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
