Lucy– Check out Nurturing Heart Birth Services (link above) but my sense is that we can use them. The photographer says she took these for educational purposes. Very generous and very, very helpful!

Great images!

Great pictures–thanks for sharing! The link behind “great education website” is broken. Where was it supposed to go.

that is cool. we debated on this, and ultimately really wanted to donate the cord blood, for all of the good it could do. i vacillated for a while, knowing the delayed cutting would be a boost to my baby, but also knowing that my baby’s blood might do someone a tremendous amount of good (you can’t delay cutting AND donate). i still feel torn on the issue. thoughts?

About that cord around then neck. I have been a midwife for 17 years, seen many cords around babies’ necks (occurs more often than most people realize – it’s normal). Cutting the cord prior to deliverying the shoulders can be very dangerous. It is the only source of oxygen for the baby. In the event that there is a shoulder dystocia (difficulty getting the shoulders out), the only thing the baby has as an oxygen is the blood from its cord. A better strategy is to somersault the baby up onto the mother’s abdomen and then gently unwrap the cord. Works every time. I’ve never had to cut a cord – even very tight ones.

I would love to know the statistics on how many of the delayed cord cuttings are related to hyperbilirbinemia/jaundice in the next few days after birth. Jaundice can cause problems fro the baby as well.

It is worth mentioning that during the switching of the newborn blood circulation from the placenta to the lungs, the baby collects oxygen from TWO sources: from the mother through the placenta and from his lungs that gradually take over the whole process. That process involves the closing of an orifice in the heart and the gradual opening of blood vessels, as well as the opening and dilation of the airways in the lung. Meanwhile, the condition of the newborn is easily monitored by looking at the color of the skin, testing the muscle tone (in the legs) and the pulse in the umbilical cord.
Precipitating the natural switching process by clamping prematurely the umbilical cord suffocates the newborn and causes the onset of brutal and painful gasps that makes the newborn cry in pain.
More at http://www.betterchildbirth.com
Edmond Devroey MD

Did this with my last child, as it was a home birth and I had so much more control, (wanted it with my other three, but hospital, no control). It was amazing, I was nursing him while he was still receiving cord blood. When it was empty and it stopped, my 9 year old cut the cord. What a miraculous moment!!

God in His infinite wisdom knew babies needed this life giving 15 minutes.
I am thankful He shared that wisdom with me, and now all of you. ♥.

I had the cord cut immediately with both of my children and they are both healthy babes. i really don’t think one way is better in the long run than the other. It’s just a personal choice.

already common practice in Canada (unfortunately not with my child cause she was breach and we had to have a c section but i even heard of hospitals that wait after a c section), america is really way behind regarding childbirth, a very good documentary about this is “the business of being born”, i can’t imagine a single women who wants to have a birth in a regular american hospital after seeing that, worth to watch!!!!

Wanted to do this and my OB was for it. However, I had an emergency c -section with a very dramatic drop in blood pressure so I have no idea if it was actually done (I was very woozy.) Considering all the drama that was going on, I think they wanted to get the babies out as quickly as possible. My little girl did have some trouble breathing on her own and I wonder if delayed cutting would have prevented that.

Midwives have been practicing this forever now… So glad to see that ‘known’ source picked up on this.

Yes, I am an OB nurse. I do believe in baby friendly practices. We do promote waiting until the cord has stopped pulsating until it is cut BUT in certain instances this is just not safe. In the case of meconium, it is more dangerous for the baby to take the firdt cry and inhale meconium into the lungs. Bulb suctioning only removes what is in the upper airway and mouth,deep suctioning is needed to clear all the meconium. And for the midwife that talks about somersaulting the baby onto the mom’s abd? Really? Guess you’ve never had a short cord. If the nuchal is tight with a short cord, the baby can be asphyxiated BEFORE the head even delivers. Wonder how bad the heart tones on those babies looked? If it is the safe option, then go for it, but it is not always the safest option! Just like not everyone gets a vaginal delivery. Birth is still very unpredictable. Everyone wants to down the hospitals and birthing, but we strive for what is best for the patient. Music, warm bath, massage, etc. But if it is a high risk pregnancy, we do constant fetal monitoring, but do invite position change. We encourage doulas. But, when a baby gets in trouble, we can act fast. Interventions are available. You may not have that at home. If it takes 10 miutes to drive to the hospital, if the baby drops its heart rate to 40, chances are that by the time intervention is preformed, it will not be a very favorable outcome. So, before you diss the hospital birth experience, check out some of the stories of babies that have been saved!!!!

I agree with Baby Friendly OB Nurse, sometimes the cords are so short you can’t even separate the baby 3″ from the perineum, let alone place the baby on the mom’s chest.

As for JoAnn Peistrup comment about the cord being the only source of oxygen during a dystocia: you don’t think a nuchal cord is being compressed during a dystocia? Unless you have a magic want that tells you cord length prior to delivery, you don’t know if you’ll end up avulsing the cord at the insertion point in the placenta or not, so cutting it seems a reasonable option.

I haven’t seen anyone discuss the risk of jaundice and hyperbilirubinemia that comes with delayed cord clamping, if untreated, this can lead to kernicterus (ie permanent brain damage), the baby may need multiple blood draws (ie needles in a vein or a hole poked in the heel) to check bilirubin levels (this hurts by the way) and placement under bili lights (baby can’t be with you during this, he/she is alone under the lights, for as long as it takes for the bili levels to drop) with possible dehydration.

And no, you can’t collect enough blood form the placenta for banking, it’s just not possible after the cord is empty. The blood is collected form the umbilical vein, not the parenchyma (placental disk), once the vein is empty, you can’t refill it. You usually need over 3 oz (100ml) for an adequate collection and at minimum 75 ml. Either the baby gets it at birth or when the baby or donor need it for a stem cell transplant; can’t have your cake and eat it too on this one.

As for delayed clamping during a cesarean section: The uterus bleeds where it’s cut to get the baby out until it’s able to contract the muscle and compress the vessels that were giving blood flow to the placenta. As long as the placenta is inside the uterus, the contraction can’t happen, hence the muscle bleeds wehre it was cut. So you can’t wait until it stops pulsating or delay preventing the mom from hemorrhaging for this. Average blood loss for a cesarean section is 1L as it is, you don’t want to do anything on purpose to increase this.

How about the happy medium of milking the cord towards the baby before cutting it? Takes 5 seconds, the baby gets the same benefit and can be done in vaginal or cesarean section.

Anyone consider the risks of polycythemia? That along with hyperbili came along to mind, as a NICU RN. I work in a children’s NICU though, so I don’t go to deliveries.

Suctioning has not shown to make a difference in preventing meconium aspiration, since this is associated with fetal hypoxia (intrapartum hypoxia and cord clamping) and not just the presence of meconium. Healthy newborns that transition normally clear their own lungs, and the blood derived from placental transfusion is part of this mechanism.
This brings me to cutting a nuchal cord because it is applied tightly around the neck – which most likely tightened as the head descended. Yes, the cord may be short and there could be a dystocia – neither of which can be known before contractions/maternal effort to deliver the shoulders occur. Yes, a truly compressed cord can result in temporary asphyxia – HOWEVER the point of keeping the cord intact is to ensure the compression can be relieved immediately after birth, the baby does not experience further oxygen-deprivation, the baby access to the placental circulation to correct low blood volume/academia, and avoid increasing the risk of meconium aspiration (gasping, vagal response from suctioning!).
Most of the data shows delayed clamping is not the cause of clinical jaundice, polycythemia etc – the studies that showed any significance (still small) are unpublished and/or did not adjust for factors like labour induction and augmentation with oxytocics (which are associated with clinical jaundice).
There is no biological evidence to prove that normal placental transfusion at birth causes hyperbilirubinemia leading to brain damage – the etiology of this disease has been shown in other primates to be preceded with severe fetal hypoxia which damages the blood/brain barrier. This makes it even more imperative to avoid obstetric interventions whereever possible that risk fetal hypoxia (prolonged contractions from induced/augmented labours, premature cord clamping of compromised infant).
Avoiding the cord clamp during placental transfusion avoids terminating the normal, placental-mammal birth process and physiological transition at birth. There is no adequate evidence or justification for phlebotimising human infants at birth.