Anyone considering delayed cord clamping?

[ppgirlsteph]

I really wanted this but in the end LO's cord had to be cut quickly as he had pooped and they thought he might have inhaled meconium

 

[MissMaternal]

My midwife automatically did delayed cord clamping without me asking,
I had never heard of it before. But after reading a little about it, I am going to request it in my birth plan for this baby x

 

[Jess137]

I'm going to request it and put it in my birth plan but it may not be possible. I'm on medications that may cause her to be a little lazy with breathing initially It's not common practice in the US as far as I know, especially in hospitals. Do you think it has anything to do with the fact that everyone is pushing moms to either bank or donate cord blood?

 

[Amygdala]

I requested it in my birth plan but when the midwive went through that with me, she said that they delay clamping anyway (unless there's an emergency obviously). My LO had a short cord so spent the first few minutes of her life on my lower belly.

 

[Fortune Cooki]

What about the increased risk of jaundice due to delayed clamping? The baby gets more iron but the increased bilirubin can't be processed and causes jaundice.

 

[MindUtopia]

What about the increased risk of jaundice due to delayed clamping? The baby gets more iron but the increased bilirubin can't be processed and causes jaundice.

I was actually reading about this the other day and the current opinion is that the kind of jaundice that is caused by the extra red blood cells breaking down isn't the same kind of jaundice that a baby (or an adult, for that matter) would get from poor liver function. Actually, there is some evidence that the bilirubin actually acts an an antioxidant for the baby in the first few days, pumping up their immune system and dealing with oxidative stress, which is why it seems to occur more often in women/babies following more natural practices, like leaving the cord intact and breastfeeding. Usually when something tends to occur in nature, there's a darn good reason for it. But normal jaundice in newborns (not the severe jaundice caused by baby having a liver problem or being unable to process the bilirubin, which is totally different) isn't usually something to be concerned about and can be treated easily and at home even with lots of skin-to-skin contact and exposure to natural light. There's been a lot of interesting studies done on this. I don't have the links to them now, but if you do some hunting around on the internet, you should come across them.

Also, if your baby needs to be resuscitated for any reason after birth, much of the current thinking now is that it's best to leave the cord intact while this is done right next to the mum. The reason being that babies continue to breathe through the cord until they start breathing on their own through the lungs. Even the first few breaths aren't actually designed to supply oxygen but to help get the lungs ready to work, so by cutting the cord before baby starts breathing, you actually remove their only source of oxygen. My midwife was actually telling me that the early breathing done by babies with intact cords is so different than those whose cords have been cut too early. The ones with intact cords start breathing gently and calmly, while the ones with cords that were cut before they started breathing tend to gasp and cry and breathe really fast at first (because they were deprived of oxygen). She said it's kinda shocking to see the difference and she would always recommend delayed clamping at least until baby is breathing well on his/her own and especially if baby is having any trouble breathing or needs resuscitation. Unfortunately, I think early cord clamping was the standard practice for so long (even though there's no medical evidence it's better) because it's just easier for medical staff. It gets the baby out of the way, usually requires faster delivery of the placenta with synthetic hormones, and gets overworked midwives and doctors out of the room quicker and on to the next case.

 

[MrsWhite]

What about the increased risk of jaundice due to delayed clamping? The baby gets more iron but the increased bilirubin can't be processed and causes jaundice.

I was actually reading about this the other day and the current opinion is that the kind of jaundice that is caused by the extra red blood cells breaking down isn't the same kind of jaundice that a baby (or an adult, for that matter) would get from poor liver function. Actually, there is some evidence that the bilirubin actually acts an an antioxidant for the baby in the first few days, pumping up their immune system and dealing with oxidative stress, which is why it seems to occur more often in women/babies following more natural practices, like leaving the cord intact and breastfeeding. Usually when something tends to occur in nature, there's a darn good reason for it. But normal jaundice in newborns (not the severe jaundice caused by baby having a liver problem or being unable to process the bilirubin, which is totally different) isn't usually something to be concerned about and can be treated easily and at home even with lots of skin-to-skin contact and exposure to natural light. There's been a lot of interesting studies done on this. I don't have the links to them now, but if you do some hunting around on the internet, you should come across them.

Also, if your baby needs to be resuscitated for any reason after birth, much of the current thinking now is that it's best to leave the cord intact while this is done right next to the mum. The reason being that babies continue to breathe through the cord until they start breathing on their own through the lungs. Even the first few breaths aren't actually designed to supply oxygen but to help get the lungs ready to work, so by cutting the cord before baby starts breathing, you actually remove their only source of oxygen. My midwife was actually telling me that the early breathing done by babies with intact cords is so different than those whose cords have been cut too early. The ones with intact cords start breathing gently and calmly, while the ones with cords that were cut before they started breathing tend to gasp and cry and breathe really fast at first (because they were deprived of oxygen). She said it's kinda shocking to see the difference and she would always recommend delayed clamping at least until baby is breathing well on his/her own and especially if baby is having any trouble breathing or needs resuscitation. Unfortunately, I think early cord clamping was the standard practice for so long (even though there's no medical evidence it's better) because it's just easier for medical staff. It gets the baby out of the way, usually requires faster delivery of the placenta with synthetic hormones, and gets overworked midwives and doctors out of the room quicker and on to the next case.

This is a great point. Also, I hear about MOST babies having jaundice. My son had it, my friends kids all had it, my nephew had it. And none of those were natural births and I highly doubt there was delayed cord clamping. I don't really think it's something to really worry too much about, as long as the levels are going down and not up. I think it's just part of it. They make you feel like a bad mother "oh your kid has jaundice, better not breastfeed because that can make it worse", but I don't buy into it.

 

[Fortune Cooki]

I had jaundice too. 'Scared the crap out of my mom, because I guess the doctor and nurses seemed all panicky about it. I was a week early, unless they got the due date wrong, who knows. I can't wait to ask my OB about delayed clamping. Do you think I should ask if they clamp after the placenta is out?

 

[Sam Pearson]

I'm going to request it and put it in my birth plan but it may not be possible. I'm on medications that may cause her to be a little lazy with breathing initially

Wouldn't a baby struggling to breath be a reason not to clamp the cord and cut off it's placental oxygen supply?

 

[Sam Pearson]

Do you think I should ask if they clamp after the placenta is out?

Best practice is to cut the cord only once the placenta has stopped functioning and the umbilical cord has stopped pulsing.

BTW there is a difference between neonatal jaundice (normal and common and a situation that rectifies itself in a short time) and clinical jaundice.

 

[Sam Pearson]

Anecdotal, my hospital born baby who's cord was clamped and cut early had jaundice. My other three babies didn't - one had delayed cord cutting and the other two were lotus births.

https://www.bflrc.com/newman/breastfeeding/jaundice.htm

So called breastmilk jaundice
There is a condition commonly called breastmilk jaundice. No one knows what the cause of breastmilk jaundice is. In order to make this diagnosis, the baby should be at least a week old, though interestingly, many of the babies with breastmilk jaundice also have had exaggerated physiologic jaundice. The baby should be gaining well, with breastfeeding alone, having lots of bowel movements, passing plentiful, clear urine and be generally well (handout #4 Is My Baby Getting Enough Milk?). In such a setting, the baby has what some call breastmilk jaundice, though, on occasion, infections of the urine or an under functioning of the baby's thyroid gland, as well as a few other even rarer illnesses may cause the same picture. Breastmilk jaundice peaks at 10-21 days, but may last for two or three months. Breastmilk jaundice is normal. Rarely, if ever, does breastfeeding need to be discontinued even for a short time. Only very occasionally is any treatment, such as phototherapy, necessary. There is not one bit of evidence that this jaundice causes any problem at all for the baby. Breastfeeding should not be discontinued "in order to make a diagnosis". If the baby is truly doing well on breast only, there is no reason, none, to stop breastfeeding or supplement with a lactation aid, for that matter. The notion that there is something wrong with the baby being jaundiced comes from the assumption that the formula feeding baby is the standard by which we should determine how the breastfed baby should be. This manner of thinking, almost universal amongst health professionals, truly turns logic upside down. Thus, the formula feeding baby is rarely jaundiced after the first week of life, and when he is, there is usually something wrong. Therefore, the baby with so called breastmilk jaundice is a concern and "something must be done". However, in our experience, most exclusively breastfed babies who are perfectly healthy and gaining weight well are still jaundiced at five to six weeks of life and even later. The question, in fact, should be whether or not it is normal not to be jaundiced and is this absence of jaundice something we should worry about? Do not stop breastfeeding for “breastmilk” jaundice.

https://www.ivillage.com/breastfeeding-breastmilk-jaundice/6-n-137282

Jaundice refers to the yellow coloring of the infant's skin that is associated with elevated bilirubin levels in the blood. All babies have slight elevations in bilirubin after birth. This is related to the normal breakdown of extra red blood cells that occurs as the infant adjusts to life outside the womb. High levels of bilirubin are a concern because it can lead to brain damage, but there have been no reports of a baby with breastmilk jaundice developing this dangerous complication. Preemies, more vulnerable to brain damage from high bilirubin, rarely develop serious complications. (Mohrbacher, N. & J. Stock, 1997)
True breastmilk jaundice, also referred to as late onset jaundice, is relatively rare, in the range of 0.5 to 4 percent of births. (Riordan & Auerbach 1999) (Lawrence 1994)
Breastmilk jaundice is defined as serum bilirubin greater than 10 mg/dl in the third week of life, when other organic and functional causes have been ruled out. It is sometimes diagnosed by feeding the baby other milk in addition to, or in place of, breastfeeding to see if the bilirubin level drops. This method of diagnosis is controversial and may not be necessary. (Riordan & Auerbach 1999) Dr. Jack Newman feels that an interruption of breastfeeding to diagnose breastmilk jaundice is "completely unjustified." (Newman & Pitman 2000)

Physiologic or normal jaundice occurs in about one-half of all newborns. Physiologic jaundice causes a peak in bilirubin levels at about three to five days of age. It can be caused by, or aggravated by, an inadequate intake of breastmilk, which is why it is sometimes confused with breastmilk jaundice. A better name for it may be "lack of breastmilk jaundice."
Once reasons for the infant's inadequate intake of breastmilk are corrected, physiologic jaundice is often easily resolved with improved nutrition and other interventions that do not interrupt breastfeeding. Because this type of jaundice is often associated with a less than adequate intake of milk, it is not possible to diagnose breastmilk jaundice until it is established that the baby is feeding well. (Newman & Pitman 2000)
Breastmilk jaundice usually peaks at seven to ten days. This often follows the earlier elevated bilirubin levels associated with physiologic jaundice. According to Dr Lawrence, it is only necessary to discontinue breastfeeding if the bilirubin level rises above 16 mg/dl for more than 24 hours.
According to research as many as 36 percent of babies may have some elevation in bilirubin levels into the third week, yet these babies suffer no ill effects. Some are theorizing that elevated bilirubin may be normal or even have a protective factor that is not yet understood. Typically babies with late onset jaundice are thriving and no interruptions of breastfeeding are necessary in most cases. (Riordan & Auerbach 1999) (Lawrence 1994) (Newman & Pitman 2000)
It is true that breastmilk jaundice tends to repeat in siblings. It is also more common in non-Caucasians. Be sure to discuss your concern with your pediatrician before your baby is born.. Ask how they usually treat jaundice in the breastfed baby and express your desire to avoid formula if at all possible because of the associated risks. You are off to a wonderful start by addressing your concerns and becoming informed early.
References:

Breastfeeding: A Guide for the Medical Professional, Lawrence, R. ,Mosby, New York, 1994, 152-4.
The Breastfeeding Answer Book, Mohrbacher, N. & J. Stock, La Leche League International, Schaumburg, Illinois 226-7, 1997.
Dr. Jack Newman's Guide to Breastfeeding, Newman, J. and T. Pitman, HarperCollins, 130-35, 2000.
Breastfeeding and Human Lactation, Riordan, J. & K. Auerbach, Jones and Bartlett, Boston, 382-89, 1999.

1. Clinical evaluation

Kramer's Rule6


Breast Milk Jaundice

This occurs infrequently, peaks in the 2nd or 3rd week, and may persist at moderately high levels for 3-4 weeks before declining slowly. It is a diagnosis of exclusion. In an otherwise well infant, it is considered a benign condition. If feeding with breast milk is stopped, the serum bilirubin usually falls, however this would very rarely be indicated. The potential harms of stopping breast feeding would outweigh any risks of a mild or moderate hyperbilirubinaemia. The aetiology is unknown, but there is some support for both a hormonal factor in the milk acting on the infant's hepatic metabolism, and an enzyme (lipase) facilitating intestinal absorption of bilirubin.


Rather than estimating the level of jaundice by simply observing the baby's skin colour, one can utilise the cephalocaudal progression of jaundice. Kramer drew attention to the observation that jaundice starts on the head, and extends towards the feet as the level rises. This is useful in deciding whether or not a baby needs to have the SBR measured. Kramer divided the infant into 5 zones, the SBR range associated with progression to the zones is as follows:

Zone 1 2 3 4 5
SBR (umol/L) 100 150 200 250 >250

 

[Kota]

jaundice is a completely NORMAL physilogical process for newborns to go through, it shows that their red blood cells are kicking into gear, and unless quite severe, needs no treatment other then feed and natural light, delaying cord clamping is not going to change this,


Think of it this way, if someone came up to your newborn baby, with a big needle, and said "Excuse me, I'm just going to drain 1/3 of your babies blood supply out of them now" How would you respond?? Because thats how much blood can be sitting in the cord and placenta that is being pumped back around to your baby if the cord is clamped and cut too soon. even 1-2 mins can make a HUGE amount of difference, and tbh, if people started allowing the cord blood to go back into their babies, the amount of T-cells that would re-enter the baby's system, would pretty much cancel out any reason to store and bank blood cells, as they're already in the body.


So yes, Short of the cord ripping/tearing like it did last time, , I'll be leaving that cord attached until after the placenta has been delivered and is completely white and still.

 

[GreyGirl]

We didn't have the cord cut for 1/2 an hour, we just sat in the pool chilling

 

[Jess137]

I'm going to request it and put it in my birth plan but it may not be possible. I'm on medications that may cause her to be a little lazy with breathing initially

Wouldn't a baby struggling to breath be a reason not to clamp the cord and cut off it's placental oxygen supply?

I read about that after I posted Though I don't know if the doctors and nurses will see it that way They're planning on having NICU in the room just in case so I worry they may just cut the cord and take her if she has breathing issues.

 

[MummyToAmberx]

I will be with #3 but sure what happened regarding my girls births though.

 

[jensha]

I'm going to request it and put it in my birth plan but it may not be possible. I'm on medications that may cause her to be a little lazy with breathing initially It's not common practice in the US as far as I know, especially in hospitals. Do you think it has anything to do with the fact that everyone is pushing moms to either bank or donate cord blood?

No, it just has to do with the medical staff wanting to get out of the room as quickly as possible. Sad but unfortunately true.

If your medication causes the baby to be lazy at breathing on her own, it's a damn good reason to delay cord clamping, as baby will need all the oxygen she can get.

 

[jensha]

I'm going to request it and put it in my birth plan but it may not be possible. I'm on medications that may cause her to be a little lazy with breathing initially

Wouldn't a baby struggling to breath be a reason not to clamp the cord and cut off it's placental oxygen supply?

I read about that after I posted Though I don't know if the doctors and nurses will see it that way They're planning on having NICU in the room just in case so I worry they may just cut the cord and take her if she has breathing issues.

You MUST insist. Of course, the medical staff is going to do that because it's what they are trained for. Hire a doula. She can help you regain "your voice" when you're exhausted and vulnerable and the staff is pushy.

 

[Jess137]

I'm going to request it and put it in my birth plan but it may not be possible. I'm on medications that may cause her to be a little lazy with breathing initially

Wouldn't a baby struggling to breath be a reason not to clamp the cord and cut off it's placental oxygen supply?

I read about that after I posted Though I don't know if the doctors and nurses will see it that way They're planning on having NICU in the room just in case so I worry they may just cut the cord and take her if she has breathing issues.

You MUST insist. Of course, the medical staff is going to do that because it's what they are trained for. Hire a doula. She can help you regain "your voice" when you're exhausted and vulnerable and the staff is pushy.

I actually spoke to my ob today. She was very reassuring, I don't think I'll have a problem with the cord cutting, immediate skin to skin, etc. Also neither she nor the other two docs in the office do episiotomies. She says she's only done two her entire career when she just couldn't get the baby out. I'm pretty confident now that it will go how I want.

 

[jensha]

I'm going to request it and put it in my birth plan but it may not be possible. I'm on medications that may cause her to be a little lazy with breathing initially

Wouldn't a baby struggling to breath be a reason not to clamp the cord and cut off it's placental oxygen supply?

I read about that after I posted Though I don't know if the doctors and nurses will see it that way They're planning on having NICU in the room just in case so I worry they may just cut the cord and take her if she has breathing issues.

You MUST insist. Of course, the medical staff is going to do that because it's what they are trained for. Hire a doula. She can help you regain "your voice" when you're exhausted and vulnerable and the staff is pushy.

I actually spoke to my ob today. She was very reassuring, I don't think I'll have a problem with the cord cutting, immediate skin to skin, etc. Also neither she nor the other two docs in the office do episiotomies. She says she's only done two her entire career when she just couldn't get the baby out. I'm pretty confident now that it will go how I want.

That's good news