Answers to common objections to delayed cord clamping

Most Bradley students include in their birth plan that they desire delayed cord clamping. Sometimes they are met with objections from their birth team. Here is an article, siting recent research, that pediatrician Mark Sloan, MD wrote refuting common objections.

Unclamped cord over the course of 15 minutes

Please click on the title to read the full article.

Common Objections to Delayed Cord Clamping – What’s The Evidence Say?

November 13th, 2012 by Sharon Muza

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by Mark Sloan M.D.

Today’s guest post is written by Dr. Mark Sloan, pediatrician and author of Birth Day: A Pediatrician Explores the Science, the History and the Wonder of Childbirth.  Dr. Sloan shares information and current research on delayed cord clamping after birth, in a helpful Q&A style format that consumers and professionals can use to discuss this important topic.

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photo credit pattiramos.com

Many maternity care providers continue to clamp the umbilical cord immediately after an uncomplicated vaginal birth, even though the significant neonatal benefits of delayed cord clamping (usually defined as 2 to 3 minutes after birth) are now well known.

In some cases this continued practice is due to a misunderstanding of placental physiology in the first few minutes after birth. In others, human nature plays a role: We are often reluctant to change the way we were taught to do things, even in the face of clear evidence that contradicts that teaching.

Though there is no strong scientific support for immediate cord clamping (ICC), entrenched medical habits can be glacially slow in changing. Here are some often-heard objections to delayed cord clamping (DCC), and how an advocate for delayed clamping might respond to them:

Delayed Cord clamping

In Bradley classes you will learn that delayed cord clamping is beneficial for the baby. Delaying the cord clamping allows for the baby to get the proper blood volume and additional iron. The link below is a scientific study of the benefits of the delayed cord clamping (in this case only 45 seconds!) for premature infants, delivered by cesarean. Not only was it found safe, but beneficial.

A randomised controlled trial of delayed cord clamping in very low birth weight preterm infants

European Journal of Pediatrics

September 2000, Volume 159, Issue 10, pp 775-777

If you don't want to buy and read the entire study:
Conclusion Delayed cord clamping of 45 s is feasible and safe in preterm infants below 33 weeks of gestation. It is possible to perform the procedure at caesarean section deliveries and it should be performed whenever possible. It reduces the need for packed red cell transfusions during the first 6 weeks of life.

Birth plans

A great article of why birth plans DO matter and what to include for a natural, Bradley birth:

Writing a Bradley Method Birth Plan  original source
By CAITLINHTP | April 4th, 2012 at 9:50 pm

When you say the term “birth plan,” there are two general reactions: 1) “That’s a really good idea.  If you are sure you do or do not want certain things under certain circumstances, it’s helpful to write it out so your midwife, nurse, and doctor are aware,” and 2) “Birth plans are pointless. You can’t plan birth.  Just go with the flow.”  Since I’m writing a birth plan, I’m obviously in camp #1, but I can understand what those in camp #2 mean when they say you can’t plan birth.  It’s a natural process, things don’t evolve according to a chart, and sometimes, emergencies happen. 

That being said… This is my body and my baby.  I have a right to make informed medical choices.  And, quite frankly, I need to write a birth plan because the statistics regarding what commonly occurs in a hospital are not in line with my personal preferences regarding childbirth.  For example, in 2004, the episiotomy rate was 24.5% (an episiotomy is a surgical incision of the perineum).  I would rather use midwifery techniques to prevent tearing (massage, warm compress) or tear naturally than get an episiotomy (here’s why).  I want to be 100% sure that my midwife, nurses, and doctor are aware that I do not want an episiotomy preformed unless it is a true emergency.

I feel the need to preface the rest of this post by saying that my opinions about my ideal birth are just that… My opinions on my ideal birth. I’m not trying to preach about what other women should do or judge other choices.  Personally, I have always found it interesting to read about what women decide to do and why, even if they do something I would not choose for myself, so that is why I am sharing.

As I sit down to write my birth plan, I’m trying to integrate as much as the Bradley Method as possible.  I am waiting to write a complete summary post on the Bradley Method (probably post-baby), but I really love it so far and would recommend it to any expecting momma, even if you want an epidural, because the 12-week program gives you and your partner so much confidence regarding birth.  Bradley Method teaches natural childbirth techniques, and 90% of Bradley women who have a vaginal birth do it without medication – a pretty good success rate!

The #1 rule of the Bradley Method is not to go to the hospital too soon.  Basically, the later you arrive, the less chance of medical intervention (such as pain medication and drugs to speed contractions; remember, Bradley mommas are trying to avoid these things).  We are taught a variety of physical and emotional signposts to know when we should ideally go to the hospital.  Under normal circumstances, I’ll be laboring at home for as long as I can stand it and is safe – I really don’t want the Husband delivering the baby in our bedroom – and then my birth plan will kick in.

I’m not ready to share my final birth plan quite yet (if you’re interested in reading the draft, feel free to shoot me an email at caitlinjboyle at gmail.com), but here are some highlights.  Note that all of these items have been approved by my midwife; I can’t say that every doctor, midwife, nurse, or hospital would allow these things, but mine do.  Most of these items are in line with Bradley Method teachings, which is why I’m including them:

• Caitlin plans to have a medication-free labor. Please do not offer her an epidural. She does not want any drugs to speed along labor (i.e. Pitocin). If there is an issue, and you believe these medications are necessary, please discuss it with Kristien.
• Caitlin would like to labor out of bed and would like to be encouraged to try different laboring positions.  She may want to deliver out of bed.
• If water has not broken by the time Caitlin arrives, water should be allowed to break naturally. Breaking water should be discussed with Kristien first.
• Kristien would like to announce the gender of the baby to Caitlin.  Please do not spoil the surprise!
• Please do not clamp or cut cord immediately.  Wait at least three minutes prior to clamping or cutting.  (Side note: here’s why.)
• Please allow the placenta to come out naturally (no pulling or Pitocin injections, please).  We will be signing a medical release so we can take the placenta home. (Here’s why.)
• Baby should be placed on Caitlin’s stomach or chest immediately for a minimum of two hours of skin-to-skin contact.

I imagine that, at this point, many of you are thinking, “Dude, if you don’t want them to do anything to do, why aren’t you delivering at home or in a birthing center?”  Good question!  Ultimately, I truly understand that although I can write a birth plan, I cannot plan birth, and scary things do happen.  For me, the best place to be in that scenario is in the hospital with doctors and nurses who can help.  If there is a true medical emergency, I will trust these people to make the appropriate choices for me – screw the birth plan.

Another remark that I commonly hear about birth plans is that the birth doesn’t really matter that much.  All that matters is that the baby comes out, healthy and safe.  While I do think the ‘bottom line’ is true, I do believe that the birth matters, not only in regards to the physical health of my baby, but also for my emotional health.  The birth process does matter to me.  It doesn’t have to be perfect; it doesn’t have to follow my exact birth plan.  But I know this will be a transformative moment in my life, and I want the space around that moment to be one of positivity.  Leaving the hospital with our little boy or girl will be the most amazing thing in the entire world.  But if I can walk out those doors feeling protected, respected, happy, and healthy… then that’s just icing on top of the cake.