Inspired by conversations I’ve had with people on my facebook page and elsewhere about research showing that there is no difference in blood gases measured in blood taken before and after clamping the umbilical cord, and in the spirit of enabling babies to be able to have their full complement of blood, here are ten things you can do before clamping the umbilical cord… Not necessarily all at the same time or in this order though!
1. Engage in some skin to skin cuddling. It offers loads of benefits, as the UNICEF page listing some of the significant research studies in this area shows.
2. Bond. Until recently, many have underestimated the importance of oxytocin in helping labour progress and getting breastmilk to flow. The level of oxytocin in a woman who has just given birth is likely the highest that she will ever experience. The feelings of love and euphoria (which new dads, co-mothers or birth partners may also find themselves experiencing) are there to be enjoyed and savoured. Keeping the lights dim and the mood happy leads to less adrenaline, more oxytocin and a lower chance of a retained placenta or excessive bleeding.
3. Transfer bugs. We are only really beginning to understand the importance of bacteria in our lives and health, and how our efforts to improve on nature may be having unintended consequences. Being born vaginally and being held by one’s mother immediately after birth are both thought to be important factors in how we collect the bugs that we need. If you want to read more on this, I highly recommend this blog post by Rachel Reed and Jessie Johnson-Cash.
4. Breastfeed. Yep, still no need to clamp the cord as in most cases it is long enough to allow baby to reach the breast and feed. You’ll find some interesting articles on biological nurturing here.
5. Count fingers and toes. Not that this is strictly necessary, but I understand it’s traditional… I’ve never found any research on this topic, but that doesn’t mean I might not sit a group of mothers and midwives around a bottle of wine and do some of my own one day 😀
6. Discreetly take blood for cord gases if you’re in a hospital and the woman wants this. Contrary to what some believe, and now supported by the findings of Di Tommaso et al (2014), sampling of cord blood for gas analysis may be performed on the unclamped cord right after birth without reducing the accuracy of the analysis. Midwife and delayed cord clamping campaigner Amanda Burleigh joined our conversation, adding that, “Doctors requesting blood gases immediately after birth causes a lot of concern as many feel wrongly that the cord needs to be clamped before it can be done. All it needs is a small amount of pressure over the puncture site. The cord should be handled as lightly as possible. (Use a small bore needle, if possible, but not essential) This does not interfere with pulsation.” Blood can also be taken for Coombs testing before the cord is clamped.
7. Birth the placenta. Most of my experience is of physiological placental birth, which I can attest works very well when the cord remains unclamped, but I have also promised the lovely and aforementioned Amanda Burleigh that I will be sure to mention that there can be a delay even for women who decide to have a managed third stage. Most sources agree that, even if an oxytocic is given immediately, there can be two minutes delay before the cord is clamped. Amanda notes that some practitioners and NICE advise that cord clamping may be delayed for up to five minutes after an oxytocic is given, but shares that there is a bit of concern amongst midwives that this may be too long in the absence of good research showing what the effect of the oxytocic might be on the baby, or on the volume of blood received. This area is still being debated. Some forward-thinking practitioners have stopped doing immediate cord clamping at caesarean section, instead waiting until two minutes have passed before clamping and cutting the cord. There’s lots more on placental birth in general in Birthing Your Placenta; the book that Nadine Edwards and I wrote for AIMS about placental birth.
8. Admire the placenta. And why not; no matter whether it was born physiologically or with help, it’s an incredible organ that has sustained the baby for many months. Parents might even want to take some time to ponder whether they’d like to do something with it once the baby doesn’t need it anymore.
9. Have a cup of tea. In my humble opinion, tea and toast are an absolutely essential part of the postnatal period, and because no-one else had given this important topic the research attention I felt it needed, I researched it myself.
10. Post pictures to facebook. Now let’s be clear though… I’m not saying I think this is necessarily the best way for a family to spend their first moments together, but I really do believe that there are sound scientific, physiological reasons to return to the practice of leaving the umbilical cord intact for a while after the baby is born. So if it’s a case of choosing whether to start uploading baby’s first pictures or cut the cord first, I’d reach for the smartphone before the scissors 😉
If you’ve got a bit of time and want to learn more about delayed cord clamping, check out Alan Greene’s TED talk… And as ever, feel free to debate, disagree or add your own!