I’ve just been reading on the Lactnet list that the Swedes are implementing a policy of leaving the umbilical cord to pulse for three minutes after birth in order to prevent anemia in infants. This is in accordance with the latest “science” which was published in 2007. I’m mystified why a country takes until October 2008 to announce implementation of a meta analysis that was published in 2007 in a respected medical journal but I suppose that long delay is not as bad as countries who have just ignored the study completely e.g. the U.S. and Canada.
It is a matter of the utmost frustration to me to think about the fact that we need a meta analysis of studies to tell us not to amputate a pulsing organ from an infant as soon as the cord becomes visible and clampable. What “science” was ever used to start this interference in the first place? Absolutely none. It started as a matter of convenience and reaction. Convenience, in that the obstetrician could remove the baby from his/her sphere of responsibility and hand the baby over to a nurse or second physician. This allowed the obstetrician to get on with pulling the placenta out and suturing the episiotomy. Reaction, in that many babies have been anaesthetized so deeply by epidurals that their apparent lifelessness could be stirred into immediate response by cutting off the oxygen supply and forcing that infant to breathe/cry/respond and thereby relieve the anxiety of the attendants. Never mind that the baby lost up to 40% of its blood volume (Mercer 2002) and would become anemic in the first year of life. In their ignorance, physicians attributed infant anemia to insufficiencies in breast milk. Basic rule of obstetrics: when in doubt, always blame the mother and/or the baby.
The “science” in obstetrics often follows the lead of the alternative birth movement which points out the obvious. Unfortunately, it rarely goes all the way with backtracking on a bad practise. For example, when we had many parents in North America objecting to caustic silver nitrate being used in the eyes of the newborn, the medical profession finally came out with the idea of less caustic erythromicin ointment. Yes, the ointment doesn’t burn, but it still interferes with the newborn’s vision at an important time of imprinting and using antibiotics unnecessarily is inadvisable. It’s interesting that no eye treatment of newborns is done in the U.K. or Australia. So, a half-measure was tossed at North American parents to appease them and stop the demands for change.
We see the same mentality in so many areas of maternal/infant care—they just don’t get it! When we want mothers and babies kept together, skin to skin, in order to facilitate breastfeeding, the next thing we see is nurses jamming the nipple into the mouth of a baby who is just relaxing and not interested in nursing right at that moment. When the staff don’t understand that the pregnancy, birth, breastfeeding and recovery from birth are all one continuum, there is a frantic need to have “rules” and bend the mother/baby dyad to fit into those rules.
With this cord pulsing idea, what we see in actual practise in hospitals is:
1. the meta analysis is ignored and instant cord clamping still takes place
2. someone is assigned to watch the clock and 3 minutes is the exact cutting point as if that is somehow dictated by science (obviously it is not).
3. doctors invent a complicated explanation for withholding the baby from the parents for the time that the cord is pulsing i.e. “I have to keep the baby below the level of the placenta”. If that were true, why do babies do so well at homebirths where the midwife places the baby on the mother’s belly immediately and leaves the cord alone for over an hour?
To keep the cord intact, we have the science. We have the instincts. We have all the knowledge we need to leave an infant’s placenta alone without any harmful consequences whatsoever. Now, what will it take to change the hospital practice worldwide? As the consumer demand for homebirth increases, that may be the impetus for institutional change.
Henci Goer shared her frustration with UCLA Hospital on her blog when her premature grand daughter was born. The little girl’s umbilical cord was amputated immediately. I think it’s a big wakeup call to the rest of us that the woman who wrote “The Thinking Woman’s Guide to a Better Birth” can’t get evidence based care for her own family member.
This umbilical cord cutting issue is just one more reason why parents give birth at home for the safety of their child. If parents are planning to go to a hospital to give birth, I recommend that they plan a “Lotus Birth“. Keep the baby, placenta and cord all together until they bring the baby home. I’m sure the hospital will provide them with a cord clamp and they can be assured that their baby has received his/her full complement of blood from the placenta. I’ve even read that a few midwives in Australia have managed to have Lotus Birth for clients that needed cesarean section.