Premature Cord Clamping: Another Head-Banging Moment

Sometimes you just want to head-bang - and it's not because you've found the perfect beat.

It's because you see something about birth in the media that makes you want to run to the nearest wall and banging your head against it. Repeatedly.

Okay, well, maybe this one wasn't one of the "violent head-banging moments" - perhaps just a "moderate head-banging moment." But it's about one of my special birth interests - premature cord clamping - so that kicked it up a notch with me.

I firmly believe that clamping the umbilical cord while it is still pulsing (that is, while blood is still being actively transferred from the placenta to the baby) is harmful. There is plenty of evidence that this is true, and that delayed (or physiologic) cord clamping (DCC) is beneficial (for example, see this great article), but unfortunately immediate cord clamping (ICC) within seconds of birth is still the standard of practice.

If you have doubts on this issue, consider the following: How many baby animals have you seen in the wild who are dead and dying because their umbilical cords weren't clamped and cut immediately? That's right, none. And how did people survive before the advent of premature cord clamping, which is only about 100 years old? That's right, the species survived just fine - because it's not a necessity. (There was plenty of mortality/morbidity surrounding childbirth, but delayed cord clamping was not an indicated factor.) If umbilical cords needed to be cut before they stopped pulsing, then they would clamp down naturally. It goes along with my new maxim - in the absence of pathology, go with the default. Routine interference with a natural process or state is risky.

So it's not surprising that in the story below, the 911 operators told the children catching the baby to clamp (tie) the cord.... but it's still saddening, and somewhat revolting (tie it with a shoelace??).

California Kids Help Mom Deliver Baby

Let's look at the possibilities. Possibility #1: The dispatcher tells the kids to leave the cord alone. The cord finishes pulsing on its own, ensuring that baby gets all the blood it was meant to have, and the cord can later be cut with a sterilized instrument. Possibility #2, which is what happened: The dispatcher tells the kids to tie the cord with a string:

"After the baby was born, the dispatcher can be heard telling Faith to wipe the baby with a clean towel and tie, not cut, the umbilical cord with a string or shoelace about six inches from the baby's body."

Meaning what? (1) Baby loses a substantial amount of blood which he would have otherwise received. (2) The cord is tied with a non-sterile, possibly quite dirty piece of material which could possibly contribute to infection. Both are completely unnecessary risks introduced artificially into the situation by bad protocol.

I wonder if there is any way to contact emergency services to encourage them to change their childbirth-coaching protocol?

There are multiple other problems with this situation, which I won't go into, but for now - I really hope that some influential MDs can get ahold of the premature cord-clamping issue and start championing it. Until then, it will stay a grassroots issue. But definitely one worth fighting for!

This reminds me of something that a midwife-friend of mine said a month or two ago. She was talking about a report from post-earthquake Haiti in which doctors delivering babies were complaining about having to use dirty twine to tie umbilical cords and a non-sterile shared knife to cut cords. She said (and this is a paraphrase): "This is where my midwifery knowledge would come into play. I know that immediate cord clamping and cutting is not necessary. In this situation, they could just leave the cord intact, bundle the placenta together with the baby and then cut the cord the following day when it has completely clamped down and is dry - and the risk of infection is nil. The way they are doing it, they are just asking for infection and tetanus." (Not to mention the whole issue of blood-deprivation.) Good thoughts.

Comments, anyone? Thoughtful and civil discourse is always welcome!

Have a wonderful weekend, all!