Article about Delayed Cord Clamping

Good article about why the cord should not be clamped/cut until it stops pulsating after birth.

Excerpt:

"Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial(7)

Randomized 72 VLBW infants (< p =" 0.03)" p ="">

The Influence of the Timing of Cord Clamping on Postnatal Cerebral Oxygenation in Preterm Neonates: A Randomized, Controlled Trial (8)

Randomized 39 preterm infants to immediate clamping vs. 60-90 second delay, and examined fetal brain blood flow and tissue oxygenation. Results showed similar blood flow between groups, but increased tissue oxygenation in the delayed group and 4 and 24 hours after birth.

Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomized controlled trial(9)

Randomized 476 infants to immediate or 2 minute delayed clamping and followed them for 6 months. Delayed clamped babies had higher MCVs (81 vs. 79.5), higher ferritins (50.7 vs. 34.4), and higher total body iron. Effects were greater in infants born to iron deficient mothers. Delayed clamping increased total iron stores by 27-47mg. A follow up study showed that lead exposed infants with delayed clamping also had lower serum lead levels than immediate clamped infants, likely due to iron mediates changes in lead absorption.

A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short-term clinical and laboratory endpoints(10)

Infants delivering at 30 to 36 weeks gestation randomized to immediate vs. 1 minute delay. Delayed group had higher RBC volumes (p = 0.04) and hematocrits (p < p =" 0.03)">

Immediate versus delayed umbilical cord clamping in premature neonates born <>

Randomized 60 infants to clamping at 5-10 seconds vs. 30-45 seconds. Delayed clamping infants had higher BPs and hematocrits. Infants <>

And that’s just some of it. I’ll be happy to send you an Endnote file with a pile more of you’d like it. If the burden of proof is on us to prove that immediate clamping is good, that burden is clearly not met. And furthermore, there is strong evidence that delaying clamping as little as 30 seconds has measurable benefits for the infant, especially in premature babies and babies born to iron deficient mothers.

So basically, we should be doing this. I’m going to try to effect some change in my department, but there are a lot of things that need to happen for us to change as a general culture. It can’t just be the OBs. L and D nurses and pediatricians need to buy in as well.

Some people will argue that premature babies need to be brought to the warmer right away for resucitation. I don’t know the answer to this, but it’s worth study. One might think that it is important to intubate a very premature baby right away, but I have to wonder if that intact cord will be better at delivering oxygen to the baby for 30-60 seconds than the premature lungs. Particularly in cases of fetal respiratory acidosis, there is strong logical argument that a baby might be better resuscitated by unwrapping the cord and letting it flow a bit than trying to oxygenate it through its lungs. Until that placenta is detached, you have a natural ECMO system. Why not use it? Certainly there are exceptions to this logical argument, abruption being the biggest one, and perhaps even severe pre-eclampsia and other poor feto-maternal circulation states.

I wonder at times why delayed cord clamping has not become the standard already; why by and large we have not heeded the literature. 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, which is unfair. It is fair to critique the research and the methods used to write it, but it shouldn’t matter who the author is. In this case, Mercer and other midwives have done the world a favor by scientifically addressing this issue, and their data deserves serious consideration.

To quote Levy et al (12) “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.” We ought to heed this advice better. Like episiotomy, this change in practice may take awhile, but we should get it started. I’m going to work on it myself. How about you?"

Placenta....Not for the Sqeamish of Stomach

I'll warn you...unless you're committed to alternative birthy crunchiness, you might get a little ill over this one. :P I'm trying to spare you, so you can reconsider and not scroll down if you don't wanna. If placentaphagy gacks you out, turn away, dear reader. Laaaa dee da, dootie do: filling up the page so you can click away if you must...
.
.
.
.
.
..
...
.....
.......


No? OK. Here we go.




This weekend, I had several doula friends at my house, and, at my request, we all had some fun with the placenta from Eva's birth (which, until Sunday, had resided in my freezer). Wheeee!
;OP It was actually really cathartic for me to examine it and marvel at the miracle of life, after the whole retained placenta drama. A friend helped me examine it and try to find the spot where the retained piece had been, and then we dehydrated it for encapsulation.

my friend L helps unfold it, while Essie is very interested. She's striking a pose here...silly willy.

Essie's words were, "This is SO. COOL. I'm going to be a midwife or a SURGEON when I grow up, because I'm a *lover* for how the body works!" She asked us over and over to explain the order of how nutrition gets to the baby. Her original theory was that the placenta carried milk directly to baby's tummy, and when she found out that the nutrients and oxygen went from one bloodstream to another, she was over the moon. She asked us to draw us a diagram: mommy to placenta, placenta to cord, cord to baby's belly button.


We first thawed it with lukewarm water...you can see the cord (white) still attached

The water bag membrane was tough and wicked cool, if I do say so myself. :P All that vitamin C payed off, apparently, because it was beautifully flexible but super, super tough. It was so very smooth and supple, the perfect home for a tiny baby in utero. God's seriously smart. That bugger was STRONG. No wonder my water stayed intact until the pushing phase! That's the way mama likes it. ;oP


When it finally thawed and we could unfurl it completely, my friend Jen pointed out small patches of white calcification, on par for a 41 week baby. :O) Baby's side was smooth, while the side that had been attached to the uterine wall was wrinkled, and the wrinkles fit together like a puzzle piece. It was really amazing to see how functional, comfortable and miraculous this temporary organ was for my baby girl...her very first "home".
Jen shows me how the wrinkles line up. It look oddly pale after rinsing, as I'm used to seeing them very red right after birth.

There was literally an odd, small rip on the very edge of mine on the side where the piece had been retained, and it was exactly the length of the piece my midwife retrieved and showed me. Bingo! Little booger. That was the trouble maker. :P There was a bit of strangeness going on at the cord attachment site, AFA how the membranes were attached to it. I need a midwife opinion on that one.

The actual separating of the membrane and the placenta was the trickiest part of the whole deal, really. My friend J did that bit, and I'm forever grateful...it took quite a bit of doing. Then I (forgive the gory detail) chopped it into little chunks and we blended it to a pate consistency witha ridiculously funny shot taken by my Lindsay...placenta bead provided by another sweet, funny friend. Oddball humor abounds.

some ginger (ginger optional ), spread it thinly into dehydrating trays and dehydrated it. I left the dehydrator on 150 or so for probably 12 hours, and probably it would have been safe with less...but we went to bed.

(At this point in the process, I suggest cooking something that smells rather strong, or sticking the dehydrator on the porch. My dh made curry for us that evening, and the scent of the dehydrator was pretty much completely masked. No earthy icky weirdness, unless you just stuck your nose into it. MUCH better than I'd imagined.)

Me and baby Eva...cuter than her "wombmate", eh?

It's broken into dried wafers and stored in my fridge (sorry, dh).

I have some pics of the dehydrated bits for anyone who's interested...in fact I'll go ahead and commit to posted them later. This afternoon, I'll do the actual encapsulation and post that, too. :O) Thanks for looking, and HTH if you're intested in your own dehydration! It's much, much simpler than I'd originally supposed.

Finally, Eva's birth montage

Make an on-line slide show at www.OneTrueMedia.com

The Other Side of the Glass

A new documtary, The Other Side of the Glass. A birth film for fathers, discussing (from daddy's perspective) the effect of modern birth on the family. I'm so excited someone finally picked up that ball and ran with it! :D There appear to be some great interviews, including Micheal Odent. I can't wait to see the whole thing.

Bed commercial...love it!

Miss Eva at a month old!

I'll spare you the details of the three day prelabor...suffice it to say, it was emotionally and physically trying, and had I not gotten enough rest, good positioning advice and encouragement, I might still be in labor. Really. But I did get rest and the baby did turn, and so I went into labor on Sunday evening after a day of hip lunges, dinner with dh and a couple of funny movies.

Around 9:3opm or so, it suddenly hit me that my contractions were actually growing more intense. A few minutes later, Robin Hood Men in Tights ceased to be even a tiny bit amusing.

I gripped the bookcase and swayed my hips through the next contraction, and as it eased, I told Nate to call our midwife and heat my rice sock. Through the next pressure wave, I leaned over the arm of the couch and wished my rice sock were already hot.

I retreated into the candlelit bedroom, and leaned forward through the next half hour of rushes, finally settling on my knees with my arms draped over the bed. I mused inwardly at the fact that I could feel the baby rotating downward through my pelvis, and the back pressure was intense! At that point, I realized I'd reached the point of no return. Ready or not, my baby was coming, and I needed to get to a place of release and surrender. A small amount of hesistation and fear crept in for a short while, and I didn't want to accept that I needed to change my physical position. I'd just stay on my knees forever!!

I was vaguely aware of front door opening down the hall, and of my MW calling hello softly, but I didn't look up. I was lost in a celtic drumbeat for the moment, still convincing myself that I could just hang out at the end of the bed forever.

Somewhere in the middle of half an hour in the draped on the bed position, the song "Everyone's got Something To Hide Except for Me and My Monkey" by the Beatles came on my iPod. Dh snorted and teased me for having such a weird song, and it broke my tension. I heard Michelle, the MW's apprentice giggle, too, and that did it. I laughed, and the endorphins from the fast guitar riffs and laughing with Nate saw me easily through that intense contraction.

After my first and only cervical check of that labor, Debi let me know I wasn't ready for the birth pool yet. Four centimeters. I was incredulous. I could feel my body speeding towards transition, and suspected they should fill the tub soon anyway. She suggested a hot shower (I suspect to coax me off my knees!), and I lept at the chance.

I spent 15 or 20 min in the shower, and being on my feet intensified the contractions. (Nate commented later that in the pics of me in the shower, you could tell by the shape of my belly that the baby descended quickly into my pelvis at that point!) Nate leaned halfway into the shower and braced his arm across the end of it for me to grip, and I squeezed his arm with my hands through the powerful waves, puffing a steady stream of air out of my cheeks. The feel of his sturdy, sinewy arm and the hot water pounding my back made standing up much more bearable. In the back of my mind, I knew I'd be complete soon, and got out of the shower sooner than I would have otherwise...I wanted hot water for my birth tub, lol! I shuffled my way back to the bedroom, and Michelle tied a red rebozo around my belly and encouraged me to stay vertical. It was at this point that I surrendered completely to the idea of meeting my baby soon, to opening my body to let my baby out. I became instinctual, and my thoughts were more like a consciousness hovering above my body than my own. My mind became an observer of my most primal instincts, and only interjected enough dialouge to inform my body on a "need to know" basis. :oP

For the next 45min, I gripped dh's hand and stood and swayed my way through powerful waves. I gripped Nate's fingers so hard, his normally pale strong Dutch knuckles turned an even more ghostly white. At one point, I called out, "Someone hold my other hand!!", and the instant I felt a strong, womanly hand in my own swollen left hand, the edgy fear left me.

I could feel my cervix stretching and quivering, and a voice that didn't sound like my own was making low, moaning sounds. My doula brain informed me that those were very "birthy" noises, and I smiled inwardly as I heard my MW chuckling in happy agreement somewhere across the room. She whispered, "Nate, go start up the hoses!" I suspected as much..and the water sounded GOOD. I was ready to meet my baby. I trembled all over, and stated the obvious: "I'm shaking."

I don't remember taking off my lounge pants. I remember feeling the heat of the water slither up my ankles, calves, and around my middle as I sank myself into the water. It took every ounce of courage I had to relax and accept the knowledge (gained from experience with my second birth) that I would soon be doing the hard work of pushing a new child into the light of the room.

My legs were in a weird position, but another rush had already started, and I heard the earthy voice shift from a low moan to a rumbly growl. Was I feeling push-y already? I gripped the handles of the pool, and fought the impulse to tighten my lower body in a fight against birth. I rested and breathed. I knew I'd be pushing with the next contraction.

I never asked for permission; when the next contraction came, I growled and pushed. As it peaked, I pushed HARDER, because pushing was the only relief that was to be found in that intense moment. I vaguely remember hearing Debi call, "That's it, girl, bring that baby down! Reach down and touch your baby!", but by the time I let go of the handle to feel, the rush was over. It made me mad, and it fueled my determination to hold her soon, lol.

With the next contraction, I felt like a strong mother cougar, throwing a screaming growl into the night, fighting to bring my baby into the world. The feeling was so very intense. I could feel the baby crowning, but didn't dare to believe I could get her out this time. I pushed and growled in frustration, not realizing how CLOSE she was.

I did this for another contraction. And one more.

The next contraction, I was so very exausted, using up every last bit of energy I had in a mighty effort to push that little head OUT. I thought it would be stuck there forever. I stopped screaming and grunted and felt my face glowing with the effort, and finally gasped in air and yelled, "Oh, c'mon, get the frick OUT!!!!" (At least that's what I vaguely recall saying...both Nate and Debi have asserted that I actually dropped an F-bomb)

One last angry, determined push, and I heard the amazing words: "Head's out!!" I perked and happily pushed the rest of a slick body easily into the water, and was astounded at the big, healthy GIRL that landed on the top of my now-puffy belly.

Nate's face was streaming tears. I hadn't seen him cry that freely since our wedding. And she was lovely. So very lovely, and I was completely exhausted. She stared at me, stunned and alert, but not wanting to take the first breath. I felt a bit stunned, too. The MW puffed a breath into her mouth and rubbed her back, and she began to cry. I was relieved, and so, so tired. I had to be coaxed to push out the placenta, lol. I was happy to just sit there, grinned dumbly and blissfully, and listening to Nate mumur contently to himself, "I knew she was a girl!"

At 1:16am, Eva Grace was born, 9lbs, and 22inches. And we were in love. <3