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midwife muse -- a community midwifery bulletin board
Sunday, 28 December 2003
cords


The baby was wonderful -- gave a huge gasp as her head came out of the water; good color and great apgars. But.......... As her head was born, i felt and saw her cord was around her neck; not just "tight" but also limp. Many texts instruct you to cut the cord in these cases - but I believe it's important to deliver with an intact cord whenever possible, so I left the cord -- even though it tightened further -- and hurried the shoulders. She was clearly beginning to show some effects of the pinched cord (wrapped around her neck and under her arm) - and i think that's why she breathed so deeply, so rapidly. Babies usually take about ten to fifteen seconds before they give a full breath like that, but one of the signals telling them to breathe is a rise in carbon dioxide/drop in oxygen. This generaly happens just "after" birth, but it was happening this time during the FAST trip down the birth canal. She was born so quickly, she didn't suffer any harm...but she could have IF the bag of water had been broken earlier!


AS it was -the intact bag protected her cord from being squezed. And the intact cord allowed an additional life-support system if she'd had trouble getting her breathing started. If we had broken her water-bag earlier -- in an effort to speed up labor --this baby might have had some serious problems!


SOmetimes labors like this tempt me. I know that there's a prety good chance the birth will happen quickly if i break the bag (there's the chance it won't of course), but it could dramaticaly speed things up. But then I see something like this --where breaking the bag would likely have changed this birth from a lovely event into a frightening and possibly dangerous one. Possibly even requiring a transfer for surgery -- or a baby who needed resucitatin. Or worse.


It reconfrmed my belief about the wisdom of leaving the bag of waters intact. A birth is not a horse race! There is no prize for a faster delivery! Letting the birth proceed within it's own timing, gave us a healthy baby and a restful, slow, easy labor. A nice combination.

And a wonderful few-days-late Christmas present.
They lived up in the mountains. There was a good bit of snow and we couldn't make it down thier long driveway, so we walked the last bit. It was so quiet, peaceful, lovely to walk in the icy dark -- the reflections of christmas lights being our guide! Yeah, it was a cold walk and slippery, and Tevas sandals arent' the best winter shoes -- even with thick socks-- but the walk just made things that much more memorable! All in all, a lovely birth to a very lovely family!

but, it got me thinking about cords -- and it was amaxingly coincidental that I found an email from someone asking a question about the values of keeping those cords intact, and the benefits of delaying the time of cord clamping.
I'm going to post some references here for public view rather than just in a private email. This information is good to know -- and it's important to be reminded of from time to time (I confess i was tempted to break the bag of waters during this labor. I'm very glad the temptation was resisted!).

These days there are many refferences found online --rather than just in the books on our shelves. The issue of early cord clamping is so important that there are several websites dedicated just to this subject. One of the best is by
George M. Morley, M.B., Ch. B., FACOG who writes about how hypo-volemia from early cord-clamping can be the CAUSE of brain damage after an accident-of-labor -- and that asphyxia can often be reversed by keeping the cord intact.

Dr.Morely argues strongly against cutting cords when they are around the neck. In his words "By relieving the cord compression, (unwinding the cord from around the neck, loosening the true knot) placental circulation reverses the asphyxia and placental transfusion rapidly reverses the hypovolemia. Pulmonary resuscitation with the placental circulation intact will usually result in a pink, crying newborn (with an intact brain) within five minutes. Transfusion of oxygenated placental blood that increases blood volume by less than 50 percent prevents hypoxic, ischemic injury".
He includes a good bit of documentation.

He also reminds us that there is NO DOCUMENTATION -- ever in history -- of any benefit from early cord clamping! He writes. "Not one publication over the past 200 years, peer reviewed or otherwise, endorses the practice of immediate cord clamping; all relevant articles and opinions condemn it," and i think he's correct. I can only find the occasional annecdote or oppinion piece about theoretical benefits -- mainly being an unsupported assumption that early-cord-clamping prevents polycythemia. The lack of data doesn't seem to stop the spread of annecdotes --or cause many to question this routine and dangerous intervention. Immediate cord clamping of a healthy baby has many negative health affects, and clamping the cord of an asphyxiated infant? Well... see Dr Morley's article titled "Neonatal encephalopathy, Hypoxic Ischemic Encephalopathy, and Subsequent Cerebral Palsy: Etiology, Pathology and Prevention" in the Lancet for yourself.
The website http://www.cordclamping.com/ has many intersting articles and links. The evidence for harm from early-cord-clamping is pretty overwhelming.

The evidence showing benefits is pretty overwhelming also. The Journal of Midwifery Womens Health. 2001 Nov-Dec;46(6):402-14,published an article by J.S. Mercer titled "Current best evidence: a review of the literature on umbilical cord clamping."
Here are some excerpts: "Immediate clamping can reduce the red blood cells an infant receives at birth by more than 50%, resulting in potential short-term and long-term neonatal problems... without symptoms of polycythemia or significant hyperbilirubinemia". Listed benefits include: Higher red blood cell flow to vital organs in the first week;less anemia at 2 months; increased duration of early breastfeeding. For preterm infants benefits included higher hematocrit and hemoglobin levels, blood pressure, and blood volume, "with better cardiopulmonary adaptation and fewer days of oxygen and ventilation and fewer transfusions needed". PMID: 11783688 review

Delaying cord clamping has long lasting benefits including reducing infant anemia in the first year of life. The World Health Organisatin is now considering recomending delayed cord-clamping as the preferred routine procedure.





Posted by midwiferyeducation at 9:37 PM PST
Updated: Sunday, 28 December 2003 9:51 PM PST
Saturday, 27 December 2003
OMC meeting
I had been told the location of the jan 9th meeting was changed, but apparantly that's not so.......It will be held at the usual location --the spiritual center in eugene.

Posted by midwiferyeducation at 1:25 PM PST

well, Christmas has come and gone. I don't know about most folks, but i always feel melancholy this time of year. Seeing freinds and family is wonderful, but it almost points up how fragile are our connections and how short our time together may be. The baby neices and nephews-- the young cousins - grow to be toddlers, kindergardners, teens and college age -- and it all seems to happen so swiftly. (Perhaps i'm feeling this so strongly because this is my sons first year "away" at school -- OSU - and I've discovered the empty nest syndrom is a true malady! It doesn't seem to matter that there are four still left at home-- one is gone! But, the solstice is past! The days are now just a tiny bit longer. Morning comes about ten minutes earlier each day - -and the difference is now noticible! I LOVE IT! On the midwifery front -- did anyone see a recent news article about a possible link between low-selenium levels and pre-eclampsia? It'll take a lot of work to see if there is any true link - and which is cause and which is affect. And whether supplementation works for treatment or for prevention. Butit's interesting to see another theory proposed (there've been so many over the years).

Posted by midwiferyeducation at 1:04 PM PST
Monday, 22 December 2003
OMC
I've been busy tweeking the website (midwiferyeducation.org) posting pictures of the novemenber conference etc. Having some troubles with the pictures -- some people can see the and some can't and it's probably my fault - but I'll figure it out eventually.
Making some cookies this evening -- that's a christmas tradition almost forced upon us isn't it? I think my kids would feel more deprived if they missed cookies than if they missed gifts!

anyway, i was adding links to the page and added the OMC link - but that webpage is still down and has been for a long time --weeks maybe? Lisa (current president) told me the next meeting is january 9,but the location is different from before?

Posted by midwiferyeducation at 9:42 PM PST
Friday, 19 December 2003

well, spent some of the day on a job interview! Yippee, it went well! I'll have a hole in my birth schedules for a while (which I'm committed to using for my book), but with some part-time work i can bring in some income too. Good news indeed! One of my other projects is learning webcraft, and i learn best by doing: so I'm going to post those websites as links right in this post (just to show i can do it). Oregon Poison Control SIDS RESOURCE CENTER OREGON HEALTH DIVISION PUBLIC HEALTH WEBSITE

Posted by midwiferyeducation at 8:16 PM PST
Updated: Friday, 19 December 2003 8:26 PM PST
Thursday, 18 December 2003
links to important things
I want folks to use this page as a community resource, so I'm going to post a few local links here, and then try to set them on the sidebar too. If you have any good ones, let me have 'em! OREGON POISON CONTROL http://www.ohsu.edu/poison/ SIDS RESOURCE CENTER http://www.teleport.com/~sidsor/index.htm OREGON HEALTH DIVISION http://www.ohd.hr.state.or.us/ccfh/welcome.htm NEWBORN HEALTH BOOKLET http://www.ohd.hr.state.or.us/ccfh/welcome.htm

Posted by midwiferyeducation at 7:20 PM PST
funeral
it's been a long couple of days. Did get down to Peggy's funeral. It was sad and sweet as all funerals are. Her family and freinds gave us all a wonderful gift of a celebration of her life.

It rained heavilly all the long drive down......almost three hundred miles of driving rain. Most appropriate for a funeral!
It finally cleared for a while as we drove into Ashland -- a really sweet town -- nice to see it again.

Peggy died unexpectedly. We lived on opposite ends of the state so I didn't know her as well as I wished, but felt an instant freindship with her. She called me on the phone a few weeks ago; we talked "midwifery business" for about an hour! She was full enough of energy and enthusiasm. "You can do it, I know you can", she said to me several times when I expressed uncertainty. She was so sure -- and her "sureness" was infective. I guess it's a great thing if opptimism could be contagious!

Funeral --- Maybe we should use a better name for this goodbye ceremony. I often feel closer to a person AFTER the funeral than before - as if it's not 'goodbye" but more of chance to know someone in a new way -- a more complete way.

I've had a number of freinds die the last few years. I guess that will naturaly become more common as we age. I hate to lose someone.......and i hate the REAL grief which comes from knowing that we would have, could have, should have, spent more time together, if we'd only known how short our time was going to be.

My freind Terry and I were always "going to go to Hawaii someday". We had both lived there separately as children and longed to go back, even if only for a few weeks. We met in oregon as adults and people often assumed we were sisters. We felt that way. She died of a virulent, rapid, evil cancer. When she was sick -- far too sick to travel --we regretted we'ld never taken that trip together. There had always been some reason to make it happen "next year maybe", when there was more money or more time. But TIME was what we didn't have. What SHE didn't have. And now she's gone. What's the use of the money we saved by not taking that trip? We're just as poor as we've always been... we're not any richer for having stayed home - done the responsible thing. We would have gone -- if we'd only known the time was running out.

"If only"
Those are two very sad words.

well, i'm gonna get off to bed.


Posted by midwiferyeducation at 12:09 AM PST
Friday, 12 December 2003
just linked to the website
i just set a link to my website, midwiferyeducation.org
We'll see if it works.

Posted by midwiferyeducation at 6:12 PM PST
getting together
guess i'm gonna go down to the funeral - unless something comes up. Dunno who else is going or whether carpooling might happen.
mostly posting this just to see if i can find the blog afterwards..........and when i get time wanna figure out the easy way to set up links.

Posted by midwiferyeducation at 11:45 AM PST
Thursday, 11 December 2003
first post
i'll try this a while; see how it goes. I'd like to make this a public blog for area midwives - -a sort of group discussion and communication place.

but today's entry is pretty basic.
The large issue is whether I can make arrangements to go to peggy's funeral. She was a nice woman to know -- sad to think of her dying so suddenly and so young. I was brought up in a culture which MANDATES attendance at a funeral..and excuses of time, expense, inconvenience are never allowed. It's 300 miles, but that isn't much time in the scheme of a lifetime -- i've been to double features that long! (heck, the starwars trilogy was longer than that!)
soi will definitely go if i can get coverage for my client due on CHRISTmas. She's extremely unlikely to go into labor before the 24th.

midwives are going from all over the state -- might have a sort of slumber party down there in Ashland.
There's that old irish blessing "May the church be too small to hold all those who come to your funeral" -- it's a good thought.
though we'dbe better people if we honored each other more while we were alive --rather than waiting for the touch of death to bring people in one place to show honor, love, and appreciation.

Posted by midwiferyeducation at 10:00 PM PST

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