umbilicalTsukasa

Who Cut The Cord?! A Fading Practice

At some point in the last 9 years, most of us have had our minds blown open by a TED talk.  That platform for speakers presenting bound-to-be viral “ideas worth spreading”. Well, most speakers share inspiring stories about shifting paradigms in their fields after stumbling onto practices that they believe were out-dated. They know that highlighting this one big idea could change the world. Or at least the part of the world they are tasked to serve.

I asked myself, are there any innovative ideas worth spreading that will optimize the experience of childbirth for women and babies everywhere?

 

Yes. Plenty.

 

I see common practices in childbirth still awkwardly persist, despite studies and plenty of experience indicating that they are more disruptive than beneficial to the process of a woman giving birth — or to the health and well-being of her newborn baby.

 

We have professional bodies that help classify, regulate, and introduce new techniques and technology that guide our whole pregnancy and birth path. However, there is enough evidence to prove some of these old recommended practices out-moded at best, and harmful at worst. Now, I question whether we are effectively clearing out these routines fast enough.

 

The aim should always be the most optimal outcomes for those that matter the most: new mothers and our babies.

 

When some routine is obsolete, let’s try to see it gone.

 

My first complete experience with birth came with my first daughter. She was spontaneously born at home with no birth attendants. Contrary to the most common narrative about birth, this felt like a very profound, yet involuntary occurrence. This got me very curious about anything and everything to do with childbirth physiology.

 

I had a basic question: How much did we know about a woman’s body in labor back when many birth practices were standardized in clinics? What were those standards based on?

 

Those are two questions. This is how it works, one question leads to a thousand more.

 

Naturally, I did not expect my own birth experience to be the same for everyone, however I needed to understand why my experience could be possible at all. Across the spectrum new parents have similar questions pop up as they reflect on those critical or serene moments bringing their new baby into the world.

 

We all somehow become research machines.

With today’s standard of a normal amount of preparation for this big moment, I had learned quite a lot about what my body was capable of doing in the broader scheme. However, there were some details that were simply left as unquestioned assumptions about what happens when a baby is born.

 

I would like to bring to our attention to one idea worth spreading: Delay umbilical cord clamping!

 

At the time, I would not even entertain the possibility of using any sharp object to sever a part of my or my newborn’s body (or anything in between). I held a latent belief that the ability to use a surgical tool for this critical procedure was a key role that a health care professional served.

 

“Who cut the cord?!” was one of the most frequent questions I got from many people after they had learned of my first birth experience. The prominence of this question makes complete sense in the context of any popular narrative I’ve heard or seen in films about birth. This one act of cutting the cord is played out as a time sensitive, albeit sentimental, urgency.

 

Is it really that urgent?

 

What we know today about cutting the umbilical cord.

 

One resource that opened up a new line of curiosity for me was a [http://www.youtube.com/watch?v=cX-zD8jKne0] talk given by a professor of obstetrics and gynaecology, Nicholas Fogelson, discussing the physiologic and clinical impacts of delayed umbilical cord clamping in human birth. Essentially he documented the benefit to the newborn’s health of keeping the umbilical-placenta connection intact for a minimum of 2 minutes after the birth of the child. He went on to discuss the further benefits the longer the cord was left unclamped.

 

I shared my interest in delaying the clamping of the umbilical cord with my midwife in Germany and was delighted to learn that this was a practice that she had already employed with the women she supports.

 

Many more question were popping up, but I couldn’t find or consume conferences on each.

 

I was in a new country where prenatal advice in English was a challenge to come by. As expectant parents we try to find experts that we trust and resonate with. This need is not always fully met locally. I would have loved access to some of the midwives, doctors, and other childbirth experts I came across online or in books.  I was always in search of reliable evidence-based information in one place.

 

This generation of expectant parents are products of the internet age. We are pretty accustomed to getting much more information than we can even process. And during pregnancy, it’s often frankly just too overwhelming to pull our heads around where we should place our focus. Unfortunately, this is also sometimes the case with professionals that serve us during our pregnancy. If a health care provider hasn’t stumbled across that conference presenting the latest research on a topic, as clients or patients, we are sometimes bringing these developments to their attention for the first time.

 

HHC Fan Final_

 

For this reason I was thrilled to come across Happy Healthy Child, a holistic childbirth education series produced by Sarah Kamrath. The video series is one of the best resources I’ve come across for childbirth preparation, so I highly recommend it to all of the couples I consult. It is intended for women and their partners to better inform themselves about the many important practices and procedures they are most likely going to have to make decisions about before, during, and after the birth of their child. The series is also used by healthcare professionals to guide their own clients. It features over 30 childbirth experts including obstetricians, midwives, family physicians, and doulas using very accessible language to help the lay mother and father-to-be really understand the pros and cons of these major decisions.

 

Umbilical cord clamping is one topic beautifully and clearly illustrated in the series by a range of childbirth experts and authors including Christiane Northrup, Debra Pascali Bonaro, Sarah Buckley, Robert Biter, Paul Crane, and Stuart Fischbein.  This series is full of evidenced-based ideas worth spreading.

 

 

7 Things everyone will know more about cord clamping by 2020

 

 

1) Low Risk, High Benefits

There were two medical concerns that have helped cord clamping practice persist: risk of baby developing jaundice and haemorrhaging in the mother.

We now understand there is no evidence of risk of haemorrhaging in the new mother due to early cord clamping. But what do we know about jaundice developing in the newborn?

Many childbirth experts have come to understand that some forms of jaundice can be benign and potentially beneficial to a baby’s primal health.  Obstetrician Sarah Buckley, MD explains that “jaundice is almost certain when a baby gets his or her full quota of blood, and is caused by the breakdown of the normal excess of blood to produce bilirubin, the pigment that causes the yellow appearance of a jaundiced baby. There is, however, no evidence of adverse effects from this mild jaundice. In fact, jaundice, which is present in almost all human infants to some extent, and which is often prolonged by breastfeeding, may be beneficial because of its powerful anti-oxidant properties.”

 

Penny Simpkins a long time household name in the world of childbirth explains that “it was commonly believed that the increase in red blood cells from the remaining placental blood would break down and cause so much bilirubin that the baby would develop jaundice. But the studies, especially by Hutton in her systematic review has shown us that although bilirubin levels are somewhat higher, they do not reach clinical jaundice levels.” Other clinical studies conclude that these levels appear to be benign.

 

More health care providers will be able to inform new mothers and fathers based on evidence that allowing the umbilical cord to remain intact for at least the minimum recommended time of 1 minute after the delivery of the newborn. However, more and more healthcare providers will shift to practicing the option with more critical overall benefits. They will choose to allow for the cord to stop pulsating before clamping.

If phototherapy treatment for jaundice (which notably can also be caused by other factors) is ever necessary, it will be readily available either at home or in birth clinics.

The known benefits of this placental blood transfusion back into the baby’s body will be widely accepted as valuable from a primal and wider public health perspective.

 

2) Baby’s Organs are Dormant and Need Blood

While the baby is in-utero, most of their functions are being taken care of by their mother’s organs.  All the blood vessels in the baby’s organs are dormant until the baby is born, so they need all of the extra blood from the placenta to gradually fill up all the vessels throughout the baby’s body, which starts immediately after birth.

 

3) Baby’s Second Life Line

The connection to the placenta gives the baby a second source of oxygen before their lungs get accustomed to breathing room air. Cutting the umbilical cord prematurely while it’s still pulsating may force the baby’s dormant organs into a mode where they need to function before blood enters all of their organ vessels. Clamping takes away this second back-up option that the placental blood still supplies.

 

4) Placenta Contains Richest Blood

The blood in the placenta provides the equivalent amount of iron and other nutrients as 1 month of breastfeeding. Not clamping the cord immediately after birth can naturally help prevent anaemia or other deficiencies.

5) Blood Belongs in the Baby

Pediatrician Sarah Buckley and Penny Simpkins highlight that the average baby’s blood volume is approximately 300-350 ml at birth and the extra blood in the placenta can provide about 100ml more.

 

In the womb, the blood in the baby’s body is constantly in transit moving towards the placenta for oxygen and other nutrients, then it re-enters the baby’s body. When the baby is born, some of it’s blood supply is still in the placenta, so basically you want to wait until the blood transit slows down and the umbilical cord stops pulsating in order to be sure that the baby has gotten its full blood supply back and circulating in its body. It needs this to fill up all of it’s vital organs.

This is probably why we refer to it as “The Baby’s Placenta”.

Imagine how disoriented or weak adults feel after donating blood. Our systems rely on full volumes of blood to feel stabilized, so we can only imagine that allowing the full volume to re-enter the baby’s body creates a balance.

6) Protecting Baby’s Stem Cells

The blood in the placenta is rich in haematopoietic stem cells, that transform into all the different cell types required by the newborn. We still don’t fully understand the effects of depriving the baby of this early stem cell supply.

Parents-to-be will be made aware of their newborn’s right to its full blood supply and the placenta, when possible. The question of when the life of a child begins is the topic of a familiar ethical debate. Premature cord clamping procedures introduce similar questions. Is the baby’s placenta an extension of it’s body, a unique organ it shares with it’s mother? The blood within that organ supports the baby’s vitality during this primal period — and it’s unknown to which extent thereafter. When the umbilical cord is prematurely cut, and the placenta is discarded as medical waste, the question will arise whether this is not the property of the baby itself? Giving over this blood to banks for future treatments that may or may not have been made unnecessary in the wider population by routinely allowing each newborn it’s full blood supply will likely be something more rigorously considered.

I expect typical health care providers will respond similarly to how Swiss midwife Maike Hofstede consults her clients:

“I tell them that it is a beautiful idea to donate blood for research and for curing other children and I can understand why people consider it. There are other important facts to know, for instance that the probability of the stem cells being used to cure someone isn’t very high, and that the success rate of a stem cells therapy is not as high as we would like it to be, so maybe the benefit-cost ratio of this whole procedure shows us that it may not be worth it.

 

Then I encourage them to think about a scenario where no one touches the cord, the blood goes to the baby, and so do the stem cells in that blood. The baby’s body will redirect those cells to where they are needed at that moment, for that precise baby. We don’t know at this time what difference it makes for a baby to get or not get those stem cells at birth. Will that have an influence on the likelihood of an illness — one of those that may develop later on in his life we then attempt to cure with stem cells? And what about all the other elements we find in cord blood? The baby gets antibodies, iron, oxygen, nutrients, and more.”

 

 

7) Promotes Mother-Baby Bonding 

Those days are fading when we see images of newborns being rushed away from their mother before she has the chance to smell and greet her newborn. We find it odd to hear that a room full of healthy babies are waiting behind glass to be held by their mothers for the first time. Even today we’re becoming accustomed to seeing newborns nested in their mother’s breast in those precious moments after birth. Images and records we have documenting the old routine of hurriedly taking baby away from the mother to perform routine procedures on them immediately after birth provoke some concern. Standard routines like bathing, dressing, placing babies in separate nurseries, or for injecting routine medications — are more frequently opted out of by informed parents. These were all cultural practices that would make immediate cord clamping necessary.

Not severing the cord can ensure that a new mother can keep the baby on her skin and breasts for as long as possible following baby’s arrival. This is also very beneficial for bonding and transfer of the mother’s health-inducing micro-organisms directly to the baby through skin-to-skin contact.

There are additional benefits to not washing or scrubbing off the newborn. The World Health Organization already recommends leaving vernix, that white creamy film, on the skin after birth. We now know that vernix provides protections for the baby which include balancing moisture in baby’s skin, helping baby adapt to new environment outside of the womb, it has anti-infective, thermal regulating,  antioxidant, wound healing, and skin cleansing properties.

The scent of the baby is also an important trigger for the release of one of a mother’s bonding hormones, oxytocin, which also promotes the natural release of the placenta through post-partum contractions.

If for any reason the cord has to be cut, then we will try to maintain immediate contact with the mother’s body. The microorganisms present on the mom’s body immediately after birth is also going to be the baby’s most familiar bacterial environment. At home these are plentiful and will be a more familiar environment for the baby to adapt to. In hospital environments it will be even more important to have exposure to the mother’s protective microbiome, especially if the baby wasn’t able to get the full blood supply from the placenta. This contact will help cultivate the baby’s gut flora and protect it from harmful foreign bacteria. Prematurely cutting the cord will really only be the case in an emergency.

 

Enough evidence is there for these changes to be more widely practiced today. If you’re considering any of these decisions before the future trends set in, and you’re having challenges discussing whether or not these are appropriate for you, these points may help guide you.

In my capacity as a dedicated birth companion, or doula, it’s very common to point pregnant women and their partners to reliable evidence-based resources. I have found the Happy Healthy Child series to be one of the most comprehensive sources of up-to-date guidance made easily accessible to any mother or father-to-be. I have become a partner of the series in order to make this informed approach to childbirth more widely available.

 

Essentially this series highlights the most important ideas worth spreading about childbirth practice today. The hope of the series is to guide us all towards a more positive experience of birth, because sometimes it’s just a matter of knowing our choices.

 

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For a FREE three part video series on this and other important topics you want to be informed about as you go through your pregnancy, click here: Happy Healthy Child