NHS cutting cord too early?

[wifflepuss]

Just wondering what peoples thoughts were on this.

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

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.

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?

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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

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!

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

This- 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.

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

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.

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.

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.