Birthillogics #2 – cutting the oxygen line when it’s needed most…

sara_wickham_birthillogicsI am so glad that the fabulous people who are campaigning for delayed cord clamping seem to be having an impact, and I want to join in this debate today and ask why it is that, when a newborn baby needs some help, the first thing we do is to cut off their existing oxygen supply by clamping and cutting the cord?

I know that the rationale usually given for this when it occurs in hospitals is that the baby needs to be taken to the other side of the room to the specially designed trolley (or resuscitaire) that is used for resuscitation, but do they really?

Does the resuscitaire on the other side of the room really have any benefit that (a) outweighs the significant advantage conferred by the intact umbilical cord that will be pumping oxygen into and around the baby’s body while he is helped to begin normal breathing and that (b) truly cannot be replicated in a position on or next to the baby’s mother, who can perform a vital role during the resuscitation by providing aforementioned oxygen? Oh, and helping remove carbon dioxide as well as providing warmth and even more important but less measurable things like love, although I do acknowledge that mums aren’t quite as flat as resuscitaires, which for the other 99.99% of times that their baby needs them is a really good thing.

I truly cannot think of any other medical emergency situation in which the permanent severing of the one route by which a compromised person was successfully receiving oxygen would be seen as the right thing to do.

We are starting to see movement on this in some areas, as we discussed in Birthing Your Placenta, but we have some way to go before practice is grounded in common-sense thinking about issues like this.

7 comments for “Birthillogics #2 – cutting the oxygen line when it’s needed most…

    April 6, 2014 at 4:46 pm

    Love this post and all so true…

    A quick question! When a mum births in a birthing pool and the baby needs help following birth (when this isn’t anticipated) I find it very frustrating as I have no other choice but to clamp and cut. Do you have any suggestions what to do in this scenario??
    Kind Regards

    • April 7, 2014 at 10:07 am

      I’m not sure if your frustration is because of local policy which prevents you from trying alternatives or because you’re not sure what the alternatives are, but I know from my own and others’ experiences that (a) leaving the cord attached and gently stimulating the baby (while it is still receiving oxygen via the cord) can sometimes be all that is needed and (b) even if further measures are deemed necessary, it can be possible to get the baby into an optimal position in the pool while still attached mum via the cord. Anne Frye discusses this in Holistic Midwifery Vol 11. I’m not saying this will always be appropriate, of course … there is a wider context to consider and situations need to be assessed individually.

      • October 20, 2014 at 8:46 am

        It makes absolute sense not to cut off baby’s oxygen supply at a such a crucial time in its life. Surely nature intended that babies are to have a transitionary period to adjust to the difference from womb to outside world.x

  2. Elisabeth Saether, midwife
    May 20, 2014 at 9:39 pm

    Agree with your reply, Sara. In addition, the Midwife can ask the mother to stand up in the pool, while the baby is dried off / stimulated and kept as low as possible. The effect of gravity will in most cases increase the speed of the placental transfusion, making resuscitation efforts more efficient. In case of low response (low heartrate / shallow respiration) it is also proven safe to milk the cord towards baby with a speed of max 10cm per second, 3-5 times. This will imitate delayed cord clamping. This can be done while helping the baby breathe with a resuscitation mask and bag if needed. Most babies will be ok with the initial help.

  3. March 11, 2016 at 8:06 pm

    What has happened in a year ? I agree that many babies who seem to need help at birth to strat breathing will do so on their own if the cord is left intact, but for the carer it is a worrying time. Thus you need to have a backup so that if t does not start breathing you can provide the help without clamping the cord.

  4. Stephanie H.
    March 13, 2016 at 1:55 am

    Yes! I’m amazed that the umbilical cord, which has provided oxygen to baby during the pregnancy, is somehow suddenly deemed incapable of continuing to do so the instant the baby is born. If a baby needs help, the most prudent thing would be to keep the cord attached while other resuscitation efforts are being made. Why not take advantage of the assistance nature provides via the cord?

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