Cord pulsing policies

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.

6 thoughts on “Cord pulsing policies

  1. A local ob was SO CONCERNED about not clamping the cord. May still be, I try to ignore and avoid him…

    He only permitted the lithotomy position, and if
    the mother was lucky enough to get a vaginal birth and persistent/savvy enough to demand delayed cord clamping, he would “deliver” the baby, and
    immediately admonish the mother not to bring it above the level of the still intact placenta.

    One day, we were talking about his concerns with DCC. He told me he was worried that all of the blood from the baby would drain into the placenta. I
    asked him if the vein in the umbilical cord had the typical venous character, the valves which prevented backflow of blood. “Well, of course!” Are the arteries in the umbilicus under pressure, as they are in the rest of the body? “Well, of course!” Then, what would be the difference between the
    baby or a lower leg? He didn’t have an answer, got irritated at me, and left.

    I haven’t had to face him in birth since (because the mothers I attend know about him, and avoid him), but I’m in clinicals as a student RN at the hospital I avoid (because of their archaic birth/postpartum ideals…) so I figure it’ll happen in the next 4 weeks. Not looking forward to that, but maybe he’s forgotten who I am??

  2. Here’s another thought…

    One of the “reasons” to immediately clamp the cord is polycythemia. According to my friendly doc, if we don’t clamp the cord immediately, the baby will get too many red blood cells (RBCs), and the influx of cells cause the blood to get sluggish, causing all sorts of problems to the newborn.

    According to my text for my nursing class, polycythemia is the body creating more RBCs due to hypoxia (lack of oxygen). In another place of the text, we are informed that the fetus is in a hypoxic environment inutero, and as a result, the fetal body has elevated levels of erythropoietin (the hormone released by the kidneys to increase RBC production). After birth, the RBCs drop quickly, in response to oxygenation. erythropoietin levels drop in response to oxygen.

    When a baby is born, it takes a while to change from the hypoxic fetal environment, and adjust to an environment where they exchange their own oxygen.


    When the cord is clamped immediately (before the baby is breathing well on it’s own) to prevent polycythemia, we are actually creating a hypoxic post-fetal environment, where the newborn (not the fetus) is creating RBCs to make up for not having enough RBCs. In essence, we are creating the risk of polycythemia.

    Basic physiology tells us the increasing level of carbon dioxide, not lack of oxygen, is what triggers the brain to cause the reflex of breathing. If the supply of oxygen is cut off, we still have to wait for CO2 to build before the brain recognizes the need to breathe.

    This doesn’t begin to touch the subject of persistent fetal circulation – which I think is a result of lack of blood volume due to premature amputation of the placenta.

    Good grief. The baby creates the placenta, it is a part of it’s body, let it decide when it is time to get rid of it, not an outsider.

  3. About time someone finally looked at all this. I can’t believe the rush cord-cutting seems in hospital births. Hopefully eventually this will spread to other countries. Little by little . . .

  4. Pingback: Gloria Lemay » Umbilical Cord Integrity

  5. I always wondered why my 3rd son was bright red for about a week after he was born I have never had a child before or since (10) that colour. He was also my biggest 13lb (looked like a two month old in photos, the only way you can tell he’s not is the umbilical stump was still on him) unassisted homebirth, & fastest delivery 1.5 start of first contraction to catch but he has never been sick fed like a champ (still does) he’s 8yr old now & never had any health problems. Had you ever seen that colour before?

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