Cord Clamping Question

[Elucida]

Hello!

I'm planning a homebirth for this baby and am very, very passionate about delayed cord clamping.

I'm going for an all natural approach but would like help with delivering the placenta. My question is, if I accept the injection does this affect cord clamping at all? Am I better to delay the injection until the cord has been clamped?

I know that I had the injection as soon as my daughter's head was delivered but they clamped straight away (how I wish I had known back then, it caused so many unnecessary problems ) so I'm not sure what the official line on this is?

Thanks!

 

[freckleonear]

In the UK midwives usually prefer to give Syntometrine after the cord is clamped due to theoretical concern that the induced contractions could cause an overtransfusion in blood leading to polycythaemia. On the other hand, an American reviewers suggested that uterotonics could speed up the effects of placental transfusion during delayed cord clamping, but it hasn't really been studied. Most women choose to delay the injection or try a physiological third stage for a while with the option of having the injection later if needed. Just out of interest, what kind of problems do you think early cord clamping caused with M?

 

[stardust599]

I have heard that once the injection is given many MW's and Drs will insist on clamping the cord.

I have on my birth plan that the injection is not to be given and I want delayed cord clamping. I will try a natural third stage while having skin to skin/breastfeeding but if the cord is done I will ask them to clamp and cut it and give me the injection xx

 

[Sam Pearson]

I'm going for an all natural approach but would like help with delivering the placenta.!

Why if you want all natural would you want an injection to deliver the placenta? The best thing is to let nature take it's course and if you feel the placenta is taking too long to be birthed there are many natural things you can do to help it along, standing up, using the loo and feeding your baby are all helpful for moving a placenta along as it causes the uterus to contract thereby sheering off the placenta from the uterine wall freeing it to be birthed. Uteruses generally don't need any interference to expel placentas and there are dangers to receiving the injection that you might want to investigate before deciding.

Here are some of the side effects of the injection as listed in the manufacturers insert:
Nausea and vomiting
Abdominal pain
Headache
Dizziness
Skin rashes
High blood pressure (hypertension)
Abnormal heart beats (arrhythmias)
Chest pain
Fall in blood pressure (causing dizziness, lightheadedness, feeling faint)
Difficulty in breathing
Shock (blood pressure too low to maintain blood supply to the tissues)

 

[amjon]

I talked to the new OB today. I asked about not getting Oxytocin. He was very reluctant, but said it could be delayed if wanted. He said it's mainly for bleeding and not placenta delivery and wouldn't want to risk too much bleeding, so I think I may go with it after a few minutes. He also said a new study showed babies do best with pushing blood from the placenta into the baby four times and then clamping, so we will likely do that. He said delaying until pulsing stops gives the baby too much blood and they have problems from it.

 

[Sam Pearson]

Obviously, the decision is up to you and nobody else, not even your Ob

I talked to the new OB today. I asked about not getting Oxytocin.

Your body will be providing you with oxytocin naturally - both in late pregnancy, labour and afterwards. b If you have birthed your baby naturally that would suggest that your body is producing oxytocin adequately.

He was very reluctant, but said it could be delayed if wanted. He said it's mainly for bleeding and not placenta delivery and wouldn't want to risk too much bleeding, so I think I may go with it after a few minutes.

What reason does he hve to expect unusual bleeding? I believe it's always best to only medically treat a medical issue and so long as you aren't bleeding more than expected there is no medical basis for accepting an injection.

He also said a new study showed babies do best with pushing blood from the placenta into the baby four times and then clamping, so we will likely do that.

Stripping the cord is better than simply clamping and cutting soon after birth but is not as beneficial as delayed cord clamping.

He said delaying until pulsing stops gives the baby too much blood and they have problems from it.

What problems exactly? Did he provide you with any medical evidence to prove this? Nature rarely makes mistakes like this and primates and tribal peoples never rush to cut the cord. I find it highly unlikly to be the case since 100% of the babies I know of who have experienced delayed cord clamping and Lotus Births have not encountered any medical issues as a result. But anacdotal evidence isn't the same as medical evidence.

If you have a look at this talk (links below) you can hear explained referenced evidence that this is a common misperception for birth professionals to hold. The doctor in that talk is looking at a variety of studies and explains them very clearly so that anybody can understand and he explains that not only does the baby come to no harm from DCC but it benefits. You can also go to Academic Ob/Gyn Org to find more information that backs up the benefits of DCC. You might like to show this lectre to your Ob and see what his response is.

https://www.youtube.com/watch?v=cX-zD8jKne0

https://www.youtube.com/watch?v=YDLywaBTd-o&feature=related

https://www.youtube.com/watch?v=SYhWzAjjRu8&feature=related

https://www.youtube.com/watch?v=t5CelB63QR8&feature=related

 

[Cjackord]

thanks for the research! great info!

 

[flubdub]

I refused the infection this time - it makes me ill beyond belief! I was told that they like to cut the cord as soon as possible after the injection, to stop it travelling through the cord and into the baby.
My placenta was a b*tch to get out which was a shock as with my first two, I had the injection and it was out in a minute or two! It took exactly an hour with a lot of pushing. MW said that if it goes on longer than an hour, they insist on the injection as your risk of hemorrhaging increases. Sam Pearson probably kows more about that than me though.

Still, I would never have the injection again. Horrible, horrible thing.

 

[flubdub]

He said delaying until pulsing stops gives the baby too much blood and they have problems from it.

What the hell?? It has quite the opposie effect. Babies whos cords WERE clamped, often are having a third of their blood supply cut off.

This is a great read;

www.erinmidwife.com/2011/05/30/omg-you-did-not-just-clamp-out-a-third-of-my-babys-blood-supply/

 

[lilacmonkey87]

Im currently studying to become an antenatal tutor. I have found that the vessels in the cord close on their own after the transfusion...when i had my son at home last march, i had the injection but this was after the cord stopped pulsating and had been cut, my son was being helped with his breathing with an ambubag and i was panicking that much that i wasnt giving a second thought to the placenta, i had the injection to hurry things along so i could follow my son in the ambulance to SCBU. i think with something like this...a wait and see approach might be more appropriate. if you are struggling to birth the placenta on your own then think about having the injection. but please do keep in mind that an actively managed 3rd stage carries risks:

hypovolemia: the baby receives a reduced amount of blood and in some cases this can cause problems. For example, the incidence of anemia is higher in babies who had active management of the third stage, in particular premature babies

uterine prolapse: because of the traction used on the umbilical cord during an actively managed third stage, excessive traction used before the placenta has come away from the uterine wall can cause the uterus to prolapse and come down, sometimes into the vagina

breaking of the umbilical cord: the cord can snap, leading to a retained placenta. This is particularly a problem when the cord is unusually attached such as a velamentous insertion

retained placenta.

With an actively managed 3rd stage the midwife will aim to have the placenta out within 6 minutes, this is because the cervix can begin to close after that time with the injection. with an expectant birthing of the placenta it is up to 2 hours. Providing that your labour hormones arent being inhibited for any reason there is no reason why you cant birth the placenta on your own, with out interference.

HTH

 

[Elucida]

Argh, OK... I clearly need to go away and have a think and do some reading. Honestly, pph scares me more than anything else about labour and I have a tendency to obsess and become anxious about health issues.

I hope that I can find some empowering, informative reading or this might just ruin my plans for a homebirth. I totally plan to delay cord clamping, no matter what, but if I'm going to start freaking out it will ruin the whole labour.

 

[Elucida]

In the UK midwives usually prefer to give Syntometrine after the cord is clamped due to theoretical concern that the induced contractions could cause an overtransfusion in blood leading to polycythaemia. On the other hand, an American reviewers suggested that uterotonics could speed up the effects of placental transfusion during delayed cord clamping, but it hasn't really been studied. Most women choose to delay the injection or try a physiological third stage for a while with the option of having the injection later if needed. Just out of interest, what kind of problems do you think early cord clamping caused with M?

Well, all was fine with the labour and she was born just fine. We had skin to skin and she looked perfect. They cord was clamped and cut rapidly and pretty quickly she started to look "dusky" so they took her away to a little table, gave her a bit of oxygen, called a paediatrician and had a look at her. She was perfectly fine, just "dusky". They handed her back and she nursed fine for 30 minutes and she was then taken and swaddled and popped into a little cot by my bed.

I was so exhausted from all the drugs and the birth and being awake for 24h that I wasn't able to keep my eyes open and OH had to go home immediately after the birth as it was out of visiting hours... so, the rest is a blur.

Over the next 8 hours people came in and out of our room, me totally out of it still not able to stay fully awake. I didn't know what time it was or how long it had been between people visiting but one particular midwife was pestering about this duskiness so M was whisked away on various occasions by various health professionals including 3 paediatricians and somebody who took her for an x-ray. All of them declared her fine and healthy but the MW was still concerned so they took her away from me to NICU for 24h observations (though I didn't leave her side other than for the initial hour when they said I couldn't go too and, naively, I listened) and started to give her "precautionary" anti-biotics while they ran blood tests as, apparently, duskiness can be a sign of infection. The blood tests came back fine and they carried on with the antibiotics just in case. They wound up giving her an overdose and having to run tests to make sure they hadn't damaged her kidneys or hearing...

All of this led to extra time in that place, and that bloody MW came back again to pester about jaundice so they plonked her into an incubator next to my bed, under a UV light. Except they messed up the humidity levels (set it to 0...) and had the heat up way too high.

In the end, we got out a week later and ALL of it was totally unnecessary. She was and is perfectly healthy.

The amount of heel prick tests she had, the amount of prodding, jabbing, poking and dragging her away from me... it infuriates me to think about it even now. Partly because I feel so stupid and so naive to ever let them do any of it, starting right at the beginning with the cord.

I am adamant that none of it would have happened if they hadn't clamped it so soon. We'd have been out by the end of that first day and home, away from the chaos.

This is very long winded but, above and beyond the simple issue of cord clamping - the knock on effects were incredibly traumatic for both of us and I will never go through that, or put my baby through that, for no good reason, ever again.

 

[Sam Pearson]

That sounds terrible. A reason to aim for homebirth I would think where you will be left to birth naturally uninhindered with nobody taking your baby away from you.

Here in Australia the Syntometrin is not routinely given in homebirths nor in hospital births. Most homebirth midwives don't even bring it to births so if you want it you need to get a prescription from a doctor and organise to order some through a Chemist and purchase it yourself. I find it a bit shocking that it is given to so many UK Mums without any indication that it's necessary.

 

[freckleonear]

Eeek, I can see why you're passionate about delayed cord clamping after what happened with Molly! Regarding PPH, the risks are very small unless you have any risk factors and in most cases midwives would be able to deal with it at home, including giving the injection if you did start bleeding heavily. Our bodies are designed to give birth, so my view on syntometrine is that it's a way to treat problems if they arise, rather than something that is needed. This page has got loads of info on PPH: https://www.homebirth.org.uk/pph.htm.

 

[mrssat]

Hi ladies, just wanted to post and say the info on this thread has really helped me gain more info about cord clamping, I loved the vids Sam Pearson posted.
I defo think I am going for delayed cord clamping, I had though about it before, but not done much reading about it. I've been googling like a mad woman since coming across this thread.
I plan to give birth in water (fingers crossed) so am a bit concerned about babies temp if we are hanging around......anyone have any info experience of this?
I will ask my midwife as well she is fab and seems to be quite into natural birthing and is very supportive.

Thanks for the info girls.

 

[Sam Pearson]

I plan to give birth in water (fingers crossed) so am a bit concerned about babies temp if we are hanging around......anyone have any info experience of this?.

Do you mean because you are wet you and baby might get cold? You can guard against that but also if you feel you or bub are cold at any time you can get out and get warmed up.

I've had two waterbirths. I highly recommend them. As is standard for homebirths in Australia the midwives brought no pain medication with my first and my second waterbirth was a freebirth. My personal choice for pain management were Clary Sage essential oil and the pool. It was wonderful in that regard - I can still capture that feeling in my mind so clearly - it was evern better than I had hoped. I felt immediate and significant relief as soon as I got in. I am a big bath/water person though and some people find the don't like it. in which case no biggie they can just hop out and continue to dry birth. You don't have to comit to waterbirthing ahead of time but it's great to have that option. For me I looooove water in my regular bath in early labour, looooooved the pool for second stage and have the instinct to hop out for third stage. This pattern felt natural to me and research shows that my timing encouraged the "expulsion reflex" which helped my body to birth so it's not just a relaxing strategy. I'm happy to explain more about that but perhaps a separate thread might be appropriate for general waterbirth discussion?

One of my waterbirths was during a heat wave and I had the water rather cool, we had fans going and windows open to catch the ocean breeze. With the Winter birth we had the water significantly hotter and the room closed up with heaters on. I never worry about measuring the water temperature but go by my body.

The pool temperature should be whatever you are comfortable with - not so hot as you dehydrate and not too cool or you will be cold and that won't be relaxing which is what you want - whatever is comfortable for you will be fine for baby. If the water temp gets too cool your birth support people can top it up with kettles of water.

It's recommended that you have the water up to your armpits. Apparently, this is ideal in all regards. You aren't so submerged that you are bobbing around and having to stabalize yourself in the water but that's deep enough to keep you warm and you can slide down into it a bit to cover your shoulders if you wanted. Once bub was born I held her with her body under mostly in the warm water and we had a towel that we covered her shoulders with although that did keep slipping. We also immediately put a little cap on our baby but again, that kept popping off so really wasn't much use but she wasn't cold.

With our Winter waterbirth we had the room heated to a comfortable temperature. If you are birthing in hospital I'm not sure about air temp as they always have air conditioning and I 'd imagine that might be problematic. I know with my first birth in hospital I had been in the shower right up until birthing so my hair was wet and I was naked and the air conditioning was making me very cold. I was shivering hard and complained I was cold but the staff ignored me which upset me since they were all dressed with dry hair and comfortable. At home though you can have towels/blankes being warmed by the heater/fire to snuggle under if need be.

Once my water babies were birthed I just lay there in the pool enjoying them for around 10 minutes. Then when I start to feel more contractions indicating the placenta is coming I get the instinct to be upright so I get out of the pool holding baby and in a standing squat beside the pool over a large stainless steel bowl I birth the placenta and the second time I stood up and birthed the placenta into a bowl while still standing in the pool then I hoped out. We had some old towels on the floor to save the carpet getting wet. I then did a wee so I could settle in on the couch for a rest without needing to get up for a while. I had my hubby hold baby beside the bowl with the placenta while I did that but if you didn't feel comfortable to hand baby over to anybody yet you could also take bub to the loo and have somebody help you by carrying the bowl.

Some women birth the placenta underwater which is fine.

 

[NaturalMomma]

Midwives here carry Pitocin (synthetic oxytocin) with them in case of PPH or problems delivering the placenta. But they do not give it out to everyone or anyone who doesn't have PPH, etc. Even many Doctors here just let the placenta come out by itself and then watch for signs of PPH.

I personally feel that giving medications for a compliacation that could happen before it happens is one of the things that is still wrong with Obsetrics. That is managing something that doesn't show signs of being managed. Having a provider keep a watchful eye on the bleeding in the immediate postpartum is better then just injection moms with medications all willy nilly like. Breastfeeding within 20 minutes after birth also helps to clamp the uterus.

 

[Sam Pearson]

Midwives here carry Pitocin (synthetic oxytocin) with them in case of PPH or problems delivering the placenta. But they do not give it out to everyone or anyone who doesn't have PPH, etc. Even many Doctors here just let the placenta come out by itself and then watch for signs of PPH.

That's good to hear )

Having a provider keep a watchful eye on the bleeding in the immediate postpartum is better then just injection moms with medications all willy nilly like.

Or if you freebirth like me you educate yourself as to what is normal blood loss and what to do to address heavy blood loss. It's very simple to learn about.

 

[Elucida]

So, birthing the placenta naturally... what can I expect? I've just read about contractions from yourself, do you need to push? Or is it like with baby and you get the urge to push naturally?

 

[freckleonear]

I've had two natural third stages. The first time I don't remember much at all (damn pethidine!) but I delivered the placenta in less than 10 minutes. The second time it took just under an hour, but in hindsight that's because of the way I was slumped on the sofa. Once the placenta had detached I could feel it as a weight by my cervix. The midwives encouraged me to cough to get it out, but because of the way I was slouched gravity basically prevented it moving down. As soon as I moved to a better position (on the toilet) it came straight away. There wasn't really much pushing involved, not compared to a baby anyway!