Cord Clamping

[mim]

After doing some research, I have decided to not have the cord clamped. Few questions - is it better to leave the cord until the placenta is delivered, or is it okay to clamp and cut it once is has stopped pulsating?
The injection they give you when the baby is delivered (can't remember the name, it's to help deliver the placenta), what are the risks, benefits to not having it? Also cord traction, what are the risks, benefits with that? I'd rather leave the placenta to be delivered on it's own, but don't want to risk heavy bleeding.
Has anybody done this, and what were the attitudes of docs, midwives? I'm delivering in a public hospital. I just want to get some advice before I present this to my doctor
Thanks!

[poshBecks]

Well, I know nothing at all about any of it really. I cant remember much about my 1st labour (except that it hurt).

I'd be interested to hear too!!

All i know is that once bub was delivered i was relieved & let the docs work their magic down stairs :eek: At the time i coulndn't have cared less about the cord!! :eek: However, you have got me thinking now....

[JanetF]

Nice to see such great research happening! :D You can easily leave the cord until way after the placenta has been born. Even when visible pulsing isn't occurring, there is still a transfer of remaining blood happening for quite some time. A managed 3rd stage (Syntometrine) has little to recommend it, although Obs believe that a trial called The Bristol Trial demonstrates that a routine managed 3rd stage is safer. The trial has been discredited by many medical people who did far better research. Check out these links :) I also have some articles which are no longer available online which are very good research into early cord clamping. PM me if you'd like to read them!

http://sarahjbuckley.com/articles/leaving-well-alone.htm
http://sarahjbuckley.com/articles/lotus-birth.htm
http://www.gentlebirth.org/archives/thirdstg.html#Postpartum/
Third Stage / Placenta / Postpartum Hemorrhage
NOTE - A separate section has been created for Umbilical Cord Issues.
Subsections formerly included on this page:
• Fetal Circulation
• Delayed Clamping/Cutting
• Cord Cutting - Round 2
• Cord Cutting - Round 3
• Lotus Birth - Really Delayed Cord Cutting
• Burning the Cord Instead of Cutting
• Early Cord Clamping - Rh Negative
• Collecting Cord Blood
• When to Clamp the Cord When Collecting Cord Blood for Stem Cell Storage or Donation

http://midwiferytoday.com/articles/bristol.asp
If you set out to compare a policy of intensive, precipitous intervention with a policy of sitting back and watching the patient bleed, obviously the former will be seen to be safer. This was the approach and conclusion of the Bristol Third-Stage Trial. But the trial, based on false premises, is completely misleading, and numerous criteria are mistaken, misunderstood or misinterpreted.
http://www.empoweredchildbirth.com/articles/birth/whatifs/bleeding.html

[JanetF]

This is on PPH which is much more common in hospitals these days as we pull on the cord ie cord traction. Drives me nuts when I hear about that happening :( Like most things in birth, they normally work perfectly brilliantly if left well alone and if the signs are clear that you need help, get it then. Routine obstetric care doesn't improve outcomes. The other risk with administering Syntometrine is that the cervix can close without the placenta getting a chance to get out and that leads to a manual extraction where you ahve to go into OR and your uterus is scraped out. Not exactly how you want to spend the hours straight after birth when you should be glowing and getting to know your baby ;)

http://midwiferytoday.com/enews/enews0135.asp
Avoiding Postpartum Hemorrhage

The three main keys to avoiding postpartum hemorrhage are good nutrition and supplements as needed, knowing the mother, and not rushing the delivery of the placenta. I always require that mothers keep a five-day diet diary. As soon as possible I recommend changes in their dietary habits if they are needed. I encourage the use of liquid chlorophyll, red raspberry and nettles. I also make a tincture of nettles, yellowdock, alfalfa and red raspberry, which I have on hand if it is needed.

The second key, knowing the mom, means making sure I have recent blood work for this pregnancy. I check hemoglobin and hematocrit and platelet count. I want to know if the mother's blood will clot properly after the placenta detaches.

As to not rushing the placenta, almost all postpartum hemorrhages are caused by being in a hurry to delivery the placenta. I believe hemorrhage is caused by the intervillous spaces not having a chance to contract and help control the flow of blood. Overmanipulation of the uterus can also cause lobes to be left on the uterine wall which result in uneven contraction of the uterus. These lobes need to be manually removed to prevent postpartum hemorrhage and infection.

Uterine atony is also a major reason for postpartum hemorrhage. It can be caused from a long labor or a precipitous labor, either of which can induce uterine fatigue and facilitate possible partial separation of the placenta. I also ascertain whether the mom has not displaced her uterus by not emptying her bladder, either shortly before pushing an/or after delivery of the baby.
-Margaret Scott, CPM in Midwifery Today Issue 49

http://www.netdoctor.co.uk/medicines/100002520.html
Syntometrine:

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.


Nausea and vomiting


Abdominal pain


Headache


Dizziness


Skin rashes


High blood pressure (hypertension)


Abnormal heart beats (arrhythmias)


Chest pain


Fall in blood pressure (causing dizziness, lightheadedness, feeling faint)


Difficulty in breathing


Shock (blood pressure too low to maintain blood supply to the tissues)


The side effects listed above may not include all of the side effects reported by the drug's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

Your doctor or midwife will make sure that all medicines given during labour are compatible.

Prostaglandins increase the effect of oxytocin and vice-versa. If you are given oxytocin after a prostaglandin your contractions should be carefully monitored.

This medicine may enhance the blood pressure raising effect of medicines given to constrict the blood vessels.

Some inhaled anaesthetics used for general anaesthesia (cyclopropane or halothane) may reduce the effect of oxytocin and ergometrine. There may also be an increased risk of a drop in blood pressure and abnormal heart beats if oxytocin is given with these general anaesthetics.

[Lucybelle]

Janet, will the fact that I am RH neg bother anyone? I refuse the stupid injection, and let the placenta come out on its own (never had a problem with this by the way).
I would prefer the cord stop pulsating before clamping too, but will my blood type be a worry? This is bub #3, I have not had any other medical problem.

[JanetF]

If it bothers your c/p they're not reading the latest research ;) In the end it's up to you! Go to this and read the 2 articles on Rh-. I think they're great! :D

http://www.withwoman.co.uk/

[Lucybelle]

Oh no, they haven't mentioned it yet, but I wasn't up with the latest research myself until my last appointment.
Glad to see it won't be a problem, I'm going to the Angliss Birth Centre and it's wonderful not to have to explain my reasoning for a gentle, natural birth to them. It's just a given, and I don't have to take my soapbox with me when the times comes YAY!

[BJelly]

Hi Mim,

I put in my birth plan that I wanted to wait until the cord stopped pulsating before clamping and cutting it.

I also requested not to have the injection unless needed - which it wasn't - I delivered the placenta within 30 mins no problems.

I discussed both these things with the midwives who were looking after me during my pregnancy, and neither was a problem.

Bub and myself were fine. Bub was very healthy, alert etc. I would definitely do it again :) .

[schmell]

I delivered my placenta naturally within 10-15 minutes of DD1 being born.

I was given the injection after having DD2 - after I told the midwife I did not want it, she told me not to be silly it was only a little needle, before I could tell her it wasn't the needle that bothered me she had jabbed me in the leg with it!! My placenta was delivered in less than 5 minutes and I was rushed into the shower and off the to maternity ward. If the silly woman had listened to me I would have been able to tell her that I wanted to deliver the placenta naturally but I didn't in the end thanks to her, I was dissapointed as I had a drug free labour and really didn't NEED my placenta to be hurried up.

I delivered it the first time while I was feeding DD1 her first feed, didn't even notice really. As it was, after the injection with DD2 I had cramps and all sorts of pains in my abdomen as my body obviously wasn't ready for this final process to be hurried along.

Make sure you tell the midwives or ob as soon as you get to the hospital and make sure your support person/people inform any shift changes of your wishes as they can be a little wham bam thank you maam at times.

[JanetF]

Sometimes it's good to have a birth plan signed by Important People in the hospy attached to your record so it's on plain view for everyone. You can also stick copies up next to the bed and on the door and have big letters saying "Please read on entry"

[mim]

Thanks everyone for replying! :D

Janet that info has been great, still haven't been through it all but I'm getting there!
I'm planning on discussing my plans with my doc, giving him a birth plan, getting a plan put with my records when I book into the hospital, taking some with me when I go to the hospital, and explaining everything to my DF.
There is quite a bit I'm planning on putting in there, so another question, how do I actually write a birth plan?
Can I insist that no one touches me without permission?

Sorry about all the questions, but all your help has been invaluable :)

Mim xxx

[JanetF]

Mim you can absolutely INSIST that no one at all touches you unless you request it. You can state NO VEs unless you ask for them and there is no reason anyone actually *has* to touch you at all. You can order people from the room if you don't feel comfortable with them. Remember, you're the boss! I strongly recommend that you buy "Thinking woman's guide to a better birth" which goes through the pros and cons of all possible interventions and explains with reference to hundreds of studies exactly what is good, bad or indifferent and what outcomes are most likely. I'll email you some birth plans written by feisty women who knew exactly what they wanted. What rates of intervention does your doc have? It's good to know that when you hire them as it gives you a far better idea of whether or not your plans and theirs are similar, and trust me, docs always have a birth plan for you which is what will happen if you don't put your own in. I love to see an informed consumer at work but you need to be very aware of the plans the institution and the doc have so you can protect yourself from them.

[mim]

Thanks Janet :D

The reason I don't want anybody touching me without permission is because when I had DD, when I was ready to push a midwife marched in, ripped off my knickers then took DD away from me as soon as she was born and I didn't get to see her for 10 minutes :( .
Where can I get the 'thinking woman's guide to a better birth'? It sounds wonderful!
Those birth plans sound great. I'm looking forward to reading them.

Mim xxx

[JanetF]

Shocking! I'm so sorry!


"Thinking woman's guide" can be bought online from a few places. I'll PM you!
:) I also recommend "Birthing From Within"

[schmell]

Sometimes it's good to have a birth plan signed by Important People in the hospy attached to your record so it's on plain view for everyone. You can also stick copies up next to the bed and on the door and have big letters saying "Please read on entry"
I had a birth plan written for both . The middies for DD1 were fantastic and took a copy to keep on the front page of my file. The middies for DD2 waved it off and told my DP there was no time to worry about that now but wouldn't listen to what either of us said we wanted after the delivery. That is the whole reason that if I have any more I will be at home with a doula!! Hence why I say make sure your support people are pushy with the middies about reading or at the very least hearing your plan.