Delayed Cord Clamping
Delayed Cord Clamping
On waiting until the cord stops pulsating. It’s pulsating for a reason.
The problem with cutting the cord while it is still warm and pulsing is that doing so actually deprives the newborn of its own blood, which is still in the cord and the placenta and has not yet finished circulating back into the baby. Up to 40 percent of his blood volume, including platelets and other clotting factors, is lost. Studies have shown that, among other benefits, infants whose cords are not clamped right away have higher iron stores in their blood and are less likely to hemorrhage … Waiting to cut the cord until after it stops pulsing means that the after-birth process has to be slowed down and individualized. This is inconvenient for medical professionals who are rushing to get to the next birth and for hospitals that want to move the birthing women along because they are being reimbursed at a fixed rate for a prescribed amount of time for delivery. – Jennifer Margulis (Your Baby, Your Way)
Considering that a very close friend is pregnant, and that I am currently in Jennifer Margulis’s slipstream, here we are talking about when to clamp the umbilical cord.
It looks like I am putting together a Birthing Series, with this being the fourth item following on these three:
By the way, I cannot recommend Jennifer’s book highly enough. It should be read by all pregnant women (and men) to understand the baby business, a very profitable subsidiary of Cartel Medicine.
Your Baby, Your Way: Taking Charge of your Pregnancy, Childbirth, and Parenting Decisions for a Happier, Healthier Family: Margulis, Jennifer
To truly be an informed “consumer” of medical services you need to read, there is no avoiding it I’m sorry, otherwise Cartel Medicine is the real consumer, and you are the consumed.
How is it that The Whitecoats™ of The Science™ of Cartel Medicine have been denying babies 40% of their blood volume?
Is this for real?
I’ve been wondering, what other two-legged creatures seek to deprive a human of their blood…?
I’ll give you a few seconds to think about it…
It starts with a V…
Vampires.
Anyway, now that I’ve gotten that off my chest, let’s look at a comprehensive Q&A on the subject.
The material I have relied on for this series of Questions and Answers is:
Your baby, Your Way – Jennifer Margulis
Risks and Benefits of Delayed Cord Clamping - New Beginnings Doula Training (trainingdoulas.com)
Baby's Umbilical Cord | 8 Reasons NOT To Cut (bellybelly.com.au)
I also recommend watching all the videos embedded in this stack, especially this first one. They are not very long.
Questions & Answers
Question 1: What is delayed cord clamping, and how does it differ from immediate cord clamping?
Delayed cord clamping is the practice of waiting to clamp and cut the umbilical cord after birth, usually until it stops pulsating or for at least 3-5 minutes (emphasis ideally on stopping pulsating). In contrast, immediate cord clamping involves clamping and cutting the cord within seconds of the baby's birth.
Question 2: According to Dr. David Hutchon, what are the dangers associated with early cord clamping?
Dr. David Hutchon suggests that early cord clamping is harmful to the baby, as it deprives the newborn of its own blood, which is still in the cord and placenta and has not yet finished circulating back into the baby.
Question 3: What movement has gained momentum in the UK regarding the practice of cord clamping?
In the UK, a movement to change the practice of premature cord clamping has gained support from midwives, obstetricians, pediatricians, medical bodies, senior doctors, and the National Childbirth Trust. They are calling for maternity care providers to stop routinely clamping the cord within seconds of the baby's birth.
Question 4: What are the potential risks for newborn babies when they are deprived of 25-33% of their blood volume at birth?
When newborn babies are deprived of 25-33% of their blood volume at birth due to immediate cord clamping, they are at risk of developing iron-deficiency anemia.
Question 5: What percentage of UK toddlers are iron-deficient, and what health problems are associated with iron deficiency in young children worldwide?
About 10% of UK toddlers are iron-deficient. Both iron deficiency and iron deficiency anemia are major public health problems in young children worldwide, as anemia is associated with impaired brain development.
Question 6: What changes did the Royal College of Midwives and the Royal College of Obstetricians make to their guidelines in November 2012 regarding cord clamping?
In November 2012, the Royal College of Midwives and the Royal College of Obstetricians changed their guidelines, recommending delaying clamping of the cord for around three minutes after birth.
Question 7: What role did American obstetrician Dr. Nicholas Fogelson play in the growing movement towards delayed cord clamping?
American obstetrician Dr. Nicholas Fogelson contributed to the growing movement towards delayed cord clamping by writing a blog post entitled "Delayed Cord Clamping Should be Standard Practice in Obstetrics" in 2009 and giving a grand round on the topic, which were viewed by thousands of people.
Question 8: According to Dr. Fogelson, how does immediate cord clamping compare to the natural birth process evolved by mammals?
Dr. Fogelson states that delayed cord clamping is more akin to the natural process of birth that mammals have evolved towards, while immediate cord clamping reduces the amount of blood in the infant in terms of volume, blood cells, and iron content, removing blood that the infant was "destined" to receive.
Dr. Fogelson at Emory believes that antimidwife prejudice on the part of American obstetricians has played a part in continuing a practice that we now know is harmful: “I wonder at times why delayed cord clamping has not become the standard already; why by and large we have not heeded the literature,” he writes. It is sad to say that I believe it is because the champions of this practice have not been doctors, but midwives, and sometimes we are influenced by prejudice. Clearly, midwives and doctors tend to have some different ideas about how labor should be managed, but in the end data is data. We championed evidence-based medicine, but tend to ignore evidence when it comes from the wrong source…” - Your bay, Your Way
Question 9: What is the current practice of active management of the third stage of labour in New Zealand, and what percentage of births follow this practice?
In New Zealand, active management of the third stage of labour, which involves giving the mother an injection of artificial oxytocin, clamping and cutting the baby's umbilical cord within a minute of birth, and pulling the cord to help deliver the placenta, is the norm in the vast majority of births. In 2011, active management was used in at least 90% of vaginal births in National Women's Hospital and 70.6% of births included in the Midwifery and Maternity Providers Organisation (MMPO) statistics.
Question 10: Is there evidence to support a relationship between delayed cord clamping and increased maternal postpartum hemorrhage?
There is no evidence to support a relationship between cord clamping time (independent of other active management techniques) and postpartum hemorrhage.
Question 11: What does the research say about the relationship between delayed cord clamping and the occurrence of hyperbilirubinemia (jaundice) in newborns?
Research has shown that there is no evidence to support the relationship between delayed cord clamping and hyperbilirubinemia (jaundice) in newborns. In fact, delayed cord clamping did not result in polycythemia or hyperbilirubinemia requiring phototherapy.
Question 12: How can delayed cord clamping potentially impact the resuscitation of babies who require immediate medical attention after birth?
In cases where babies require resuscitation, current practice is to clamp the cord immediately and transfer the baby. However, there is increasing opinion and evidence that maintaining placental circulation in these babies will aid recovery, and initiation of resuscitation is possible at the mother's side without clamping the cord.
Question 13: What effect does delayed cord clamping have on the volume of cord blood collected for stem cell banking?
Delayed cord clamping results in much smaller volumes for cord blood collection, and after a physiological transition, there is rarely sufficient blood for stem cell banking.
Moreover, the lucrative industry of banking cord blood, where parents are charged more than a thousand dollars to store their baby’s cord blood in case it is needed later to generate stem cells to fight disease, would be impossible if we let the newborns keep the blood they need to live and thrive.
“Obtaining cord blood for future autologous transplantation of stem cells needs early clamping and seems to conflict with the infant’s best interest,” writes one researcher who reviewed the current data. “Although a tailored approach is required in the case of cord clamping, the balance of available data suggests that delayed cord clamping should be the method of choice.” - Your Bay, Your Way
Question 14: What are the current World Health Organization (WHO) recommendations regarding cord clamping practices?
Current World Health Organization (WHO) recommendations are to delay cord clamping, as it is no longer considered best practice to clamp the cord immediately.
Question 15: How are mothers involved in the movement to make delayed cord clamping a routine practice?
Mothers are involved in the movement to make delayed cord clamping a routine practice by seeking information from evidence-based websites that discuss the advantages of not interfering with the natural process immediately after birth. There are websites dedicated to this issue, and the demand for change is growing.
Question 16: According to Dr. Rachel Reed, what are some of the benefits of delayed cord clamping for the baby?
According to Dr. Rachel Reed, delayed cord clamping allows fetal blood from the placenta to transfer back into the baby, resulting in higher birth weights, early hemoglobin concentration, and increased iron reserves 6 months after birth in healthy term infants. It also increases the baby's circulating blood volume and provides the extra blood volume needed for effective lung function.
Question 17: How does delayed cord clamping help the baby transition to breathing independently after birth?
Delayed cord clamping helps the baby transition to breathing independently by providing the extra blood volume needed for the heart to direct 50% of its output to the lungs, filling the capillaries in the lungs and allowing them to expand. This aids in the clearance of lung fluid from the alveoli, enabling the baby to breathe effectively.
Question 18: What impact does even a 30-second delay in cord clamping have on the amount of blood transfused back into the baby, according to Dr. Nicholas Fogelson?
According to Dr. Nicholas Fogelson, even a 30-second delay in cord clamping can result in 20-40 ml of blood being transfused back into the baby.
Question 19: How does delayed cord clamping affect the rates of intraventricular hemorrhage and necrotizing enterocolitis in preterm babies?
Delayed cord clamping is associated with decreased rates of intraventricular hemorrhage and necrotizing enterocolitis in preterm babies.
Question 20: How does delayed cord clamping impact the iron levels in babies several months after birth?
Babies who have experienced delayed cord clamping have higher iron levels 7 months after birth compared to those who had immediate cord clamping.
Question 21: What are some of the concerns healthcare providers may have regarding delayed cord clamping, particularly in cases where the baby needs immediate resuscitation?
Some concerns healthcare providers may have regarding delayed cord clamping include the belief that the baby needs resuscitation in a clean area away from parents, that a compromised baby might need external support to make the transition, and that the resuscitation area may be attached to the wall, making delayed clamping impractical.
Question 22: What is the difference in mean ferritin concentration and prevalence of iron deficiency between infants subjected to delayed cord clamping and those with immediate cord clamping?
Infants subjected to delayed cord clamping had a 45% higher mean ferritin concentration (117 μg/L vs. 81 μg/L) and a lower prevalence of iron deficiency (0.6% vs. 5.7%) compared to those with immediate cord clamping.
Question 23: How does delayed cord clamping impact infant hemoglobin levels at 2-3 months of age, particularly when mothers are anemic?
Two out of four studies from developing countries found a significant difference in infant hemoglobin levels at 2-3 months of age in favor of delayed cord clamping. This difference was more pronounced when mothers were anemic.
Question 24: What is the difference in mean birthweight between babies with late cord clamping compared to those with early cord clamping?
Babies with late cord clamping had a significantly higher mean birthweight (101 g increase) compared to those with early cord clamping.
Question 25: How does delayed cord clamping reduce the risk of intraventricular hemorrhage and late-onset sepsis in newborns?
Significant differences were found between the immediate cord clamping (ICC) and delayed cord clamping (DCC) groups in the rates of intraventricular hemorrhage (IVH) and late-onset sepsis (LOS), with lower rates observed in the DCC group.
Question 26: What is the association between delayed cord clamping and the need for fewer transfusions in babies?
Delayed cord clamping is associated with fewer transfusions for anemia or low blood pressure in babies compared to early clamping.
Question 27: How does the umbilical cord serve as a source of oxygen for the baby immediately after birth, and why is this important?
The umbilical cord continues to provide oxygen to the baby while it is still attached, which is particularly important for babies who need help breathing. This explains how water-birthed babies can breathe while underwater until they are exposed to air, which stimulates the breathing reflex.
Question 28: Why is skin-to-skin contact between mother and baby immediately after birth more important than cutting the umbilical cord?
Skin-to-skin contact between mother and baby immediately after birth is crucial for bonding and attachment. This special moment should be as immediate and undisturbed as possible, without the interference of cord cutting, unless there is a medical emergency.
Question 29: What is the minimum amount of time recommended for delaying cord clamping, and what factors influence the decision to cut the cord?
The minimum amount of time recommended for delaying cord clamping is two minutes, but most parents prefer to wait until the cord has stopped pulsating, indicating that the placenta has completed its job of transferring blood to the baby.
Question 30: What is a lotus birth, and how do parents who choose this option manage the attached placenta?
A lotus birth is when parents choose to leave the placenta attached to the baby and allow it to detach naturally on its own. Parents who opt for a lotus birth often make or purchase specialized placenta bags and sprinkle herbs and flowers (like lavender) on the placenta to prevent any odor.
Question 31: According to the latest Cochrane Database review, what impact does delayed cord clamping have on maternal outcomes, such as the risk of postpartum hemorrhage?
The latest Cochrane Database review from 2013, which analyzed 15 trials, found no significant differences between early and late cord clamping groups in terms of severe postpartum hemorrhage, postpartum hemorrhage of 500 mL or more, mean blood loss, or maternal hemoglobin values.
Lastly, here are some bullet points on the subject from the work of Hilary Butler and David Hutchon (thank you George).
Why Immediate cord clamping must cease. (whale.to)
Cord clamping at birth (hutchon.net)
Many physiology and medical textbooks incorrectly include cord clamping as part of the normal physiological transition at birth. A true physiological description cannot include this outside intervention.
Immediate cord clamping deprives the infant of 20-40 ml/kg of blood volume and 60% of red blood cells that should transfer from the placenta after birth. This is equivalent to a major hemorrhage.
There is no scientific rationale for immediate cord clamping. It only became common as obstetrics considered itself more "advanced".
Immediate cord clamping can lead to anemia, hypovolemia, hypotension, ischemia, shock, respiratory distress and other complications in the newborn.
Cord blood banking requires immediate clamping to harvest the baby's stem cell-rich placental blood as a future "investment", but deprives the baby of this blood at birth.
The baby's own stem cells transfer from the placenta to the baby at birth and are needed for normal development. Immediate clamping prevents this transfer.
Stem cells continue to be provided to the breastfed infant through breastmilk. Breastmilk also contains HAMLET, a substance that destroys cancer cells.
Cases of cerebral palsy and autism treated with the child's own banked cord blood may have actually been caused by the immediate cord clamping done to harvest that blood.
Dr. Morley considers autism and cerebral palsy to potentially be a result of brain damage from immediate cord clamping.
Some obstetricians like Dr. Hutchon and Dr. Morley advocate for stopping immediate cord clamping, calling it harmful and unnecessary.
To prevent damage, the infant must receive the full blood volume and stem cells from the placenta at birth. This is the baby's "first stem cell transplant".
The clinical debate should not be how long to delay clamping, but to not clamp at all until the cord is white, hard and empty - the physiological norm.
Cord blood is portrayed as "medical waste" to convince parents to bank it, when in fact it is highly valuable to the newborn and an integral part of normal development.
Stories of cord blood being used to treat problems may leave out the fact that immediate clamping, which was required to collect that blood, may have caused the problem in the first place by depriving the infant of stem cells and blood volume at birth.
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The birth event - one of two most important transitions in the human life - continues to be completely neglected and abused by the medical community. A lot has changed during the last 60 years or so, all owing to the hippie revolution which refocused the attention of career human beings. Many positive trends have surfaced, many medical professionals have started to see more than they had been taught in their schools. This is on the upside. In the European/post-European countries, at least, which we can see from the books published and available now.
The attitude of medical personnel to the birth event is a good example of why they should never be trusted. I purposefully overexaggerate this issue here - because the way the birth is experienced will determine the whole life of the new human being.
All sounds, lights, touches, voices, random interactions, breathing patterns heard, rushing or peaceful pace, everything is a new experience for the new human being. “New” like we don’t know how new. What we perceive as “new” is merely a quick adjustment and adaptation facilitated by enormous experience and knowledge accumulated within us. For the new human being, everything is a completely new universe in itself. He/she has never before heard the sound of air flowing around his/her body. Friction (and the associated resistance, strength, pressure, flexibility, elasticity, texture, changes over time and more) - our full-time companion throughout our life - has never been experienced in the womb.
Soundscape is an altogether different world, the only one to which the new human being was slightly introduced in his/her almost soundproof environment. But this was nothing, because there are no reference tables relating 9-month-long 24/7 external sound patterns to that deafening, untamed patchwork of unknown sounds coming from 360 degrees and constantly changing in time, amplitude, sound pressure, direction and color.
To add to the complexity of the experience, the baseline background sounds of the bodily systems in the mother-child ecosystem are completely gone. The new human being has come into this “world” at the expense of the permanent loss of the only sound environment he/she has always known. This is crucial, because hearing is the only sense which we cannot regulate, adjust or switch on/off at will. Hearing and sounds are the keys to the harmony or chaos in our life - everything is secondary.
Unfortunately, we are not aware of it even for ourselves. The experience of the new human being, both within the womb, and on transitioning between the two worlds - we simply have no idea what it is like. The only way to “touch” this experience is through acute intuition and awareness. And the problem is that both intuition and awareness are contaminated in different ways in different people. We call it “bias” or prejudice - but it really means that we are organically unable to remove ourselves from experiencing new phenomena.
The birth of a new human being is such a new phenomenon. If we are present in it, the whole event is prone to causing lifelong ripples due to our un-awareness and the mass glaciers of knowledge, “good” advice, habits, books and stupid references which “adult” people make to conception, pregnancy, and mother-child-birth.
In this context, the umbilical cord handling is merely one aspect of the new life. It is of immense significance, but its true value is appreciated only when the whole transition event is considered as oneness. Our (“western”) medical community is simply not ready for this attitude. Too much ego, too much money, too much power games, too much “I” and “me” in doctors, nurses and everybody else who feels “privileged” to be part of the medical community.
A lot of work is ahead.
By the way, it is possible to recover the birth and pre-birth experience from the depths of the adult mind. The stories told then are amazing proofs that we (adults) know really nothing about the complexity and simplicity of our own life. The most fun part is when you are asking your mother about the birth moment, relating what happened there or describing the faces you saw in the first minutes of your life here.
It is not coincidental that my research into the boondoggle of vaccination was initially informed by my early research into childbirth before the birth of my first child. It became very obvious early on that the practice of birth in western medicine was completely ignorant and uninformed. It was my first eye opener. Fortunately, we had access to midwives and were able to avoid the vast majority of issues (although they really pushed ultrasounds, probably for liability reasons, and we managed to minimize those as well).
It wasn't until years later one of my vaccine research friends sent me a short word document explaining the physiology of birth and the effect of the blood flow after birth.
I quickly browsed through the videos and documents above and one point that I personally wasn't aware of that I rarely find anywhere mentioned is that the baby's heart changes from an effectively 2 compartment heart to a fully functioning four-chambered heart. Part of this includes new blood flows of which the cord blood plays a part.
It seems over the decades, the practice of medicine has converted from that of understanding physiology to following simplified rules without any underlying knowledge of what is actually going on. Only that can explain what can only be described as butchered medical practice.