Hands off the cord!

Even before the fertilised ova, or egg embeds in the womb, there is a division of cells into those which will become baby or placenta. Both placenta and baby need to be healthy, connected and functioning as naturally as possible for the pregnancy to result in the birth of a baby and placenta at about 40 weeks gestation.

Due to its significance for Maori, most New Zealanders have learnt to respect the placenta once it is delivered, still most babies here, as elsewhere, are having their cord cut before its vital work has finished. Yet Maori acknowledge that ‘the place where one’s umbilical cord was severed is ….a place of special importance for each person…………their place of first emergence into the world, of first maturation and foundation.’  This cultural perception is consistent with the physiological reasons why the cord should be left to finish its work. Similarly those who practice Lotus birth or leave the cord and placenta to separate naturally, do it for a variety of reasons which acknowledge the united origin, life and history of baby, cord  and placenta.

What is lost with early cord cutting?
While the cord is pulsating both it, and the placenta are functioning organs. Thus, when the cord is clamped and, or cut prior to its natural shut down of these structures, both mother and baby miss out on good things intended for each of them. When not interrupted, a complex interplay of the final birth events aids the baby’s first breaths, shuts down the cord, separates and expels  the placenta from the womb and minimises bleeding. Typically, the cord continues to pulsate for up to 5 minutes after the baby’s birth, returning blood to the baby’s circulation including its lungs this increases the internal pressures squeezing fluid out of the lungs, thus helping the baby’s first breaths. The first breathing efforts of the baby also draw more blood into the lungs, again changing the internal pressure ranges which help close the heart openings which were part of the feotal (baby in the womb) circulation.

A woman who births her placenta, rather than has her placenta delivered or pulled-out, after a vaginal birth is using her body as it is intended; she and her baby are utilising the final surges of birth hormones to not only complete the birth but also to begin their new life together in the healthiest state possible. For example New Zealand midwifery data and other sources are beginning to refute the claim that ‘Active Management of the Third Stage’ reduces the risk of haemorrhage. Other studies are exploring negative impacts of the drugs used in this intervention which has over-ridden natural birthing of the placenta, with-out any evidence of benefit to mother or baby.

It is hard to know when clamping and cutting of a pulsating cord started, though the ancient Greek philosopher Aristotle warned against early tying of cords, as did Erasmus Darwin in 1801. There are many different types of cord ties or clamps these days, each with their own accessories for application, removal or both. However no manufactured versions have the natural antibacterial and softness of the traditional Maori flax tie or muka, nor the love connection of a mother’s handmade creation.

In 2009 the UK Royal College of Obstetricians and Gynaecologists said that “Immediate cord clamping became routine practice without rigorous evaluation. There is now a body of evidence suggesting that immediate, rather than deferred, clamping may be harmful for both term and preterm births.”  Professor of Obstetrics Nicholas Fogelson explores the impact of premature cord clamping and answers concerns about things like the impact of gravity on the uncut cord, in 3 YouTube videos. The primary risk for a baby of having its cord cut before it has stopped pulsating is the loss of up to one third or more of its blood supply along with vital blood-borne nutrients needed for its outside the womb life. Thus Prof Fogelson likens cord clamping to the old practice of blood letting; the original ‘iatrogenic’ or doctor caused injury, for if adults lost this much of their blood they may need a transfusion to cope!.

Because the return of cord and placental blood to the newly born baby helps the initial expansion of their lungs, cutting of this life line can be linked to subsequent traumas for baby and mother involved in resuscitation and, or separation in a nursery for observation or treatment of an exsanguinated baby. Studies have also found the loss of blood volume and associated nutrients from cord clamping places premature babies at increased risk of intra-cerebral (inside the brain) bleeding and infections. Cutting a cord which is around the baby’s neck before it has been born, risks not only the highest possible depletion of the baby’s future blood supplies, but the cutting of its oxygen supply line means there is a high risk of brain damage if immediate delivery is not possible. As information is now widely available on the web about alternative techniques and the related physiology maternity carers need to stop searching for, cutting and fearing ‘nuchal‘ (around the neck) cords thereby acting on the ethical1 and practical implications of this non-evidence based practice.

A UK Obstetrician has developed a new baby resuscitation trolley to encourage hospital staff to leave the cord intact, however home-birthers have long known that along with an intact life-line, the mothers chest and voice are vital components for reviving stunned babies. We need to go back to the ancient medical motto of “First do no harm” and keep our hands off the cord till it has finished its life saving work.

Studies into the impact of not doing immediate cord clamping and cutting are showing that this common practice denies babies their biological needs and means to reach their full developmental potential! The UK National Institute of Clinical Excellence have recently moved  to recommend delayed cord clamping of at least i minute following an online  campaign by a British midwife, it is past time that all babies were no longer robbed of their optimal circulation that nature intends them to start life with!

1. Hutchon, D.J.R. Immediate or early cord clamping vs delayed cord clamping  Journal of Obstetrics & Gynaecology November 2012; 32: 724- 729

 


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