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Licensed Midwife, Homebirth Midwifery and Holistic Women's Health

Posts tagged premature cord clamping

Your baby has just been born.  Would you let someone draw their blood and remove 30% of their blood volume?

I became a midwife before I birthed my own babies.  People often ask me how my practice changed after I became a mother and gave birth.  All midwives advocate for the needs of babies, but giving birth to my own baby afforded me a more direct and visceral connection to the baby’s birth experience than I had previously known (among other things!).   I am more deeply attuned to how both mother and baby experience labor, birth and the hours after birth — physiologically and emotionally;  From their passage through the pelvis (or abdomen) to their first moments touching, hearing and smelling each other, it is a sacred and biologically unique time.

Here you can clearly see the red, oxygen rich blood still in the cord that is about to be severed. This baby did not receive that cord blood that nature intended her to have.

Here you can clearly see the red, oxygen rich blood still in the cord that is about to be severed. This baby did not receive that cord blood that nature intended her to have.

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In hospital births, early cord clamping is one of the first interventions the newborn experiences. Physicians routinely cut the cord moments after birth, often before giving the baby to her mother.

I recently attended a planned hospital birth of a client who transferred out of my care shortly before her birth. We transferred her care to our small, local, natural birth-friendly hospital. A gracious family practice physician took over her care. Two of my client’s main hopes for her birth were delayed cord clamping (of at least a minute or two), and to receive her baby immediately from the hands of the doctor.  The doctor and I discussed the mother’s wishes more than once while she labored, and she was amenable to both. I had such high hopes for this baby’s entrance; We were going to have a somewhat physiological experience here!

After a few pushes baby comes out, pink and happy, and I’m watching, waiting…… still waiting for baby to be in mom’s arms. The doctor holds the baby down by the mother’s thighs, taking ample time to do unusual and unnecessary things. First, she bulbed the vigorous baby four or five times, then leisurely picked up a piece of gauze and slowly wiped the baby’s face. The energy shifted in the room from pure joy and excitement to mistrust and anger. She had previously agreed to give the baby immediately to the mother and now she was stalling. We were all very confused. What was she doing?

Meanwhile the mother was pleading desperately to have her baby: “Please, pleeeease, give me my baby.” I will never forget the sound of this mother begging to hold her baby. It caused me visceral pain. Every second of it broke my heart. I pray I will never again be in a situation where I, or anyone else, would withhold a newly born baby from her pleading mother.

After mother and baby were settled and nursing I seized a brief moment to talk to the doctor in the hallway. I asked her why she did not honor the mother’s desire to immediately hold her baby, as she had previously agreed to. She stated that she did honor the mother’s request to immediately receive her baby (“immediately is often a relative in the hospital), but that she also was attempting to honor her request for delayed cord clamping — requests that, in her mind, were mutually exclusive. She argued that she could not give the baby to the mother while the cord was intact because the baby’s blood would back flow into the placenta. In her mind, the delayed clamping needed to happen first, then the mother could have her baby. The two things could not happen simultaneously. We all know that thousands of babies are placed on their mother’s bellies every day, and probably have been since humans started having babies, but somehow the rules have changed.

A typical midwife-attended homebirth, where the cord is not prematurely cut and the baby receives her full blood volume. The parents decide when they are ready to cut the cord, with baby still nestled on mom.

I was stumped. Of all the bizarre medical model theories and logic I’ve encountered, this one was new to me. Typically physicians oppose delayed cord clamping because they believe the baby will receive too much of his or her own blood volume through the cord. This doctor was afraid that baby would not receive enough of her own blood because it would back-flow into the placenta if the baby was on the mother’s abdomen.

After debriefing with some of my peers I discovered that fears about blood draining out of the baby is not uncommon. But since the medical community largely opposes ‘delayed cord clamping,’ the question about where the baby should be while waiting to cut the cord rarely comes up in OB-attended births.

To be fair, there is some logic in the belief the blood will backflow out of the baby. If a woman gives birth and someone holds the baby up two feet above the mother’s body for any length of time, yes, common sense tells us the force of gravity will encourage blood flow downward, away from the baby. However, there are two problems with application of this logic.  First, suspending the baby above the mother should never happen. There is no valid reason to suspend a baby feet above her mother moments after birth. You may have seen this in birth scenes from the 80′s, but this is not an appropriate or even reasonable practice. Second, we now know that a complex feedback process  determines when the cord vessels close and thereby minimizing blood flow out of the baby and maximizing blood flow into the baby. It has very little to do with the position of the baby in relationship to the placenta.

Nature came up with a perfect design here. We can’t outsmart this one. Keeping the baby at the level of the mother’s abdomen is practical, normal, and biologically best. Fortunately for babies born in the hospital , some contemporary evidence-based OBs are coming around to accepting what midwives and mothers have long known: leaving the cord intact allows the baby to receive her full blood volume along with all the stem cells, red blood cells, oxygen, immune-boosting antibodies, and whatever other undiscovered life-giving properties our blood supplies.