Transcript: Delayed Cord Clamping After Birth

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Preggie Pals
Delayed Cord Clamping After Birth
Episode 114, August 4th, 2014

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Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.
[Theme Music]
ANNE COOPER: As you approach your birth you may be considering delayed cord clamping. What are the pros and cons for you and your baby? I’m Anne Cooper a certified nurse midwife and today we’re learning all about delayed cord clamping. This is Preggie Pals.

[Theme Music/Intro]

STEPHANIE GLOVER: Welcome to Preggie Pals, broadcasting from the birth education center of San Diego. Preggie Pals is your online on-the-go-support group for expecting parents and those hoping to become pregnant. I’m your host Stephanie Glover. Thanks to all of our loyal listeners you’ve joined the Preggie Pals club. Our members get special episodes, bonus content after each new show plus special giveaways and discounts. See our website for more information.

Another way for you to stay connected is by downloading our free Preggie Pals app available in the Android, iTunes and Windows market place. Samantha, our producer, is now going to give us some information about our virtual panellist program.

SAMANTHA EKLUND: Thanks Stephanie. So if you don’t live in San Diego but you’d like to be part of the discussion here on Preggie Pals, like us on Facebook and follow us on Instagram #preggiepals. We’ll post questions before our show starts and we’d like for you to comment so we can incorporate your thoughts into our episode. For more information head to our website www.preggiepals.com .

STEPHANIE GLOVER: Great! So we’re going to go ahead and introduce ourselves around the room here. My name is Stephanie Glover. I’m 32 years old. I’m the new host of Preggie Pals and I’m also a stay at home mom to two little girls. Gretchen is almost 3 and Lydia is 10 months old. I had two hospital births the first being a caesarean and the second a VBAC.

ANNIE LAIRD: I’m Annie the former host of Preggie Pals but I’m just hanging around until I moved halfway across the world. I’m a labor doula. I’m 36 years old and I have three little girls, a 9 year old, a 2 year old and an 8 month old. The first was a hospital birth, the second was a home birth and that was a transfer into the hospital and then the third was a home birth.

SAMANTHA EKLUND: I’m Samantha. I am the producer here at Preggie Pals. I am 22 years old. I’m currently a stay at home mom to my 20 month old Olivia. She was an unplanned caesarean and I’m hoping for a VBAC sometime in the future.

[Theme Music]

ANNIE LAIRD: Hi Preggie Pals. We have a question for one of our experts. Nancy in La Jolla in California writes “Is acupuncture effective for being on labor? My OBGYN is going to induce me if I get to 41 weeks and I would like to avoid that if it all possible”.

JAMIE BOYD: Hi this is Jamie Boyd from Whole Family Acupuncture in San Diego California. I specialize in women’s health and women’s and men’s reproductive health, pregnancy and paediatric acupuncture and I’m responding to Nancy of La Jolla who is also here in Southern California asking if acupuncture is effective in bringing on labor especially when you want to avoid induction at 41 weeks with her OBGYN.

You know it’s a kind of a loaded question depending on the state you are in whether or not acupuncture can say that they treat that. They have an encouraging labor protocol that we then use depending on the acupuncture small practice insurance they may or may not be able to state that they do that depending on the state.

However getting acupuncture throughout pregnancy a lot of times limits the chances or likelihood that induction will be necessary because the acupuncture will help organize and support the hormones in a woman’s body to allow the oxytocin to start flowing and hopefully flow high enough time that induction won’t be necessary.

The encouragement labor protocol is usually done daily for three treatments or every other day and the protocol is to encourage oxytocin to be release in high amounts to allow your body to be less stress out which actually stresses are the main reason why we don’t go into labor from our point of view is that our cortisones and adrenaline spike so high that our oxytocin cannot fully flower and allow us to go completely into labor and that’s what Pitocin is it’s just liquid oxytocin.

So if we can keep a mom distressed and relaxed during the last week they have a greater likelihood of going into labor naturally. And you know in order to avoid induction at 41 weeks acupuncture usually don’t start any kind of protocol to have baby come before 40 weeks. Pretty much across the board unless it was something really specific going on otherwise we always want to wait until the body is ready and the baby is ready before we start tinkering in any way.

So and you want to have an acupuncture to know specifically about how to treat women in pregnancy and treating women who are going into labor. She really wants to ask a lot of questions when calling for that sort of treatment and then hope to facilitate labor and hopefully avoid an induction which I know a lot of people really want to do. I thank you.

[Theme Music]

STEPHANIE GLOVER: So today we’re going to be talking about delayed cord clamping. Joining us here on our studio is certified nurse midwife Anne Cooper. Anne received her RN and Masters of Science in Nursing with a specialization in midwifery from Yale University. She currently practices at the UCSD nurse midwifery service. Welcome to Preggie Pals Anne, thanks for joining us.

ANNE COOPER: Thanks for having me.

STEPHANIE GLOVER: So to begin with, why is umbilical cord clamp…to begin with why is the umbilical cord typically clumped after delivery and what is the process?

ANNE COOPER: Well the process of clamping the cord is really the process of separating mom and the baby from each other and separating baby from the placenta. The process usually is is putting two clamps on the umbilical cord, once closer to the baby, once closer to the placenta and having somebody usually dad cut the umbilical cord.

STEPHANIE GLOVER: Is delayed cord clamping new or why we’re hearing so much about it these days?

ANNE COOPER: Delayed cord clamping is not new. It probably immediate cord clamping is new in the history of birth. Delayed cord clamping is coming about because traditional medicine has usually been clamping the cord immediately following delivery of baby. I think more people are talking about it recently because there have been a series of studies looking at risk and benefits to delayed cord clamping.

STEPHANIE GLOVER: Okay great and what typically happens during delayed cord clamping?

ANNE COOPER: So typically after baby is delivered and born depending on the practice of the provider, baby is put up on mom’s chest or held by the provider and delayed cord clamping it is not common you don’t put the clamps on the cord until usually by definition after a minute. Most of the studies look at delayed cord clamping is considered between 1 and 3 minutes. Where I practice and how I practice, for me delayed cord clamping is not clamping the cord until the cord is done pulsing.

ANNIE LAIRD: How long did you see that normally takes?

ANNE COOPER: It’s different for every mom.

ANNIE LAIRD: Yeah.

ANNE COOPER: Sometimes it’s really quick and it might only be a minute that the cord pulses. Sometimes you’ve got a big fat juicy cord that seems to pulse and pulse and pulse for 5 minutes.

ANNIE LAIRD: Yeah. Mostly I thought you’re going to say 30. So yeah…

ANNE COOPER: I’ve not have a 30 minute cord that is pulse for 30 minutes but it’s really interesting. You can actually see it pulsing and then and also feel the cord pulsing.

ANNIE LAIRD: Oh okay.

STEPHANIE GLOVER: And Annie did you delayed cord clamp with your girls?

ANNIE LAIRD: You know the second one was so chaotic like I had her 20 minutes after I showed up in the hospital. It was a little bit different there is meconium and so they wanted to check her out on the infant warmer table. So they cut and clamped immediately.

STEPHANIE GLOVER: Right.

ANNIE LAIRD: So afterwards it’s just wasn’t the place to say excused me I want delayed cord clamping. Yeah but for the third one I did. The biggest concern was just having my baby with me. Okay I had a vaginal birth. It was normal you know natural thing and now the baby is going to stay with me and stay on my chest you know and if you need to do anything you can do it with the baby on my chest.

So I feel but for me that’s the advantage of why I wanted delayed cord clamping and with my second baby it was only a hindsight so again after the third one you know it was almost a little bit long on the other side like okay you know I’m done with this you know the cord was white by then. There was no blood going through for the past 45 minutes. So yeah…

STEPHANIE GLOVER: Yeah.

ANNIE LAIRD: But that is pretty and you know you probably see that Anne as far as you know how it starts out really thick with almost purplish.

ANNE COOPER: Yeah.

ANNIE LAIRD: And then like it goes down like it’s completely white. There’s no blood at all and so thin.

ANNE COOPER: It changes dramatically.

ANNIE LAIRD: Yeah.

ANNE COOPER: In a short amount of time.

STEPHANIE GLOVER: And you’ve mentioned that there’re benefits to delaying the cord clamping, what are some of those benefits?

ANNE COOPER: So typically after the baby is born the cord continues to pulse and one of the benefits to baby is that the baby gets what’s left over in the cord. So if you immediately put the clamps on the baby on the cord it kind of stops the blood flow to the baby. So it actually prevents them from getting all the red blood cells and all the nutrients, all the stems cells that are left in the cord. So typically a baby can get a lot more blood volume in the 3 minutes that you may wait or even longer to delay the cord clamping.

SAMANTHA EKLUND: My midwife calls it the baby’s first cord blood infusion.

ANNE COOPER: Yeah.

SAMANTHA EKLUND: So.

STEPHANIE GLOVER: Yes.

ANNIE LAIRD: Yeah.

STEPHANIE GLOVER: It’s good stuff in there.

ANNIE LAIRD: Are there benefits to mom?

ANNE COOPER: I think one of the benefits that the study is miss talking about is really the benefit of being able to hold your baby and not having your baby taken from you, taken to the warmer starting measurements, starting weights and that that’s really not something that the studies addressed but I think that is a very significant benefit to new families. And I think that’s important when you’re considering what hospital you or where you’re having your baby because a lot of places their instinct is to take the baby right away and start the maybe the newborn medications if your baby is connected to you connected to the placenta your baby is not going anywhere.

STEPHANIE GLOVER: Yeah that’s a good to look at it and then it helps with the skin to skin being that having the temperature regulated and…

ANNE COOPER: Absolutely.

STEPHANIE GLOVER: Okay.

ANNIE LAIRD: Anne can I ask you a question so does this also or does it would it still apply in the case of like a caesarean like I have an unplanned caesarean and in my birth plan as far as if a vaginal birth was going to happen I did include delayed cord clamping but things happen and that’s not the way that it was meant to be but I’m also wondering I didn’t include in my caesarean birth plan to still do delayed cord clamping. Is that still a possibility or not so much?

ANNE COOPER: It’s a little trickier with the caesarean section because you have a large incision on your uterus. The risk of bleeding to mom is much greater.

ANNIE LAIRD: Where I assume they don’t want you open any longer than you really need to be.

ANNE COOPER: So it’s going to be dependent on the situation and how the how your bleeding is going. Most of the time if things are going okay and you’re not bleeding too much they can delay it up to like 30 seconds so you’re not going to get the total pulsation. Another option that you can consider asking for is something called cord milking which is where they take the cord and using their hands or instrument they milk the cord towards the baby so in fact it’s like delayed cord clamping in that you are emptying the cord into the baby and not…

ANNIE LAIRD: So it’s like expedited. Expedite…

SAMANTHA EKLUND: Delayed cord clamping.

ANNIE LAIRD: Exactly.

ANNE COOPER: And they are looking at those studies especially in preterm infants too.

ANNIE LAIRD: Oh okay. Cool. Thank you.

STEPHANIE GLOVER: Great. So you know we touch on some of the benefits but are there any risks to the baby?

ANNE COOPER: So historically the risk that have been used to kind of advocate for immediate clamping would be risks to mom having too much bleeding waiting for the placenta to come the idea of baby comes out got to get the placenta out right away, clamp the cord, pull on the placenta, deliver the placenta so that you don’t have maternal haemorrhage.

The studies have not supported that delayed cord clamping causes any increase maternal haemorrhage. Another risk that is discussed when talking about delayed cord clamping risk to the baby and that is that the increase of the red blood cells when you do delayed cord clamping has been shown to increase neonatal jaundice and sometimes and those babies do have an increased risk of needing phototherapy.

STEPHANIE GLOVER: Yup. I had delayed cord clamping and phototherapy for my baby.

ANNIE LAIRD: Well I have a question about that because one of the things I’ve heard with a few care practitioners is they say something with gravity and they want to hold the baby down below the level of the placenta. Have you heard anything about that Anne?

ANNE COOPER: Yeah. So they have had a study that showed you know the thought was that you have to if you put baby up on mom’s chest and the baby is higher there’s a potential risk that the blood flow is going to go back to…

ANNIE LAIRD: Into the placenta.

ANNE COOPER: The placenta.

ANNIE LAIRD: Yeah.

ANNE COOPER: And the baby is going to lose blood volume that way. The research doesn’t support that and they’ve look at it in delayed clamping that the pulsation from the placenta is so strong that the gravity is not a factor. So…

ANNIE LAIRD: Like it’s negated.

ANNE COOPER: Yeah.

ANNIE LAIRD: Yeah.

ANNE COOPER: And I mean I think that most of the time when you accept your baby on your chest you are lying back and you’re not that much higher than your placenta but I don’t think that’s a reason not to do delayed cord clamping.

STEPHANIE GLOVER: Okay. And when you have delayed cord clamping can your partner still cut the cord?

ANNE COOPER: Absolutely.

STEPHANIE GLOVER: Because it change any part of the cord process?

ANNE COOPER: Not at all.

STEPHANIE GLOVER: Okay. Well when we come back we’ll discuss delayed cord clamping with different birthing options.

[Theme Music]

STEPHANIE GLOVER: Welcome back. Today we’re discussing delayed cord clamping. Anne Cooper is our expert. So we were talking about benefits and risk to mom and baby regarding delayed cord clamping but we’ve loved to learn more about the different birthing options and if delayed cord clamping is possible? We already talked about caesarean delivery but what about a water birth? Is that possible to delay your cord clamping?

ANNE COOPER: A water birth is a perfect venue for delayed cord clamping. When you’re in the water you know you had your baby on your chest then that’s where you are concentrated on and you focus on your baby and so often depending on you know you and your provider the placenta is not delivered until after you get out of the tub or the cord is not even cut sometimes after the placenta is delivered. So yes absolutely water birth and delayed cord clamping go hand in hand.

STEPHANIE GLOVER: Awesome. And if you’re saving your placenta are there any effects on cord clamping then?

ANNE COOPER: I do not know of any effects on saving the placenta and delaying cord clamping.

STEPHANIE GLOVER: And then can a premature baby have delayed cord clamping? I think you touch this on a little bit but…

ANNIE LAIRD: Or like with cord milking because…

ANNE COOPER: Yeah.

ANNIE LAIRD: Yeah.

ANNE COOPER: Yeah so the American Academy of Obstetrician and Gynaecologist actually has a very strong statement that it supports delayed cord clamping in premature infants. Their stands on that is even stronger than term infants and that’s because all of the evidence really supports delayed cord clamping for preterm infants and a reduction of the [inaudible] killer haemorrhage and decrease in risk of bleeding in the baby’s brain to preterm infants.

STEPHANIE GLOVER: And how about you Anne, you’re a mother of three, what was your experience with delayed cord clamping? Did you do it?

ANNIE LAIRD: I did delayed cord clamping with all three. None of my three needed phototherapy thankfully. I had my first at home and it was 10 years ago now but I think the cord stayed connected to her for quite some time. And the second was born in the water and we did delay cord clamping. And the last one was at UCSD and did delayed cord clamping with all of them.

And I found that just really rewarding to have my baby with me on my chest even start breastfeeding before my placenta was out before that the cord was done pulsing. So for me that was a big benefit of delaying the cord clamping and that’s what I hear a lot from patients too. Is that they a lot of my patients they want the cord to be completely done pulsing before it’s cut.

Some of them want their placenta to be delivered prior to cutting the cord and as long as you know bleeding is fine I think that that’s fine and those are things that that can happen and it’s something that you should talk to your provider ahead of time if you want that.

STEPHANIE GLOVER: Yeah. And I thought too that just the conversation about delayed cord clamping really opened up kind of a lot of cool things about the cord and the placenta because with my C-section I didn’t even get to see my placenta and so I just remember it was a different approach. We talked about it. We let it finish pulsing and I got to see it afterwards and it was a pretty cool thing. And I actually have a funny story about that when I delivered my first via caesarean my OB did mentioned that she would milk the cord so we did get the you know expedited benefits of that.

ANNIE LAIRD: Yeah.

STEPHANIE GLOVER: But everyone in the operating room was commenting that it was the largest cord they’ve ever seen.

ANNIE LAIRD: The largest or longest?

STEPHANIE GLOVER: Like humongous.

ANNIE LAIRD: Oh really.

STEPHANIE GLOVER: Yeah like yeah very thick cord.

ANNIE LAIRD: Oh.

STEPHANIE GLOVER: And…

ANNIE LAIRD: How big was your baby?

STEPHANIE GLOVER: Nine five.

ANNIE LAIRD: Okay.

STEPHANIE GLOVER: She was big as was her cord.

ANNIE LAIRD: Yeah.

STEPHANIE GLOVER: And my husband does not do blood so he was like no thanks I want nothing to do with cutting this cord. And then the nurse was like are you sure you’ll regret it. And so he did and it took him several attempts to cut it…

ANNIE LAIRD: Oh no.

STEPHANIE GLOVER: And sort traumatized him and so for the second I was like really you don’t you don’t have to do this and then he thought he needed to be fair to our second daughter he couldn’t cut one and not the other. But the difference was is that we had the delayed cord clamping the second time and it wasn’t messy. You know gone let it pulse completely. You know empty if you will and so when it was cut it didn’t . . .

ANNIE LAIRD: Now Stephanie did you say that your second that you didn’t need the phototherapy or you did?

STEPHANIE GLOVER: I did. So my first was not I don’t have any you know increase bilirubin levels. My second did and it’s funny because I was jaundice as a baby so I just sort of wasn’t surprised, I know that word, I know what it means and we’ll just deal with this.

ANNIE LAIRD: Yeah.

STEPHANIE GLOVER: And it wasn’t really until after my birth and getting home that I think the paediatrician had mentioned that there is sometimes the association between delayed cord clamping and jaundice. But to me I just thought I had it so maybe that’s why. So yeah I’m not sure really how much had to do with it.

ANNE COOPER: And it could be because you had it.

STEPHANIE GLOVER: Right.

ANNE COOPER: And that’s why…

STEPHANIE GLOVER: Yes. Yes.

ANNE COOPER: It’s hard to know.

STEPHANIE GLOVER: So but my birth was just so lovely that it wouldn’t have really mattered. What I mean the effects afterwards because I had my sort of dream birth the second time around so…

ANNIE LAIRD: Yeah. Yeah.

STEPHANIE GLOVER: Are there any times a delayed cord clamping is inappropriate?

ANNE COOPER: Unfortunately yes. Sometimes I’ve there seems to be a delay in our the neonatal resuscitation and the way that we resuscitate our babies after they’re born. Most of the time that’s not done on mom it’s over done on the warmer. So and that’s where they’re most comfortable right now doing neonatal resuscitation.

So usually when babies come out and are maybe depressed and not vigorous, not breathing on their own, there is a desire to have them over on the warmer sooner and so by means of clip clamping and cutting the cord. Another time would be if you have meconium stay in fluid, if there is meconium in your fluid and the baby comes out and is not vigorous, the recommendation is to suction the baby’s nose and mouth before the baby takes a deep breath to prevent the risk of meconium aspiration.

So and both of those cases I think that delayed cord clamping beyond the initial period of you know putting the clamps on would be not advice.

ANNIE LAIRD: What do you mean by vigorous? Because I had a question about that I’ve mentioned earlier my second child and my first child actually there was meconium in the waters in both of them but they came out screaming. So that’s…

ANNE COOPER: That is vigorous.

ANNIE LAIRD: That is vigorous. So you know really it would have been fine in fact preferable to will they still do the bulb suction then…

ANNE COOPER: No.

ANNIE LAIRD: With the baby or no? Oh okay.

ANNE COOPER: So the recommendation for suctioning is if you have a baby who comes out who is limp, not breathing, not trying to make a cry, hasn’t gasp yet to take them to the warmer and before you stimulate them to look into their throat and try to suction any of the meconium fluid. And so that usually if the baby comes out vigorous and screaming then you’re supposed to just observe them.

ANNIE LAIRD: Okay.

STEPHANIE GLOVER: Are there any common objections to delayed cord clamping and any studies that support the objections?

ANNE COOPER: So the reason that the there is a mix evidence on delayed cord clamping as much as we want to do delayed cord clamping the evidence it does support that infants who have delayed cord clamping have a lower risk of anaemia in the first year of life and have increase haemoglobin in the first few months of life but it does also suggest that they also have an increased risk of jaundice and phototherapy in the first days after delayed clamping.

STEPHANIE GLOVER: And what would you say to parents who are trying to make the decision if delayed cord clamping is right for them? How will they make that decision?

ANNE COOPER: I’d say that in talking to where they’re delivering and what their provider is comfortable with and what their own desires are for where they want their baby to be after their baby is delivered. I think that women who potentially have an increased risk of maybe babies with jaundice maybe if you’ve a history of having a baby that has needed a phototherapy before or women with diabetes some have it then have an increase risk of babies that need phototherapy. Those are situations that you may want to consider maybe not the full delay or not delaying the clamping.

STEPHANIE GLOVER: Okay.

ANNE COOPER: And talking to your provider to see if you have any risk factors that they think that it’s not appropriate to do delayed clamping.

STEPHANIE GLOVER: And if you just delay for say the minute versus the full five then the risk of you know some of those risks go down proportionally or…

ANNE COOPER: They haven’t done any studies.

STEPHANIE GLOVER: Okay.

ANNE COOPER: I look on those risks…

STEPHANIE GLOVER: Okay.

ANNE COOPER: But if you’re thinking about you know most of the volume of the cord about 80% of the volume of the cord will be given to the baby in the first minute.

STEPHANIE GLOVER: Oh okay.

ANNE COOPER: So actually after a minute there’s not a whole lot extra that goes in base on like the values that they’ve looked at in studies.

STEPHANIE GLOVER: Thank you so much Anne Cooper for joining us today. For more information about certified nurse midwife Anne Cooper and the UCSD midwife practice as well as information about any of our panelists visit the episode page on our website. This conversation continues for members of the Preggie Pals club. After the show Anne Cooper is discussing delayed cord clamping and cord blood banking. To join our club visit our website www.preggiepals.com .

[Theme Music]

JENNIFER DURBIN: Hi I’m Jennifer Durbin the author of Pregnancy Tips for the Clueless Chick and the mother of two wonderful little boys. I’ve got some great tips for you for planning your maternity leave. Believe it or not it’s never too early to start planning your maternity leave. And if you plan to go back to work you’ll want to start thinking about day care sooner other than later.

In some cities you may need to register your little one for day care when you’re only 12 weeks pregnant so plan ahead. Before you let your boss know that you’re expecting, it’s a good idea to have your maternity leave plan all worked out. So start reading your company’s leave policies including short term disability and look into FMLA the family medical leave act.

Your HR department or trusted co-worker who’s taken maternity leave are other fabulous resources. When you talk to your boss, here she will likely want to know when you’re due, how long you plan to be on maternity leave and if you’ll be returning to your current work schedule.

So make sure you and your partner have work through all of these details beforehand but keep in mind once you hold that little bundle of joy in your arms, all of your carefully laid plans may be thrown right out the window. If you do decide to go back to work, don’t underestimate how challenging your transition back may be.

Not only will you be readjusting to work you’re also be adjusting to your baby’s new child care routine. You should also keep in mind that your first week back at the office will be very draining. So it’s a good idea to plan to take Friday off to recoup. The worst thing you can do is to run yourself rugged trying to do everything so plan for that extra day of vacation.

You can also save yourself a bit of transition stress by having the little ones start day care the week before you go back to work. That way you have plenty of time to ease into your new normal. But most importantly take in the consideration of financial implications of your plan so that you’re fully prepared to what lies ahead. For more great tips, visit www.cluelesschick.com .

[Theme Music]

STEPHANIE GLOVER: That wraps up our show for today. We appreciate you listening to Preggie Pals.
Don’t forget to check out our sister shows
• Parent Savers for parents with new born, infants and toddlers
• Twin Talks for parents of multiples
• Our show The Boob Group for moms who breastfeed their babies

This is Preggie Pals, your pregnancy your way.

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This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

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