A revelation that every birth worker needs to know about gravity and placental transfusion

medium_10344483104At last!  A study evaluating the tradition-based tenet that newborn babies who are still attached to their umbilical cord need to be kept at the same level as the placenta … a position that is awkward and that either interferes with mother-baby contact or leads to the umbilical cord being cut earlier than is ideal.

And the results?

Show that it makes no difference at all.  So we can add ‘hold newborn babies at the level of the placenta until their cords are cut in case too much blood drains into or out of them’  to the notion of placental insufficiency, the idea that a labouring woman’s cervix needs to open by one centimetre an hour and all of the other theories that are not supported by evidence.

The study was recently published in the Lancet.  A team in Argentina looked at normally-born, vigorous newborn babies who were held either at the level of the vagina or on their mother’s abdomen or chest.  They were weighed immediately after birth and then again after their cord had been clamped, and the researchers then looked for any differences in the two weight measurements, which acted as a measure of the volume of blood that was transferred to the baby from the placenta.  There was no difference between the groups in this respect.

In a linked commentary, Raju (2014) notes that the introduction of delayed cord clamping into practice has been sporadic, and suggests that one reason for this is the logistical problem of practitioners feeling they need to hold babies at the level of the introitus until their cords have been cut.  At this point in the birth of a new family (and here I am paraphrasing Raju), pretty much everybody else in the room, including the baby, wants the baby to be skin-to-skin with its mother.  We can only hope that this evidence will make a difference.  Then, we can get on with researching the related areas which Raju mentions, one of which I was delighted to see get a mention, because this is another topic close to my heart: resuscitation with an unclamped umbilical cord.

 

Raju TNK (2014).  Delayed cord clamping: does gravity matter? The Lancet, doi:10.1016/S0140-6736(14)60411-6

Vain NE, Satragno DS, Gorenstein AN et al (2014). Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trial.  The Lancet, doi: 10.1016/S0140-6736(14)60411-6

photo credit: Anne Worner  via photopin cc

13 comments for “A revelation that every birth worker needs to know about gravity and placental transfusion

  1. Aileen Patton
    April 24, 2014 at 7:00 am

    Sara i so admire your energy and dedication. I have to say information was out there 20 years ago when i was working in home birth in London. We never cut the cord until it had stopped pulsing and babies went skin to skin. However midwives that practiced in this way were often told we were putting the babies at risk of polycythaemia….jaundice and congestive heart failure. In my years of working in this way i remember one baby treated for jaundice (mum had placenta accreta, and i wonder if the uterus wasnt doing all it could to expel the placenta hence increased risk of polycythaemia??). Keep up the great work!

    • April 24, 2014 at 10:41 am

      Thank you, Aileen 🙂 What an interesting theory … I have literally just written a post which relates to the question of how women’s bodies are way better designed than they are given credit for in Western approaches, and stories like yours always make me re-member how little we really know…

  2. Sally Goodwin
    April 25, 2014 at 5:32 am

    Thank you for highlighting this evidence. In my experience Mum’s instinctively scoop baby up into skin to skin immediately after birth. I couldn’t imagine how that could’ve been harmful!!

    I have an entire Sara Wickham folder on my data stick ;)))

    • April 25, 2014 at 8:32 am

      I agree, Sally … I also really struggle to see how such an instinct could be harmful. Lol at having a whole folder to myself … I feel very honoured! 😉

  3. Rachana
    August 11, 2014 at 12:53 am

    Le Boyer covered all of this in the 70’s with the practice of waiting for the cord to stop pulsing. I’m so very cross at the medicos for their ongoing nonsense. The only thing they continually demonstrate is the depth of their own placental trauma. The power of the collective primal imprint is omnipresent. I think there is also a reluctance to accept the fact that they have had it so very wrong. Goodness only knows how long it will take for them to ‘discover’ that the placenta actually has the CRI- cranial rhythmic impulse- pulsing away for days when the cord is left to detach in its own time. Thank you for your work Sara.

    (CRI is a pulse that osteopaths learn to measure manually. It has a slower rhythm that the arterial respiratory rhythm, and its frequency is about 8-12 oscillations per minute. It is possible to discern it in all tissues of the living body)

  4. Ruth Davison
    March 12, 2016 at 7:16 pm

    I’ve been practicing as a midwife inNZ for nearly 30years,and have never kept a baby down at same level as placenta, it would mean I would have to be holding the baby, I’ve always believed allow mum to reach down for her baby, then keep it close for at least 1-2hours, then cut the cord. I don’t believe it has effected babies at all
    Thanks for your work Sara.

    • March 15, 2016 at 8:50 pm

      I am advocate of keeping the baby lowered if and only if the cord is to be cut in less than 1-2 min. In the cases you describe I totally agree that it does not matter where the baby is as long as the cord is left intact for a good 10 to 15 minute (giving mum a chance to have several postpartum contractions). in hospitals, often the infant is put on the maternal abdomen and then the cord is clamped in 1 to 2 min before the mum has had a chance to have any 3 rd stage contractions. I do believe that those babies are deprived. Some are putting preterms on the abdomen and cutting in 30 to 60 seconds. I think that is wrong. I am more in favor of milking the cord several times when one is going to cut it so quickly.

  5. Becky Reed
    March 12, 2016 at 10:44 pm

    It’s those baby giraffes I’ve always worried about…born with their mother in a standing position, dropping to the ground leaving their placenta WAY above their heads… They must have got it wrong, surely?? (Seriously, I’ve never understood this crazy idea!)

  6. March 13, 2016 at 3:05 pm

    Only 200 women in each group – after exclusions – and only 2 minutes on the cord – and baby held (by who??) not sure I’m impressed. Hardly compares with a truly physiological experience. If someone scoops the baby up from between a reclining mother’s legs and plonks it on her chest this seems like an intervention to me. If a woman gives birth standing, kneeling, on all fours and is left to her own devices, there is a pause before she picks the baby up herself. Still – I suppose anything that encourages the medical profession to leave the cord for any length of time is an advance of sorts. Just think that as usual, we are playing about with nature rather than respecting her.

  7. Mary Hall
    March 14, 2016 at 8:38 am

    If we think about it, the infant’s breathing is one of the mechanisms drawing blood back into the body, or if the transition is slower the cord remains pulsatile for longer. Neither of these are passive as gravity. I once worked with a midwife who had previously worked with mares foaling from prime stud horses. These were vastly expensive animals whose semen sold for thousands £. At birth they were forbidden to interfere with the cord because it was known to adversely affect the foal, and of course, where money changes hands, quality is given consideration. Interesting how knowledge on animal welfare predates human ‘protocol’.

  8. Louise Taylor
    March 16, 2016 at 6:44 pm

    Well as a midwife of nearly 30 years I feel blessed to confess that I have never been taught, or read anywhere, that I was supposed to keep a baby at the level of the placenta and it has always been my practice to place a baby straight into its mothers arms unless she is in a position to be the first one to put hands on her baby. I wonder who came up with that bizarre practice!

  9. March 18, 2016 at 8:11 am

    Dear Sara,

    thanks for this post. One thing that should be noted in the Vain study is the clamping time (2 minutes) and the mean weight change was 56 g in the introitus group compared to 53 g in the abdomen group. As they conclude: “Mothers could safely be allowed to hold their baby on their abdomen or chest.”
    But what I believe is important to note is that the expected weight gain after a unhampered placental transfusion should be about 100 g (25-30 g/kg), meaning that in this study, babies clamped after 2 minutes might only have obtained half of their possible weight gain.
    See my blog post on the subject: http://www.cordclamping.org/2015/05/24/is-2-minutes-enough–27052116

    • March 18, 2016 at 12:37 pm

      Hi Ola, and thanks for that – really good point! 🙂

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