which in turn drew my attention to this in the first place. Lotus isn't for me, but I can definitely understand the benefits of waiting a little while to cut. It's not a spiritual thing for me, but a practical one - I want to do all I can to ensure baby has as many of those unique nutrients, T cells, hormones as possible to start him on his way. I might not be able to breastfeed because I had a reduction when I was teenager.

I'll put it in my birthplan and tell everyone when I get there. I can be shy in unusual situations - I'm sure this is going to be a pretty intense time and I won't be feeling very forceful - I'm just hoping I can make them take me seriously, indulge me, whatever, but if medics are aware of this type of thing, at least I won't have to spend time explaining my reasoning in minute detail...I had images of myself taking in reams of scientific study papers etc... and trying to make everyone read through them.....

Levanna what a lovely story! And congratulations! I love the idea of a homebirth myself, but as this is my first, I'm not going to take any chances. I'm glad it's not necessary to have delivered the placenta for the cord to shut down, I was wondering about that. You've also underlined for me importance of a clear birth plan. Thanks!

Dophus, I wonder why they need to clamp if it's stopped pulsating? It's good to hear that waiting is standard procedure (at least in some places) though - I didn't want to be perceived as some weirdo by medics who'd not heard of it and couldn't understand the reasoning.

Pupuce - it was reading a thread somewhere here (originally about placenta eating I think) which mentioned Lotus Birth which in turn drew my attention to this in the first place. Lotus isn't for me, but I can definitely understand the benefits of waiting a little while to cut. It's not a spiritual thing for me, but a practical one - I want to do all I can to ensure baby has as many of those unique nutrients, T cells, hormones as possible to start him on his way. I might not be able to breastfeed because I had a reduction when I was teenager.

I'll put it in my birthplan and tell everyone when I get there. I can be shy in unusual situations - I'm sure this is going to be a pretty intense time and I won't be feeling very forceful - I'm just hoping I can make them take me seriously, indulge me, whatever, but if medics are aware of this type of thing, at least I won't have to spend time explaining my reasoning in minute detail...I had images of myself taking in reams of scientific study papers etc... and trying to make everyone read through them.....

Whoops! That darned back button!!

Whoops! That darned back button!!

Charley -did your reduction affect your milk ducts ?

Don't know! I'm sure I remember the surgeon saying I wouldn't be able to breastfeed, but since discovering I was pg, I've come across a few articles on the net indicating it might be possible. There's a site called BFAR (Breast Feeding After Reduction) which has a few tales of success to varying degrees. I'm not expecting miracles. I am particularly concerned about the colostrum though...

charleypops - there is no reason why you cannot ask for a physiological third stage. The midwives should respect your choice. I would certainly put it in your birthplan. Some midwives do not have a lot of experience of not interfering with the third stage so it would be good for you to read up on it and have information to hand. There are instances where it is not advisable or clinical reasons why it should be actively managed.

There is actually no need for the cord to be clamped prior to delivery of the placenta if all is well. I am amazed how long some cords actually pulsate for after delivery, especially in waterbirths. Do not worry too much about the position of your baby post delivery. I often deliver babies up onto their mothers with a physiological third stage. We are auditing all our wtaerbirths and they have physiological third stages unless their is a problem. There have been no problems identified really in the first week. No increase of jaundice or babies being admitted to special care.

As a rule, if there has been no interference in labour such as induction, epidural or large doses of pain relieving injections, then physiological third stage should be fine. A low haemoglobin means it is not advised due to increased blood loss. (Hb less that 10). If the cord has to be cut because it is very tight or short, or the baby needs resuscitated then the oxytocic injection should be given to help the placenta to deliver. That is because the natural process has been interrupted. The cord should not be cut before it stops pulsating in a natural third stage because, again, the natural process has been interrupted. Once it has stopped pulsating it can be cut if wished. Sometimes we clamp and cut to allow the woman to climb out of the pool more easily. Some women deliver their placentas in the pool. It is difficult to find evidence of how long a physiological third stage can last. Placentas are usually delivered within the hour but i have seen it take up to 2 hours. We tend to convert to active management after that length of time by giving the injection.

You might find this article useful \link{http://www.hulmeandassociates.com/bj/thirdstage.htm\thirdstage}

I had a pain relief-free waterbirth and physiological third stage because I've had bad reactions to pain relief in the past - I think people underestimate the pain relieving properties of water though!

The cord was clamped after it had stopped pulsating (and my mum cut it - lovely!) and I got out of the water to deliver the placenta (which I found fascinating - I got the midwife to show me it in detail!). I was amazed that my body could grow all these things properly - it's hardly ever done anything else right!

Mears - thanks so much for that link - fascinating stuff! Didn't even know it was called the 3rd stage and i was certainly not aware of the physiological/active terminology! I now have something to really aim for, namely a physiological birth!

I know the article indicates, as you do, that physiological 3rd stage can only really be achieved if the first 2 stages have also been physiological, but this is something I will have to follow up. If it turns out that I need, for instance, an induction, episiostomy, epidural or even a cs, I would still desire (specifically) full placental transfusion. Everything else in that stage, such as active delivery of the placenta would be secondary to me.

xhm - I've been giving some very serious thought to having a water birth today - they sound great! This, coming from someone who before becoming pg was determined to not even consider ANYTHING apart from a nice, neat elective cs!! How lovely having your mum do that! I'd be so embarrassed - I took a long time to work up the courage to tell mine I was pg because she'd know I'd had sex!! and I'm 34!

Charleypops, I know what you mean about being embarrassed, but I was really glad my mum was there. DH was there too, but too knackered from supporting me squatting in the water (him outside the pool - it was mine all mine!) and quite squeamish!

I put the embarrassment to the back of my mind because the idea of having her there when her first grandchild was born quite outweighed the fact she'd see me give birth I'd not have minded a marching band being there though, so long as they passed me water to drink and fanned my face (the water's very warm!). They could've taken it in turns to rub my back too - back to back labours are not to be recommended!

I wore a nightie, so wasn't starkers in the water - not earth mother enough for that!! In fact, not really earth mother at all - just did a good impression of one on DS's day of birth!

I really do believe people underestimate the power of water to soothe pain - when the gas and air made me gag (had one puff, retched and decided against it!), I figured I either had to do it drug-free or get out of the water. Getting out wasn't an option - I'd been SO uncomfortable before I got in, so I hung in there. I was lucky, because I had a relatively quick labour - not sure I could've done much more than I did.

Good luck with it - looking forward to reading your birth announcement in June and chatting before then on here.

Charleypops - I personally do not see why physiological third stage cannot be attempted evn in the situations I mentioned. However, it is not advocated in the literature. Really because I think not enough is known about it. I can't see why, if all is well, even with an epidural, if the baby had delivered on it's own, why the placenta cannot be waited for as long as there is no active bleeding. If there is a problem, the injection can be given and the placenta delivered. Epidurals can affect how the uterus works though, and that is why in theory physiological third stage is not supported. There is a greater risk of bleeding. Physiological third stage would also be a problem in forcep/C/S deliveries because the uterus is not functioning well ofetn and there is a greater risk of haemorrhage. A compromise there perhaps is to wait 30 secs before clamping the cord. That is done with preterm babies at C/S so there is probably no reason why that could not be done for term babies. A labour where there has been interference increases the risk of haemorrhage. That is why active management is preferred.

I would encourage you to consider waterbirth. Nature at it's best

xhm - Aw - can't I have gas and air AND a water birth - I've been looking forward to that - bobbling around in some nice warm water drifting away on gas and air with a nice bit of Pink Floyd on the stereo!! Ouch though - back to back sounds unpleasant - you are lucky it was quick! I will also be wearing an outfit for the event - no nudity for me either!

Mears - I wish you were my midwife and pupuce my doula!! I hope my team are half as informed about this stuff as you are! Thanks x

Oh yes, you can have gas and air and a water birth. I just couldn't because I didn't want to be sick too!

I hope it doesn't make me sick! Sounds like giving birth could possibly be a nice experience! It never occured to me it could be chilled! Great!

I did actually enjoy it. I'd do it again in the blink of an eye! And it is true what they say about not remembering how painful it is (though for me it wasn't as painful as periods - I have endometriosis). I found that the fact there were gaps between contractions (albeit very small ones towards the end!) kept it bearable.

I went in with the idea that if I had a pain-relief free waterbirth, that would be fantastic, but if I needed intervention, so be it. I planned for all the eventualities I could think of so that if I did need a help or a c-section, I'd at least have had some say in how it went because they'd know what I would like to happen. I knew that a birthplan wasn't what was going to happen - just because you write it down doesn't make it true(!), but it made my thoughts very clear and meant my mum and DH knew what I wanted as well. I was surprised how much attention the midwives paid to it though - every one I saw read it thoroughly.

And the other thing with a waterbirth is you get a midwife with you the whole time - the idea of being left in a room didn't appeal to me. I was lucky there weren't many women in labour on the day DS was born. I'm going for a homebirth if there's a next time though - in a hired pool. DH doesn't know yet

If you are storing cord blood though they will have to cut immediately. I don't know how it works in the UK. We have ds's cord blood stored in a private bank in the US.

Blimey xhm - your periods must have been a nightmare!! I have had about 4 bad ones in my life - until the first one of those, I'd never really understood what women were going on about when they said they had to have time off work etc with the pain.

The last severe one I had was, strangely, in the cycle before I became pg. It was the worst ever - I was laying on my back naked on the bathroom floor with my knees up, and all my muscles from my heels right up into my pelvis were contracting and twitching involuntarily. It lasted a whole 30 minutes and was the worst pain I'd experienced in my life!! I wondered at the time if giving birth could possibly be any worse! Hopefully it won't be....

Jaberwocky - I know next to nothing about cord blood storage, it's to do with harvesting stem cells isn't it for using to grow new cells in the future for your child? I'll do a bit of research.

Thanks x