Wednesday, 6 January 2010

Obstetricians attitude to delayed cord clamping

Obstetricians attitude to cord clamping Midwives who work with women in a one to one relationship based way with childbearing women weren't at all surprised when researchers found massive benefits with leaving the cord alone after birth for the newborn. Midwives working with women they know are also very aware of the benefits to the mother of leaving the cord alone after birth. Mainstream maternity care has yet to recognise or discover that aspect.

Photo from Wikipedia

Now that current evidence indicates that leaving the umbilical cord to pulsate for at least 3 minutes after birth confers many benefits to newborns, recommendations have been made to change established hospital practice and leave the cord to pulsate. Benefits for the baby from the extra minutes of blood transferred from the placenta include: stem cells, optimal lung and cerebral perfusion, increased number of red blood cells, appropriate blood volume transfer and placentally transferred oxygen during those precious moments as the baby switches from intra to extra uterine life and circulation; reduced rate of sepsis, reduced rates of intraventricular haemorrhage and reduced rates of necrotising enterocolitis.

Two intrepid researchers, both consultant obstetricians, sought to discover whether obstetricians have changed practice in regards to cord clamping in light of the new insights about the value of cord blood to the infant following birth.

Doctors Ononeze and Hutchon‌ said in their article in the Journal of Obstetrics and Gynaecology (2009)

"Questionnaires were given to obstetricians from 43 different units in UK, other EU countries, USA, Canada, Australia etc. There was a 100% responserate. 53% adopted the recommendation only occasionally whereas 37% have never. Difficulty with implementation in clinical practice was the main reason for failure to adopt recommendation. Unawareness of the evidence of the benefits of delayed cord clamping was the reason in half of the non-compliant group".

Interesting that so many obstetricians a) didn't know about the benefits of leaving the cord to pulsate after birth and b) didn't believe the evidence and c) found it difficult to do in practice. The researchers disagreed leaving the cord to pulsate was difficult in practice, so we can only assume it is because the doctors were not prepared to wait those few minutes.

Given that evidence informed practice is touted at every opportunity in contemporary health care, it is very surprising that our medical colleagues are not up to date and can't find ways to put evidence to work for the better health of babies.

"There is no consensus amongst medical and midwifery staff as to when to clamp the cord following delivery of the newborn. The tradition in obstetric practice is to clamp the cord immediately after birth".

The lack of consensus in timing of cord clamping may well exist in the system that approaches birth as a moving conveyor belt experience in a factory, however those of us who work in relationship based practice are agreed that the best time to cut the clamp and cut the cord depends upon the mother's thinking about how to manage her placenta. For those women who want to leave the baby and placenta attached, then the cord is never clamped and cut. The cord falls off the baby's umbilicus in it's own time. For others, they choose to birth their placenta, then clamp and cut it. Once women understand the process of third stage, they choose to manage it themselves and do very well.

Fabulous to see these two obstetricians doing such great work. Their perspective and honesty is commendable.

Journal of Obstetrics and Gynaecology. 2009 Apr;29(3):223-4.

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