Ten things you can do before clamping the umbilical cord…

keep calm delay clampingInspired 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.

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 😀

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 Birthing Your Placenta.

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.

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, 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 on 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!

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

9 comments for “Ten things you can do before clamping the umbilical cord…

  1. viv
    September 4, 2014 at 6:24 am

    Hi Sara. This is a great article! What are your thoughts on waiting two minutes before giving the oxytocic drug? Is there any research on this?

  2. anon
    September 4, 2014 at 6:50 am

    thank you for this valuable information, as always. Birthing the placenta is the one thing about birth I am least knowledgeable about, and I would like more information on the subject, so thank you for this. How do you feel about lotus births? I had a very old fashioned midwife and no interventions at my home births, but when it came to the placenta, she was a bit more hands on which I thought was a bit strange. After 25 minutes, unclamped, and I had not had any contrations to expell it, and a few little pushes did not bring it out, my midwife got me into an upright position and pressed down on my uterus in order to get it to come out. It did and there was no complications with this at either home birth, but I still wonder why it was necessary. I would like to see a cloth diaper on the baby in the picture 🙂 For a midwife’s site it makes sense to me 🙂

  3. September 4, 2014 at 8:16 am

    Thanks for a great piece of writing.
    Yesterday I cared for a client having an elective Caesarian. She had wanted DCC but the dr in that hospital didn’t feel she could agree to do this but agreed to milk the cord.
    What are your views on this? Do we know if the blood does get through to baby? Is it beneficial to baby. Instinctively I think it must be but do we actually know ? X

  4. Trudy Hart
    September 5, 2014 at 10:37 pm

    Hi Sara,
    Great piece, have had many ‘interesting’ discussions on this, in many forum, seems to me evidence based practice and the rights of the baby, make it a no brainer! Had a discussion last week with 2 OB’s who were open to it, as long as they didn’t have to rush to do another CS, and used the waiting period to do their documentation. Or they would milk it. A wee way to go yet, but ten years ago there was no discussion even. It was then I did a LLL presentation to mums, MW’s, Plunket etc and was told I was didn’t need to talk about DCC because it was standard practice, yet when i got the mums to do a show of hands, very few had experienced DCC and these were LLL mums with a strong normal birth focus. That staunched the criticism flow!
    Great to see the microbiome becoming recognised also, we naturopaths have been burbling about this forever, and it is so fundamental, we may yet survive as a species!!
    Arohanui, Trudy Hart

  5. Donna Young
    September 8, 2014 at 5:39 pm

    Please share and pass on this web site, Stronger babies by no clamping off the umbilical cord, and than cutting it.
    This is a Petition to the United Nations, as all countries are exploiting the babies by depriving them of full placental blood
    infusion and allowing private medical stakeholders to sell the wrongfully deprived whole placental blood. It is separated
    and sold into a variety of profitable elements of the whole blood, the payment most for developing blood cells of early
    clamped premature infants. The full term babies have adult blood, so that means full term babies, as well as premature
    babies have been robbed of their essentials and immunities for profits. This is when informed adults can donate their own
    blood and have it extracted for mature stem cells. Leave the babies with their full blood infusion, that is a duty and to report
    harmful clinical standards of early clamping. Those who used false studies absent of no clamping of the cord in control studies of babies early clamped in various stages of their birth, instant, to under five minutes, all left out a control group of babies, not
    cord clamped. These babies are known to thrive, and the weaker babies are those who were clamped before the placenta was birthed and all pulsation ceased.

    I have found not obstetric nurse in my area who witnessed the delay of cord clamping until the completion of the third stage of labor. That means the nurses, and the perinatal nurses have assisted the doctors in weakening someone’s baby, by their approval of setting a policy, instant and early cord clamping is to be rountinely done. The excuse is to get a cord blood sample. But they can get a blood sample by inserting a tiny needle in the cord, for a blood sample. The mother should sign for the risk factor, and inserting of a clamping tool or a needle risk the baby to a blood infection. This is sometimes seen as a juandiced baby fighting off blood infections by unnecessary medical policies set as a standard of care. This is always a local problem or a Regional allowed policy. Fight back, direct a Class Action against the policy makers, usually, ACOG in the USA and SOGC in Canada. They set the policy of early clamping before the third stage of labor has been allowed and completed, in a time period of about 20 minutes, more or less. They are the ones to be held accountable misguiding the Chief Medical Officer, Federall or Provincial. They will be fined to no informed consent, and refusing mothers a signed birth contract, all revival on the unclamped cord, even while assisting the mother for her individual needs. She has a right to such choices. We need emancipation in the birth room, or home birth, or with any emergency care provider, if calling 9-1-1. All babies will prosper and enjoy being stronger, if we got back to expectant management, following natural birth choices, and rights.

  6. March 3, 2016 at 6:05 am

    Thanks for a great piece of writing.
    Yesterday I cared for a client having an elective Caesarian. She had wanted DCC but the dr in that hospital didn’t feel she could agree to do this but agreed to milk the cord.
    What are your views on this? Do we know if the blood does get through to baby? Is it beneficial to baby. Instinctively I think it must be but do we actually know ? X

  7. June 28, 2016 at 12:16 pm

    11. Wait until the cord comes away naturally at the navel. This can be between 2-7 days. Whatever it takes it is most certainly worth the wait. The baby will be most grateful to have its placenta until it has finished its work. The family also benefits from this special Lotus birth time.

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