Ten things you can do before clamping the umbilical cord…

It’s crazy to have to say this, but newborn babies need their blood. And yet the medical model of childbirth has been preventing many babies from getting the optimal amount of blood for many years now.

I’m talking about the relatively recent and harmful practice of clamping and cutting the umbilical cord straight after birth.

This intervention is a harmful because babies need a bit of time after birth to adapt to life outside the womb. Part of that adaptation involves a series of physiological processes which ensure that they keep the amount of blood that they need. These processes ensure that enough of their blood – which also swirls through their placenta – has transferred into their body before the connection between the baby and the placenta is cut. Nadine Edwards and I wrote about this in more detail in Birthing Your Placenta.

Modern parents might think that this immediate cord clamping is the ‘norm’. After all, it’s what we’ve seen for years now. When we see birth on TV, the cord is clamped right away. Often, the cord and placenta aren’t even there! (But often, the baby looks a month old and the birth was unusual in many other ways too.) It may be what we’re used to seeing, but it’s not normal and it’s certainly not good for the baby.

 

What’s normal? What’s alternative?

The fact that the medical approach has been used for several decades now means that the ‘alternative’ (which is totally the wrong word – why should what nature and women’s and babies’ bodies have done for millenia be seen as alternative?!) is sometimes called ‘delayed’ cord clamping/cutting. The use of the word ‘delayed’ is a bit problematic though, because what we’re defining as ‘delayed’ is actually only ‘delayed’ when compared to an intervention! The more patient approach is normal, right and physiologically beneficial for babies. It’s what would happen if we didn’t interfere right away. We only need to state that it’s delayed because medical intervention is too quick in this regard. This is why many of us instead talk about the need for ‘optimal cord clamping’.

I’m not going to cite the evidence here, but a ton of research studies show that medical intervention in the form of immediate cord clamping is harmful to babies. Again, see Birthing Your Placenta. And Amanda Burleigh is the recognised UK expert in this field, and you can see her website here. There’s also a facebook page on this topic.

But change is still needed, 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.

 

Cuddle, bond and transfer bugs!

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.

 

Feeding and counting!

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.

medium_46192065335. 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…

 

If you want cord gases taken

6. If you want cord blood gases taken (and remember that this is your decision, as with all interventions), this can also be done while the cord is intact. This is supported by the findings of Di Tommaso et al (2014). Their research showed that 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 optimal cord clamping expert Amanda Burleigh adds 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. But again, it’s your decision.

 

Birth and admire the placenta

The fourth edition of a popular book helping parents, professionals and others to understand the process and the evidence relating to the birth of the placenta. Also includes more information on optimal cord clamping. No matter what kind of birth you are hoping for (or if you’re a birth professional wanting to understand more deeply or update yourself on the latest evidence) this book will help you understand the issues and options.

7. Birth the placenta. Most of my experience with birthing placentas is of physiological placental birth, which I can attest works very well when the cord remains unclamped. But there can be a delay even for women who decide to have an actively managed third stage. Most sources agree that, even if an oxytocic drug is given immediately, there can be two minutes delay before the cord is clamped. Some practitioners and guidelines advise that cord clamping may be delayed for longer after an oxytocic is given, but there is still some debate on this. The concern is that oxytocic drugs are powerful, and have a number of effects which interfere with physiology. 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 Birthing Your Placenta.

8. Admire the placenta.  And why not?! No matter whether it was born physiologically or with medical 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.

 

Tea, toast and pics

medium_4355913258 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. Take a picture.  Now let’s be clear though. I’m not saying I think that making the baby a social media account is necessarily the best way for a family to spend their first moments together. And mobile phones can be a source of tension and argument in the birth room as well as being a great way to stay connected. (Just have a conversation first about whether you agree that naked photos and birth announcements can be sent to family members while it’s all still happening. And bear in mind that, if you tell anyone outside the room, you may find they get excited and tell the world. Really, the baby will still be there in an hour’s time, but you’ll never get that first hour as new parents back.) 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 taking baby’s first pictures or cut the cord first, I’d reach for the camera/phone before the scissors.

 

How to find out more

I know that lots of people have questions about this topic. Again, there’s more on this and related topics in Birthing Your Placenta. The best sources of further information I know of on optimal cord clamping are Amanda Burleigh’s website and the facebook page on this topic. (Do be aware that some other sources of info are sponsored by cord blood banking and other companies – always check carefully to see whether information is genuinely independent or potentially biased by financial interests.) Another great source of information on this is Alan Greene’s TED talk.

 

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photo credits: tea and toast by treehouse1977 and baby toes by imallergic via photopin cc and cc

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