Episode 8: Newborn Series, Cord Clamping

Welcome back to Episode 8 of free weekly Brave Journey Birth Preparation Videos. Today we're talking about cord clamping as part of a series on newborn procedures. 
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In this newborn care series today we're talking about cord clamping! I may get slightly less excited about talking about delayed cord clamping in comparison to how much I love talking about skin to skin, but wow - the data super strong on how it's VERY beneficial to delay cord clamping!
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🌵At term, 30% of an infants blood is in the placenta at any given time. Waiting a minute or two to clamp the cord allows that blood volume to enter their body from the placenta, easing their transition in that first couple hours to using their lungs to get oxygen rather than their umbilical cord.
🌵Even one year later infants who received delayed cord clamping had higher iron levels than those who experienced immediate clamping.
🌵Immediate clamping became routine in the 60s, and birthing locations are slowly changing their policies to delay a few minutes.
🌵 There's lots of solid data about benefits for infants of waiting a at least a few minutes to clamp the, to the point where it may be considered harmful to immediately clamp.
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Talk to your medical care provider to ask about baby-friendly practices at your birthing facility. If you're not happy with their answers, go shopping and find another birthing location.💃
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Transcript:

Hello, and welcome back. I'm Cara Lee. And this is your weekly Brave Journey Birth Preparation video, where I pick a topic to talk about -all things related to birth and postpartum- and we talk about it! I'm a birth doula, a childbirth educator, and a childbirth preparation coach. And I'm currently building out my Brave Journey Birth Preparation Program online course, it's not ready yet.

So in the meantime, here are these free weekly videos. Today is the second in our series on newborn care. Which is, we're talking about, newborn procedures done typically within the first few hours after birth.

Last week, we talked about skin to skin. I started with my favorite topic because I love talking about skin to skin because I have so many great memories of my own infants being placed skin to skin with me after they were born. And I love seeing it when I'm attending births as a doula.

But, today we're talking about cord clamping, which I don't get quite as excited about, but it's super important. There's really good data on how important waiting a minute or two to clamp the baby's umbilical cord is. And we're going to talk about that in a sec.

If you'd like to receive these videos, weekly videos in your inbox, you can go to bravejourney.com and give me your email address. I don't spam. I just send these videos weekly and I'll let you know when registration opens for my Brave Journey Birth Preparation Program .

So let's get to it.

So when we're talking about cord clamping, what do we mean? As you know, when the baby is first born. So here's an, a baby in an amniotic sack in the uterus, and this is the placenta and it is stuck to the side of the uterus. When the baby is born, they emerge () hopefully not feet first, but maybe breech) they emerge.

And they're still connected to the placenta via the umbilical cord. The placenta is still within the box. And the infant is out. The question we're talking about now is when to clamp and cut that umbilical cord. And the growing evidence that indicates the importance of waiting a few minutes.

The fact is at any time during a term pregnancy, the infant has about 30% of their blood in the placenta, and 70% (I verbally said 30%, that's wrong! I said the wrong number. It's 70%) going through their body. So it's kind of like a, it's a process of the blood moving through the placenta, into the umbilical cord, into the baby.

So when the baby is born, At any point 30% of their blood is still in the placenta.

Immediate clamping became really standard practice in the 60s. So funny enough Evidence Based Birth, Rebecca Dekker, mentioned that medical care providers have been arguing about the timing of when to clamp the cord for about 200 years. She said that there was some recorded writings from the 1700s discussing when to tie off the cord. So, Apparently like many things in medicine, we're always learning. But recently new evidence has come to light to indicate that the importance of receiving that full blood volume from the placenta.

Delayed cord clamping is clamping the cord after the cord stops pulsating. So at least after one minute. Evidence does point to a full five minutes for all of the blood still in the placenta to get to the baby. But waiting at least one minute is considered beneficial in most of the studies.

The truth is that, not only is there growing evidence that it's beneficial to delay cord clamping, there's growing evidence that immediate cord clamping is in fact harmful, which is a different way of thinking about it. When cord clamping is delayed, one to five minutes, infants receive more blood volume, that 30% that was in the placenta, they're going to get more of that. The longer the delay is. They receive blood volume, which includes red blood cells and millions of stem cells as the blood from the placenta keeps pumping into the baby's body.

Delayed cord clamping increases blood volume in the baby that boost of blood volume helps with transitions. So at birth, the baby's transitioning so much, they're transitioning from a water environment to air where they're feeling air on their skin for the first time.

But most importantly, they're transitioning from receiving all of their blood oxygen from the umbilical cord to instead receiving it from their lungs. So that all has happened within those first few minutes after labor. Rebecca Dekker mentioned that before birth babies lungs get about 10% of their blood supply, but after birth, they need about 50% of their blood cells to be in the lungs. So increased blood volume is going to mean more blood is available to the lungs to help with transit.

The research shows that delayed cord clamping is beneficial, not only in those immediate moments, but may also benefit longer term in promoting greater iron levels over the first few months.

Research shows that infants with delayed cord clamping had higher hemoglobin levels at 24 to 48 hours. And a cute metaphor from Rebecca Dekker of Evidence-Based Birth. She mentioned that hemoglobin are like little school buses that drive oxygen around the body.

At four months, babies infants who received delayed cord clamping had higher iron levels and healthier myelin levels in their brain associated with motor visual and sensory processing.

At eight months, researchers found infants with delayed cord clamping had fewer cases of anemia and at 12 months they still had higher iron levels and lower levels of anemia if they had delayed cord clamping.

So there's really strong evidence that it's not just the immediate benefits, but that the benefits can be up to a year. In addition, there's really strong evidence to support delayed cord clamping with preterm infants. This is very nearly inarguable delayed cord clamping for 60 seconds or longer really clearly decreases infant mortality rates in preterm infants. The data is very clear.

The effects of delayed cord clamping on babies at term is they have more blood volume because they get that blood from the placenta. They have improved cardiac function from blood flow into their lungs, improved hemoglobin levels for the first year of their life. And it may improve their long-term neuro development.

There is a small risk that increased blood volume may increase their risk of needing light therapy for jaundice. But as long as light therapy is available, In our modern medical care system, if we're talking about people who have access to medical care, the benefits seem to way outweigh the risks .

Iron levels are important in infancy. Infants need iron to develop and delayed cord clamping is a completely harmless process for, for birthing people. So it's just a matter of that blood is in the placenta. It's not going to go into the birthing person. So whether that blood is just lost or whether it goes into the infant, that's the question.

A delay of two minutes means they get some of their blood back from the placenta, a delay of five minutes, mean they'll get all of their blood back from the placenta. Delayed cord clamping is practical. It's feasible. There are no risks to the birthing person. So talk to your care provider. Delayed cord clamping can have a really big benefit on your infant and ask about your care provider's routine newborn procedures, just generally ask about what's available to you and what's done typically. And if you don't like the answers you get, go shopping and find a different medical care provider.

Let me know what you think. Did you have any experience with delayed cord clamping? Did you request it? Was your request honored. Have you thought about cord clamping before? Do you find this topic interesting? Not interesting? I'm open! I love hearing from you. I love hearing what you think.

Thank you so much for listening.

Next week, we'll continue our series on newborn care and we'll be talking about eye ointment, the eye ointment that is often applied within the few hours of birth.

Thank you very much!