Delayed cord clamping after birth?

[Katigre]

What did you choose to do?

I found this post by an OB/GYN who seems like a well-researched doctor. Delayed Cord Clamping research (http://academicobgyn.com/2009/12/03/delayed-cord-clamping-should-be-standard-practice-in-obstetrics/) I didn't find this until after both of my kids were born, but it makes a lot of sense in terms of cord blood and its benefits.

He gives some medical lectures here (http://academicobgyn.com/2011/01/30/delayed-cord-clamping-grand-rounds/) that I found really interesting.

[marymoo86]

We did it and still was able to donate the cord/placenta to the cord bank. Oddly enough the cord stopped pulsating fairly quickly - maybe a couple of minutes.

[MommyAllison]

I don't remember with DD, so it was probably not delayed at all.

With DS, we asked that it be delayed (and my midwife does this as standard practice), though it wasn't delayed until it stopped pulsating - just 4-5 minutes.

[daisymommy]

DS#1 I asked for it to be delayed and was told that hospital policy dictated all newborn care needed to be taken care of immediately so that the nurses could move on to other patients. They couldn't just stand around waiting for it to finish pulsing. :irked:

DD born with midwife in birth center--she tried to clamp immediately, my mother who is a retired nurse said "wait! they wanted to delay clamping!" so the midwife sat there for an extra minute and said it was done and clamped it. My mother told me later no it was not done, it was clearly still full of blood.

DS #2 born at home with 2 nurse midwives--they waited a good 15 minutes while I bonded with the baby, and when the cord was totally white and slack, all the blood had been returned to the baby, it was clamped. Finally someone respected my wishes.

[nicepersonfl]

We delayed for 1 full minute - it was timed. I'm sure all the blood was not out of it, but at least some of it was. The only side effect I saw was that it increased his bilirubin levels faster requiring phototherapy.

[SnuggleBuggles]

I had researched it prior to ds1 and opted to delay clamping. We did it with both boys and one was born at a hospital with a CNM and the other at a birth center. The CNM at the hospital was not really that familiar with the idea but she was ok with it (we asked her weeks before the birth). I think it was a normal request at the birth center.

Beth

[mg1278]

We did it and still was able to donate the cord/placenta to the cord bank. Oddly enough the cord stopped pulsating fairly quickly - maybe a couple of minutes.

Can you tell me more about this? With my older daughter, we were told that we couldn't delay the cord cutting because we were banking the cord blood. I was under the impression that the cord blood bank instructions required an immediate/near immediate cut. It ended up not mattering, since they had to cut the cord immediately to take her to be suctioned (meconium) but we're about to go through this again. I don't really care about cord blood banking, but my husband's parents pretty much demand that we do it (they pay). If there's a way that I can get my wish for delayed cord cutting while indulging them on the banking, that'd be awesome.

[marymoo86]

Can you tell me more about this? With my older daughter, we were told that we couldn't delay the cord cutting because we were banking the cord blood. I was under the impression that the cord blood bank instructions required an immediate/near immediate cut. It ended up not mattering, since they had to cut the cord immediately to take her to be suctioned (meconium) but we're about to go through this again. I don't really care about cord blood banking, but my husband's parents pretty much demand that we do it (they pay). If there's a way that I can get my wish for delayed cord cutting while indulging them on the banking, that'd be awesome.

We donated to a public bank so the restrictions may be more relaxed than a private. The donation coordinator said it was fine to delay as they would do all kinds of tests to see if the cord/placenta were fit for use anyway.

[DrSally]

Interesting, I had never heard of this. Too late now, but I would delay clamping if I had to do it again.

[MSWR0319]

We delayed. I'm not sure how long, but I remember my CNM putting him on my stomach and it was awhile before It was clamped and the cord was cut. I can't tell you how many people said to me they couldn't believe what good color he had. If it did nothing else, I think that extra blood made him look so much better.

[SnuggleBuggles]

This thread reminds me that I must have tried to pick ds2 up higher than I should have after he was born because everyone quickly reminded me that he was still attached down below!

Beth

[brittone2]

Delayed with all 3 kids. One hospital birth, one freestanding birth center birth, one homebirth so 3 different settings.

[sewarsh]

Umm...I never even knew about this and I consider myself a pretty educated person, reads a lot, researches, etc. Why have I never heard of this???

[WolfpackMom]

I think it was clamped pretty quickly, not sure if that's because DS came out blue or because we donated the blood or just because it's what they did...

[Katigre]

I think it was clamped pretty quickly, not sure if that's because DS came out blue or because we donated the blood or just because it's what they did...
Interestingly, if you watch the videos, the OB makes the point that even in cases where the baby is struggling at birth or premature (their lungs couldn't inflate to breathe on their own), waiting 45 seconds before clamping/cutting contributed to better outcomes b/c the placenta is still 'breathing' for the baby for the first almost-minute and they're getting iron/blood/oxygen (in preemies, this additional 45 second dose of cord blood led to less infection/sepsis - there are graphs on the rates of outcome for immediate vs. 45 second delay clamping in the videos).

His proposal was that hospitals look at ways that a baby can be resuscitated and given aid while still attached to mom (ex. having crash carts at the foot of the delivery table, for example). Obviously if they're not set up to do that now the procedure is to clamp/cut/remove the baby immediately for attention. But it would be nice if in the future this was changed so that both emergency care and additional cord blood can happen for the baby at the same time.

[american_mama]

I think delayed cord clamping is probably good, but it wasn't a major concern of mine. I don't think the clamping was delayed for any of my babies. Two were born with nurse midwives in a hosptial (two different hospitals in two different state), and one was born overseas. My second child had jaundice issues complicated by ABO incompatibility, and I have read blips on the internet, none very clear, that suggest delayed cord clamping may not be good in that situation, or for subsequent siblings. Although that is not making sense to me now that I think about it.

Anyway, I know about it, asked my pediatrician about it and we both think it is probably good, probably not harmful but neither of us felt strongly about it. I never did ask my midwife about it - we didn't have the best rapport for much of our time together.

[WolfpackMom]

Interestingly, if you watch the videos, the OB makes the point that even in cases where the baby is struggling at birth or premature (their lungs couldn't inflate to breathe on their own), waiting 45 seconds before clamping/cutting contributed to better outcomes b/c the placenta is still 'breathing' for the baby for the first almost-minute and they're getting iron/blood/oxygen (in preemies, this additional 45 second dose of cord blood led to less infection/sepsis - there are graphs on the rates of outcome for immediate vs. 45 second delay clamping in the videos).

His proposal was that hospitals look at ways that a baby can be resuscitated and given aid while still attached to mom (ex. having crash carts at the foot of the delivery table, for example). Obviously if they're not set up to do that now the procedure is to clamp/cut/remove the baby immediately for attention. But it would be nice if in the future this was changed so that both emergency care and additional cord blood can happen for the baby at the same time.

Interesting...I really have no idea how fast they clamped. DH thought it was pretty quickly, but not necessarily less than 45 seconds. I just know we didn't purposely delay clamping, although we may for out next DC now that I know more about it.

[daisymommy]

In the old days, and in other cultures, cord tying and cutting was usually delayed, often as late as after the placenta was delivered. But when hospital deliveries became the norm, immediate cord clamping became standard practice for the convenience of doctors and nurses to move get their assessments done and move along to other patients and babies. Now it's considered just the norm, and most people don't know about it unless you do your own research.

A very well written, very well researched book--with all scientific and journal documentation, is Gentle Birth, Gentle Mothering, by Sarah J. Buckley M.D. She has a long section in the book discussing the medical benefits to delayed cord clamping.

[MoJo]

I have no idea! Probably not delayed.

I had heard a little about it, but it seemed fairly low on my priority list. With my first, I got very little of my priority list. With my second, I got most of my priority list . . . but my midwife had to leave another mom who was in the pushing stage to be there for my baby's actual birth, so she was in a hurry for good reason . . . she needed to get back to the other mom.

I was focused on baby both times, and DH didn't want to cut it either time.

[Tondi G]

we didn't delay but DS2 got longer with the cord than DS1 did. DS1 had the cord around his neck twice and my doctor had to cut his cord from around his neck while he was still shoulder deep in the birth canal. It was a scary few minutes right after he was born but he pinked up just fine. If we had another I would ask for the clamping to wait for the cord to stop pulsing at least.

[Lupe]

I am going to ask for delayed cord clamping unless there is a big medical reason not to. For DH is the only thing he really cares about in the birth plan since he came back from a scientific conference last year, where some neuroscientists showed that cutting the cord right away can lead to low oxygen in the brain and higher rates of autism and/or disabilities. We told this to our doctor, and she said she was not fully aware but will check the studies out and later agreed with us and told us to let the nurses and the doctor on call if it is not her know.
Bottom line doctor's are not scientists and they may not be aware of the latest scientific studies, even good doctors. When a baby is born (vaginally specially) quite a bit of blood is still in the placenta and has to find it way to the baby and his lungs for him to have proper oxygen levels in the blood, which is specially important for his brain. The research however says you have to let the baby take several deep breaths, not necessarily wait until the cord stops pulsating, so there may be room for keeping cord blood for banking.

After knowing what DH explained to me, there is no reason not to do it, unless it is a medical emergency. Lucky for me DH teaches at medical school and doctor's respect whatever he says without asking, don't let any doctor tell you otherwise, the evidence is pretty good that clamping the cord right away is not the best for the baby.

[daisymommy]

The thing is, it's not just about waiting for the baby to breathe, or waiting an extra 45 seconds. That blood in the cord belongs to the baby! If you cut before it gets to them you are shorting them out of anywhere from 1.8 to 5.1 ounces of blood, which at the upper limits is almost half of a baby's total blood volume at birth. The average placental transfusion is 3.5 ounces, one quarter to one third of an average newborn's 350 ml. total blood volume.

*Source: This is in a medical journal about premature infants, but discusses all newborn blood volume irregardless of gestational age, and the amount lost to early cord clamping.
http://bit.ly/fNI8Dq

Cesarean born babies miss the pressure reperfusion effect that vaginal born babies have, which shunts an extra 66 mil. of placental blood from their system at birth. The consequence may be an increased risk of respiratory distress. Several studies show that respiratory distress can be eliminated in cesarean born babies when a full placental transfusion is allowed.
*I can post the links to several journal articles if anyone wants them. Just didn't want to type it all out if not needed.

Early clamping contributes to materal post-partum hemorrhage, feto-maternal hemorrhage, as well as a retained placenta (when you need intervention to remove it).

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2868%2991107-0/abstract

http://www.gentlebirth.org/archives/hastyclamping.html

[alirebco]

Here's a good link that I recently shared with my sister and some friends:

http://www.themidwifenextdoor.com/?p=1364

[KLD313]

I asked my midwife about doing this but she said because I needed a blood sample from the cord (for a medical issue) and because we were banking the blood we couldn't delay. I asked the rep from the cord banking place and he told me you could do cord clamping. IDK, I ended up having a c-section and didn't give it much thought once I was on the table but I do know that they got a HUGE amount of cells from the cord.

[AnnieW625]

I don't recall with DD1 honestly and had no idea and honestly as heartless as it sounds I didn't care. I was just glad she was alive (not that there was doubt) and that my crazy labor was over.

With DD2 they waited about a minute to 2 minutes.

We didn't cord bank any blood because we couldn't afford the costs (sad if you ask me, this should be way more affordable than it is).

[edurnemk]

I don't really remember, it all happened so fast once he was out, they put him on my chest, the nurses were drying him while he was on me, and I only had eyes for him. I had not heard of this then so we didn't request it, and we did cord blood banking (and they got a HUGE amount of cells, too). DH cut the cord, so maybe he remembers more clearly, I'll ask him, but if they did delay it must not have been for more than a minute.

[mg1278]

We donated to a public bank so the restrictions may be more relaxed than a private. The donation coordinator said it was fine to delay as they would do all kinds of tests to see if the cord/placenta were fit for use anyway.

Thanks. I looked at CBR's website and it says immediately. If my husband gets around to ordering the kit, I'll call and talk to someone.

[BayGirl2]

We delayed with DS. I had read the research and included it in my birth plan. Kaiser actually had a general form you could use to create a birth plan - with check boxes for options. I don't remember if delayed cord cutting was already on there or I wrote it in.

After a 29 hour labor its a bit blurry, but I believe they handed me the baby first and I held him for a minute or two before they cut.

[MamaMolly]

I didn't know about it with Lula, but was interested in doing it with Dolly. Then my cousin was diagnosed with Lukemia and we decided to bank the cord blood, so we weren't able to delay. If I weren't banking the blood I'd ask for delayed unless there were a medical (emergency) reason not to.

[bostonsmama]

My DH said it was delayed a couple minutes, but the doc said it was done pulsing pretty quickly. She did need a little help breathing/suctioning, so after about 3-4 minutes they took her away for about 15min to the warmer. I think her first apgar was 5 or 6 (she was sorta blue), but then it was a 9 a few minutes later.

I had always been told by doctors that the baby had to be lower than the placenta for the cord blood to re-enter the baby, and that with DD on my chest, it wouldn't make much of a difference, but I asked them to delay it anyways.

[fumofu]

I had wanted to donate cord blood after deciding not to bank it. Unfortunately (and frustratingly) I couldn't find a public bank that would accept it. So I started reading about delayed cord cutting and found the site you linked. At my next prenatal appt I asked my OB about it. He said it was his standard procedure to lower the baby immediately after delivery to allow gravity aid in cord blood flowing back into the baby. He would then clamp the cord after it stops pulsating.

I do remember the doc lowering DS right after delivery, but have no idea when the cord was clamped.

[citymama]

I didn't ask with DD1. With DD2, I asked, but it was not an option with her birth b/c of hospital policy, plus she had meconium so they whisked her away to clean off her nose and mouth.

[sunnyside]

I didn't ask with DD1. With DD2, I asked, but it was not an option with her birth b/c of hospital policy, plus she had meconium so they whisked her away to clean off her nose and mouth.

Of course this was the same with us. We had the dreaded 'poop in the pool', I mean, meconium and she was whisked away with much fanfare. I wished we could have delayed the cord clamping. But I wished a lot of things could have been different and am just happy with the healthy baby and the vaginal birth I guess.

[Katigre]

I had always been told by doctors that the baby had to be lower than the placenta for the cord blood to re-enter the baby, and that with DD on my chest, it wouldn't make much of a difference, but I asked them to delay it anyways.
The OB in the video addresses this (it is a somewhat common belief). The baby being on the mom's chest doesn't affect blood going to the baby b/c it's not a matter of a slight increase in gravity so much as the fact that it is pumping blood - and pumping works on up angles just like down angles (especially when there is only one-way flow which happens after 45 seconds - the placenta then pumps only to the baby and not vice versa).

[daisymommy]

I snuggled DS on my chest the whole time after he was born, and about 15 minutes later the cord was clamped. It was flattened out, almost white, and only a few drops of blood left in it. So it's certainly true that gravity does not need to take place!

[HannaAddict]

We donated the cord blood and the blood bank was sooooo appreciative since it passed their different tests (volume and other things) and even came to my hospital room to say thanks, and sent a thank you letter.

[MommytoEliana]

I had wanted to do delayed clamping with DD but IIRC, we weren't able to either because of my being GBS positive or because of the potential RH incompatibility (I'm - and my husband is +). I didn't even ask about it with DS because both issues were there again.

I'll check with my midwife at my next appt. and see if she thinks it will be a possibility.

[Katigre]

I had wanted to do delayed clamping with DD but IIRC, we weren't able to either because of my being GBS positive or because of the potential RH incompatibility (I'm - and my husband is +). I didn't even ask about it with DS because both issues were there again.

I'll check with my midwife at my next appt. and see if she thinks it will be a possibility.
Both of those reasons sound strange to me - I was GBS positive with DS and that's not related to cord blood at all (along with many other women I know). RH would be present with or without cord blood since that blood is the baby's, not the mother's, and antibody issues would have been prevented with the shot.

[MommytoEliana]

Both of those reasons sound strange to me - I was GBS positive with DS and that's not related to cord blood at all (along with many other women I know). RH would be present with or without cord blood since that blood is the baby's, not the mother's, and antibody issues would have been prevented with the shot.

At the time whatever the reason was sounded reasonable. :-) I will definitely ask again this time around, though.