Thursday, 1 January 2004 - 10:37 AM PST

I've always agreed with this - lately I've been asking parents if we can leave the cord attached longer (like an hour or so, just until the newborn exam). I have spoken with a midwife that does this, and she finds she does not have to clamp the cord to cut it, nor does she need to use any ties on the stump.

What do you think about this?

Also, what about women who have had drugs or medications during their labor/birth? Is it better to clamp the cord early to avoid more of that getting to the baby - or is the amount that is going to go to baby already there and not much of an issue after birth?

Thursday, 1 January 2004 - 12:43 PM PST

I commonly leave cords intact untill i get around to cutting them -- often the placenta has been long delivered. I'll cut the cord first only if it's in the way -- unusualy short perhaps -- but only after it's fully stopped pulsing and gone flat and empty. Seems that usualy takes a minimum of five minutes - and sometimes a lot longer.
But -- i always do clamp/tie/or band the cord. I know some don't - but a very long time ago i saw a tie slip off of a cord about an hour after birth, ahnd the baby bled quite a bit. Maybe it's not "supposed" to happen - but it did that time - and i've always felt better if the cord is very securely tied. I usualy use one of those tiny rubber-bands --usually use an averbach but have also used kelly clamps. I like the bands best!

asfar as medications go... i don't really think that's much of a problem nowdays. WIth the old general anesthetics it was - and that's where the whole tradition of early-cord-clamping originated! The docs used a moderage anesthesia until very late second stage and then increased it to 'surgical level" at the end (or when they applied forceps). Every minute - every second --affected the baby and it was an urgent matter to get the kid out quick -- and the cord clamped as soon as possible. It was theorised that the baby might get an "extra large dose" of anesthetic with the natural cord transfusion which occurs in the few minutes right after birth. In that case - it made sense to clamp immediately. (Also, most of those kids were gonna need stimulation or resucitation to initiate breathing. The baby needed to be handed off to someone right away).
But we don't use that type of anesthetics any more, so i don't think it's an issue today.

some use the the full "active management" for third stage which requires a shot of pitocin/syntocinon with the delivery of the shoulders or within the first minute of birth. I don't know if the baby would be affected by the pit given to the mother at that time -- although i know there is some evidence that rates of jaundice might be higher if mom's are given pit in labor. But...if you followed "active management" -- seems to me you could still let the cord stay intact for a few minutes or so -- since -- by definition-- you aren't supposed to begin cord traction until the first strong uterine contraction after birth (although it seems a lot of people don't realise this!). Even if you give pit with the shoulders, there is still usaully at LEAST a several minute delay before the separation contraction (which can be expected 3 to 5 minutes later).

Monday, 12 January 2004 - 7:52 PM PST

The Midwifery Management Of Neonatal Resuscitation

Taught By: Karen H. Strange, CPM

The Midwifery Management Of Neonatal Resuscitation is an NRP class that is specifically designed and taught for the homebirth and birth center settings. It is also suitable for EMT's, CNM's, CM's, CPM's, DEM's, RN's, doulas, childbirth educators, apprentices, helpers and anyone who may encounter a newborn in distress. The participants will have a thorough understanding of the new guidelines and should purchase the Textbook of Neonatal Resuscitation Textbook 4th Edition copyright 2000 which comes with a CD-ROM. Chapters 1 through 4 and 7 MUST be read before the class. The class is shortened by 1-2 hours if everyone has read the book. If you need Medications and Intubation please inform the sponsor so Karen can bring the extra equipment for testing and be prepared to take the test for chapters 5 and 6. Participants will be taught the practical skills in an easy to recall manner.

You can order the books from AAP/AHA/NRP at 888-227-1770, or through Cascade at 800-443-9942 at Amazon.com or Barnes and Nobles online. They take 3 weeks to receive by mail unless you pay for faster shipping.



About Your Instructor......

Karen H. Strange, CPM was trained at Maternidad La Luz in El Paso, Texas. She worked there as a staff Midwife for many years and as Clinical Director for 2 years. She has also worked as an independent home-based midwife in the Dallas/Ft. Worth area. She has been an instructor for Neonatal Resuscitation since 1992, tailoring her style for those who work in the out-of-hospital setting.

In learning about her own birth and prenatal journey, Karen changed the shape and focus of her class. Her personal journey of discovery explains why she became a midwife and why she teaches neonatal resuscitation. Since this journey began it has become her passion to share what she has learned about the conscious and aware fetus and newborn.

She has come to realize that this perspective can help one appropriately respond to a newborn, especially when they are in distress. Extensive research from the new field of Pre and Perinatal Psychology will be integrated throughout the class.

Karen's workshops are very unique and in demand around the country as one of the few instructors teaching NRP in the apprenticeship model of midwife teaching midwife and from the perspective of the conscious newborn.

Karen is on the Texas Department of Health Midwifery Board, and is chairperson of the Complaint Review Committee. She lectures and teaches on midwifery issues and pre & perinatal psychology.

The AAP/AHA Neonatal Resuscitation Program will be taught in full and all requirements for NRP will be met as well as other information specifically pertaining to the out-of-hospital setting and includes up to date information pertaining to subject.

? I WILL TEACH what is appropriate in resuscitating a newborn.

? I WILL TEACH how to feel comfortable using your equipment.

? I WILL TEACH you the counts in an easy to recall manner.

? You WILL LOVE this class when you are done.

Cost of the class

First time taking Karen?s Class:

? Paid in full by 3 weeks prior to scheduled class: $125.00

? After 3 weeks or at the door: $135.00

Renewing with previous class taken from Karen:

? Paid in full by 3 weeks prior to scheduled class: $115.00

? After 3 weeks or at the door: $125.00

Please bring a dish to share for pot-luck lunch.

Please contact the sponsor in your area to register for the class and get directions. If you have specific questions about the class you can contact Karen directly at karenmidwife@yahoo.com.

?When: Feb 1st

?Where: Bellevue, WA (exact location TBA)

?Contact Person: Heather Shelley

~Phone: 425-401-8643 or 425-246-2097 cell

~Email: heathershelley@yahoo.com

Monday, 12 January 2004 - 8:03 PM PST

You go Gail! Thanks again for speakin for so many of us!

I use averbach bands. Had one break once - since then, launch two of them babies on them cords. All it takes is once. Caught it before it bled, phew.

love you, c