Wednesday, May 27, 2015

New Study on "Delayed Cord Clamping" in the spotlight.

NPR Article about Delayed Cord Clamping

This is a huge topic that has the potential to create a huge rift between Obstetrical medical practices and Midwifery at a time when they have been (in my various experiences) closer to working together than ever before.  In my nearly twenty year career as a doula, I bear witness to practices both in and out of hospital on a very regular basis.  I know that I am not a medical professional, so please don't argue that I don't know everything about medicine, I already know that.  I am very comfortable in my role and as a witness to practices in home, birthing centers, and hospitals; my experiences are relevant and valid.

Let me begin by saying that neither midwives, nor doctors are 100% right.  That is just never true.  So let's be careful about using this study to prove that doctors are "idiots" as many of the comments elude to.  We all know that's just not true.  As with all interventions in obstetric care, there ARE valid reasons to perform this.  One nurse in the comment thread offered that Polycythemia and Hyper-bilirubenemia might be indicate preventing the transmission of the blood volume in the cord.  Again...I'm no doc...and that may all be well and true, but it's the application of the cord clamping as standard procedure that we are objecting to, not the use of a specific intervention in a specific incidence.  I'm not sure that those two diseases would be diagnosed during pregnancy, but if they are, then cutting the cord could possibly be beneficial to THAT BABY, but would not be a reason for across the board treatment of all newborns as has been the case for so many years.  I know because I am on the front lines, supporting my clients as they ask to delay something that probably should never have become standard practice in the first place.  We try to discuss this ahead of time, but docs are often unwilling to offer much, stating that circumstances at the time of birth are paramount in this particular decision.  Parents, then, at the moment of delivery, have to read the doc, and figure out whether the best angle is to ask nicely, or to command the situation. We are helpless essentially to the whims of that doctor, who may be well meaning and have the best interest of Mom and Baby in mind and heart, or might be just in a hurry.  NO WAY TO TELL because they will say the same thing either way.  The script doesn't change, they will spin it to appear as if it was necessary. If a doc tends to cut the cord, they will make it sound necessary.

The main reason I have witnessed being given to cut the cord though, is regarding meconium.  If there is meconium (baby's first bowel movement) in the fluid, the medical communities practice has been overwhelmingly to clamp and cut so that we can get the baby across the room to the neonatal team to provide care.  I was glad that the study, even though it wasn't directly tested, speculated delayed cutting may most benefit babies in distress.

"So far, studies on delayed cord clamping have excluded infants born in distress, such as those with breathing difficulties or other problems. But Rabe said these infants may actually benefit most from the practice.
These babies often need more blood volume to help with blood pressure, breathing and circulation problems, Rabe said. "Also, the placental blood is rich with stem cells, which could help to repair any brain damage the baby might have suffered during a difficult birth," she added. "Milking of the cord would be the easiest way to get the extra blood into the baby quickly in an emergency situation."

Parents should not have to choose between their baby receiving cord blood (the baby's blood) and resuscitation.  Babies should have access to both, ESPECIALLY when there are concerns about the baby's respiration or circulation.  Leaving the cord intact increases the baby's blood pressure, and also provides oxygen, which gives baby additional support while other resuscitation efforts are taking place.  If you knew someone was struggling underwater, would you take away the SCUBA tank? If you knew someone didn't have a pulse would you sever an IV line that was already in place? This reason to cut the cord makes me especially crazy because it is simple logistics, bring the neonatal team to the baby, not the other way around.  Create a table that gives them access next to the delivery bed. Get a longer tube to attach to the suction/vacuum in the wall.  Let the baby stay near Mom and other family so that he or she can sense their nearness, feel their touch, and hear their voices; also proven as beneficial to newborns who are faced with circulatory or respiratory challenges at birth.  If I was found unconscious, bleeding, and not breathing, I'm quite sure I would be given an IV (to increase blood pressure) and possibly followed by additional blood, CPR/EAD/Rescue Breathing. Why deny these readily available life support tools just to move the baby across the room?

1. Just change the policy to state that because there are valid medical reasons to support both early and delayed cord cutting, babies will be evaluated at the time of birth on an INDIVIDUAL basis and that whenever it is safe, baby will remain connected to the cord for anywhere between 1 minute (since most of the cord blood is transferred in the first minute and some is usually better than none) and whenever the cord stops pulsing.
2. Work on getting the NICU team and bed closer to the baby. Suction at perineum, suction upon delivery as needed.  No one is asking you to not your job.  We all know that you are vital.  Can you just move 4 feet closer?  Use the cord as one of the tools in your belt.

There are always more questions to ask, and we'll keep asking because many of the normal practices in midwifery are now being scientifically proven as safer and more beneficial than the industrialized medical model of care.  Medicine has saved many babies, and it has also taken many babies.  Midwifery has had to evolve to include more science, why should obstetrics not evolve as science proves that some of the midwifery practices were in fact the safest?  Let's allow these "discoveries" to bring as closer as a birthing professional community to better serve and care for women and their babies.

As always, you may click the link on the right to order a copy of my book, "Expecting Kindness", a comprehensive, empowering, family centered, childbirth education course in paperback for your convenience.  It is also available on and locally at Park Place Book, Soul Food Books, and at The Eastside Birth Center.  For more information you can listen in on an interview I gave recently about my philosophy, my mission, and my book.

Wishing you and your baby a KIND BIRTH.
Kristin Dibeh

No comments:

Post a Comment

Note: Only a member of this blog may post a comment.