Delayed Cord Cutting For Diabetics...

[Mommy's Angel]

Hi ladies,

I've been very interested in delayed cord cutting since my first pregnancy that sadly ended preterm.

In bringing this up to my perinatologist, she mentioned that it wouldn't be a good idea for my baby because in children of diabetics, they already tend to have a high count of red blood cells and if allowed delayed cord cutting, the baby would surely have complications with jaundice afterwards.

I watched a video the other day from a physician in the U.S. who researches all the data for delayed cord cutting. All his teaching videos say that jaundice IS NOT an issue in delayed cord cutting.

He doesn't however mention if it matters with infacts of Type II diabetics.


Just wondering if any of you know if the perinatologist is right with her conclusion? Everything I've seen about delayed cord cutting seems to point to actually being very positive for baby.

I'm limited with EVERYTHING I can do it seems and this just frustrates me even more because I really want my baby to have all the stem cells and oxygen, etc. he or she is supposed to have. Without allowing it, the baby potentially loses 40 percent of his or her blood supply through the cord blood that was meant to go to baby in the first place. To me, it's SO important for the baby, but not if I'll be causing my baby harm. I'm a bit confused. Anyone able to help?

 

[Mervs Mum]

I honestly dont know if there would be an issue conected with diabetes but the bottom line is do you feel the obvious, well documented benefits outweigh the perceived risks? If you do then it's your choice. Maybe ask how often they don't clamp prematurely in your doctors particular practice. If it's not often then maybe they are pushing you that way for their own reasons

 

[KandyKinz]

I'd be a tad more concerned about polycythemia as opposed to Jaundice (though that is a consideration in your situation) which somewhat extends beyond the realm of topics I'm familiar with.....

But here's some info and if I were you I'd definitly go out and search for some more data from a variety of different sources before coming to any firm conclusions as to what you should do.

https://emedicine.medscape.com/article/976319-overview

 

[Mommy's Angel]

I'd be a tad more concerned about polycythemia as opposed to Jaundice (though that is a consideration in your situation) which somewhat extends beyond the realm of topics I'm familiar with.....

But here's some info and if I were you I'd definitly go out and search for some more data from a variety of different sources before coming to any firm conclusions as to what you should do.

https://emedicine.medscape.com/article/976319-overview

Actually, I did research on polycythemia. I understand that's an issue in Canada but there is no real risk of delayed clamp cutting and polycythemia.

Actually it appears to be standard in Canada that clamping of cord is delayed by 1-3 minutes, because of the reduced incidence of anemia etc (probably explains why Canadians only see anemia if the fetus has a medical problem like hemolysis )... The only indication for clamping faster than 1 minute is if the newborn needs rescusitation. So it does appear to be a Canadian-wide standard rather than centre-specific.

Here in the United States, many hospitals actually don't wait to cut the cord at all which is the reason for such a high rate of anemia. In fact, cutting the cord too soon keeps baby from receiving 40 percent of his or her total blood supply that was meant for baby.


There's ALOT of studies that have shown clamping the cord too soon is not beneficial. Some studies are even showing that vitamin deficiencies and jaundice are caused by not allowing the babies origional blood to pulsate through. I think you may be interested in checking these videos out from a Dr. at a University who does studies on this paticular subject. It's just ONE site of many with positives to allowing the cord to pulsate. I'm using this one because it's an actual Dr. from an actual research university and the videos are pretty clear for everyone to understand.

You'll find that in clamping early we're actually REMOVING 40 percent of baby's blood volume just by clamping early.

Your issue concerning polycythemia didn't show significance and can be found on the second video at around 12min 1sec based on all the research findings.

It's also exciting research to keep preterm babies alive as seen in the last video. Pretty awesome from my own experience. Though it wouldn't have saved my Jackson because he was still too early, it's hopeful for helping "viable" babies born too early.

Acedemic OBGYN USC School Of Medicine

The third video is residual benefits to delayed cord clamping. It shows significant research details.

I appreciate both your feedback and will do my best to fully continue my research before coming to a conclusion which is why I'm researching if there really IS a difference in babies of diabetic mommies.

Thank you both!!

There are 4 videos but I HIGHLY recommend anyone interested to take a look at all the research and weigh the pros and cons before deciding

 

[KandyKinz]

I think you may have misunderstood me.... I'm very much pro-delayed cord cutting and am fully aware of the benefits in normal situations.... Unfortunately, things become somewhat convoluted when pathologies such as diabetes become involved. I was just pointing out that babies born from diabetic mothers are much more likely to develop polycythemia. I believe there have been some studies which showed that these babies were as much as 30 times more likely to develop the condition as a result of them producing extra RBC's in utero as your perinatologist mentioned to you... So increasing the baby's blood volume could very well aggravate the situation because you would be adding additional blood cells to a baby whom already likely has too many. Physiologically, IDM's have very different things going on within their bodies in comparison to other babies.

And I just wanted to point out that while I do think it is quite nice that Canada had a good rep and is thought to have a standard to delay cord cutting, unfortunately such behavior is not actually practiced. I have done several placements in several hospitals both small rural level 1's and large level 3 teaching establishments and have yet to meet and OB who believes in delayed cord cutting, apparently SOGC guidelines don't apply to them Guidelines recommend that routine EFM admission strips not be performed but most hospital still do them.... Guidelines state that all women are to be offered an induction at 41 weeks yet many OBs have read that to mean if the woman says no to a 41 week addition they are entitled to refuse to provide care after that gestation.... Midwives on the other hand routinely practice delayed cord clamping and won't interfere with the cord until it stops pulsating.

 

[Mommy's Angel]

I think you may have misunderstood me.... I'm very much pro-delayed cord cutting and am fully aware of the benefits in normal situations.... Unfortunately, things become somewhat convoluted when pathologies such as diabetes become involved. I was just pointing out that babies born from diabetic mothers are much more likely to develop polycythemia. I believe there have been some studies which showed that these babies were as much as 30 times more likely to develop the condition as a result of them producing extra RBC's in utero as your perinatologist mentioned to you... So increasing the baby's blood volume could very well aggravate the situation because you would be adding additional blood cells to a baby whom already likely has too many. Physiologically, IDM's have very different things going on within their bodies in comparison to other babies.

And I just wanted to point out that while I do think it is quite nice that Canada had a good rep and is thought to have a standard to delay cord cutting, unfortunately such behavior is not actually practiced. I have done several placements in several hospitals both small rural level 1's and large level 3 teaching establishments and have yet to meet and OB who believes in delayed cord cutting, apparently SOGC guidelines don't apply to them Guidelines recommend that routine EFM admission strips not be performed but most hospital still do them.... Guidelines state that all women are to be offered an induction at 41 weeks yet many OBs have read that to mean if the woman says no to a 41 week addition they are entitled to refuse to provide care after that gestation.... Midwives on the other hand routinely practice delayed cord clamping and won't interfere with the cord until it stops pulsating.

Wow! Thanks for all this information. I kinda figured about the issue pertaining to diabetes. There's not much I have the freedom to do high risk, but this is a subject while was something I wanted to do, definitely will take more research. I'm not apposed to saying no for the safety of my baby and it looks as though that may be the case.

How frustrating about the delayed cord cutting issues you speak of there. I REALLY love midwives. I've read about the care and the fact that SO many countries only use midwives to deliver. My first experience with a midwife was actually during our fertility treatment. I noticed the medical staff across the hall was very "clinical" with a get em in, get em out kinda attitude where the midwife was slow, patient, very loving and I felt it was a Godly experience. Nothing hurt with her.

I thank you very much for your input!! You've been very helpful.

 

[KandyKinz]

I think you may have misunderstood me.... I'm very much pro-delayed cord cutting and am fully aware of the benefits in normal situations.... Unfortunately, things become somewhat convoluted when pathologies such as diabetes become involved. I was just pointing out that babies born from diabetic mothers are much more likely to develop polycythemia. I believe there have been some studies which showed that these babies were as much as 30 times more likely to develop the condition as a result of them producing extra RBC's in utero as your perinatologist mentioned to you... So increasing the baby's blood volume could very well aggravate the situation because you would be adding additional blood cells to a baby whom already likely has too many. Physiologically, IDM's have very different things going on within their bodies in comparison to other babies.

And I just wanted to point out that while I do think it is quite nice that Canada had a good rep and is thought to have a standard to delay cord cutting, unfortunately such behavior is not actually practiced. I have done several placements in several hospitals both small rural level 1's and large level 3 teaching establishments and have yet to meet and OB who believes in delayed cord cutting, apparently SOGC guidelines don't apply to them Guidelines recommend that routine EFM admission strips not be performed but most hospital still do them.... Guidelines state that all women are to be offered an induction at 41 weeks yet many OBs have read that to mean if the woman says no to a 41 week addition they are entitled to refuse to provide care after that gestation.... Midwives on the other hand routinely practice delayed cord clamping and won't interfere with the cord until it stops pulsating.

Wow! Thanks for all this information. I kinda figured about the issue pertaining to diabetes. There's not much I have the freedom to do high risk, but this is a subject while was something I wanted to do, definitely will take more research. I'm not apposed to saying no for the safety of my baby and it looks as though that may be the case.

How frustrating about the delayed cord cutting issues you speak of there. I REALLY love midwives. I've read about the care and the fact that SO many countries only use midwives to deliver. My first experience with a midwife was actually during our fertility treatment. I noticed the medical staff across the hall was very "clinical" with a get em in, get em out kinda attitude where the midwife was slow, patient, very loving and I felt it was a Godly experience. Nothing hurt with her.

I thank you very much for your input!! You've been very helpful.

I quite like midwives myself I'm lucky to be in Ontario and things have really progressed here in terms of midwifery care... It's been legal for almost two decades now It's an integrated component of our health system so we don't have to pay and they actually take the time to talk to their clients and respect informed choice while still following evidence based practice I can't say that that last statement is true of most OB's I have encountered over the years.

Diabetes is certainly a difficult thing to have to deal with in pregnancy especially if it is a long standing issue and not just gestational. It opens the doors to ALOT of interventions some beneficial... Some not so much so doing your research is definitly a good and beneficial thing Knowledge is definitly power and it's lovely to see women being proactive in their care as opposed to just accepting everything their doctors puts in front of them.

 

[Mommy's Angel]

Oh yes, I have to be my own advocate. With my first pregnancy, the first thing out of the perinatologists mouth was my baby would be big so I'd need a c-section no matter what. THE FIRST DAY! I told him to hold off.

In fact, while I had my insulin pump put in at the hospital, there was another woman with Type II diabetes like me who had an all natural birth with an 11lb baby WITHOUT an episeotomy.

I lost my son because I wasn't listened to. I lost my mucus plug on the road, before that I had chronic BV and their office kept giving me creams for even though I told them it wasn't working. Their nurse practitioner kept telling me everything was fine. Had I been listened to, I should have had a cerclage and an antibiotic suppository and my son may have made it to their standards of viability.

I WON'T let that happen again. I'm my own advocate. Though I do want to make sure I do the research and don't get too cocky to overstep the knowledge they "may" have.

We're hiring a dula this time around. My hope is that it will be a much better experience for me.