Meeting National Science Challenge 2 !

As per the Prime Minister’s Science Advisory Committee’s website , the 10 National Science Challenges has care of older citizens ahead of a better beginning for future generations, so as an older midwife I have written to Sir Peter Gluckman suggesting  one way of “improving the potential of young New Zealanders to have a healthy and successful life” is by national adoption of delayed cord clamping and, or cutting after birth, as standard maternity care.

The letter contained information from a previous blog as follows;
Due to its significance for Maori, many New Zealanders have learnt to respect the placenta by burying it at home rather than leaving it for hospital disposal. Yet most babies here, as elsewhere, are having their cord cut before its vital work has finished. 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 perspective matches physiological reasons why the cord should be left to finish its work, knowledge of which is being internationally recognised and New Zealand needs to incorporate into its unique maternity care services.

In 2009 the UK Royal College of Obstetricians and Gynaecologists stated “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.”   Since then this issue has become the subject of a growing number of web sites, discussion boards, videos on YouTube, TED Talks, international campaigns and conferences. This is because the primary risk for a baby of having its cord cut before it has stopped pulsating is the loss of possibly one third or more of its blood supply and vital blood-borne nutrients.

Studies have also found that premature babies are at increased risk of intra-cerebral bleeding and infections due to the loss of blood volume and associated nutrients from immediate or early cord clamping at birth. The cutting of nuchal (around the neck) cords is doubly dangerous as it not only depletes the baby of blood volume and nutrients but it cuts its vital oxygen supply creating a high risk for brain damage if immediate birth is not possible, which at least one court case for compensation has recognised.

No wonder USA Prof Fogelson draws a comparison with archaic blood-letting and suggests cord clamping may be the original ‘iatrogenic’ (doctor caused) injury, for if an adult lost this much blood they would probably be offered a transfusion regardless of the cause. As a paediatrician and researcher into hormones, epigenetics and development from birth, Prof Gluckman would appreciate that while we allow the cord to physiologically complete its work the mother and baby are sharing peak levels of labour hormones that are the best foundation for the baby’s ongoing emotional and physical health[1], [2]. Not to discontinue this non-evidence based practice has ethical[3] as well as physiological implications that should be addressed by all professional maternity care provider organisations and institutions in New Zealand. Meanwhile New Zealand data and other sources are refuting claims that ‘Active Management of the Third Stage’ reduces the risk of maternal haemorrhage whilst other studies are revealing negative impacts of the drugs used in this questionable ‘treatment’.

A UK Obstetrician concerned about this practice has developed a bedside, baby resuscitation trolley to encourage hospital staff to leave the cord intact. Also skin-to-skin studies are now confirming that along with an intact life-line, the mother’s chest and voice help the baby to transition to extra-uterine life especially when shocked and recently revived one pronounced dead. Therefore birth attendants need to “First do no harm” by allowing future umbilical cords where-ever possible to finish their life giving work as a means to improve “the potential of young New Zealanders to have a healthy and successful life”.

Five other cost effective ways to meet the Second National Science Challenge would be to have the Ministry of Health integrate all the evidence based recommendations of the Maternity Manifesto  into national maternity policies and guidelines. The Maternity Manifesto which has the support of most New Zealand maternity consumer and professional groups, seeks national adoption of the following maternity care strategies;

  • Normal Birth: Labour and birth which starts, progresses and ends naturally achieves the best outcomes for women, babies and whanau as well as uses less health resources, should be the New Zealand gold standard for maternity services with campaigns to monitor and improve such “normal birth” rates.
  • Alternatives to Hospital Birth: The place of birth dramatically affects birth outcomes, therefore New Zealand needs promotion and support for healthy women to access birth centres or birth at home to increase “normal birth” rates, benefiting women, whanau and the community.
  • Mother-Baby Unity Care Of All Sick Newborns; The New Zealand “rooming-in” standard for healthy babies and sick children should be applied to the care of sick babies as this approach has short and long term benefits for babies and our community.
  • Human Milk Banks; New Zealand, like most other countries, should re-establish human milk banks utilizing the high level of screening techniques now available.
  • Comprehensive Implementation of the WHO Code; To achieve the MOH target to raise the proportion of infants exclusively breastfed for at least the first six months, New Zealand needs to fully adopt the WHO Code to regulate the marketing of breast milk substitutes, as marketing currently undermines the efforts of our women and communities.

If you agree with these propositions you can use any of this information in your letter or email (Tweet) to Prof Gluckman at;

Office of the Prime Minister’s Science Advisory Committee
Email: info@pmcsa.org.nz
Mailing address: PO Box 108-117, Symonds Street, Auckland 1150, New Zealand
Physical address: 2-6 Park Avenue, Grafton, Auckland 1023, New Zealand
Phone: +64 9 923 6318

 REFERENCES:

[1] “The hormones of closeness; The role of oxytocin in relationships” by Kerstin Uvnas-Moberg (2013) London

[2] “Functions of the Orgasms; the Highway to Transcendence.” by Michel-Odent (2009) London

[3] 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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