Tuesday, August 31, 2010

Physiological 3rd Stage, without the "as long as..."

I shared a link to my post A Natural Third Stage with Buscando la Luz after reading two posts on her blog, Birth Faith, called Preventing postpartum hemorrhage naturally and Preventing Postpartum Hemorrhage: a follow-up. She shared it on her facebook page and my live traffic feed has been going crazy with hits to that post. One commenter was a former L&D nurse who said her experiences backed up the theories I wrote about.

If it is true that keeping mother and baby together reduces the risk of hemorrhage, then that is a good reason not to cut the cord immediately. According to Dr. Nicholas Fogelson of AcademicOBGYN,research does not support the current standard practice of immediate clamping. (I also love this post also because of his example of routine episiotomy as a practice that is very obviously passe. I know from a first hand conversation that there are some dinosaur OBs out there who don't stay up to date on research who still use them liberally--I should post about that conversation sometime)

Someone on the Childbirth International e-mail group recently shared a link to a beautiful series of birth photos by Patti Ramos called Emergence. One of the photos shows an attached cord that is simply beautiful. I never knew they were that color.

Later timing of cord clamping may better for both mother and baby. However, after two hospital births where clamping occured earlier than I preferred both times, I have come to believe that physiological cord clamping is still quite rare in hospitals. I think this is partly because they have been conditioned to believe that routine immediate clamping is normal and may subconsiously look for a reason to cut the cord, partly because they have narrow parameters for what constitutes a "healthy" newborn and are quick to provide support, and partly because they aren't set up to provide transitional support to neonates without moving them away from their mothers. Often "delayed" cord clamping is only available at special request and "as long as the baby is doing okay."

In a post at her blog Midwife Thinking, The placenta--essential resuscitation equipment, one homebirth midwife discusses her reasoning for keeping cords intact no matter what and explains how she goes about doing that. She also talks about obstetric pracitces that contribute to the need for babies to be given support. In a response, Navelgazing Midwife shared pictures of the wooden board she brings to births so that she has a hard surface she could use without cutting the cord in case she ever needs to do chest compressions on a baby.

This just goes to show that in some things, both your choice of provider and the equipment aviailable in your chosen birth location can influence what happens in your birth.

2 comments:

  1. What about the legal issue that the baby is the responsibility of the OB until the cord is clamped; then the pediatrician takes over? The OB wants to hand off the baby and turn his attention to the mother, do what he has to do and be done. The primary mood in a hospital is a sense of urgency, of time passing too quickly, of too much to be done. This doesn't facilitate anything which involves waiting.
    Susan Peterson

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  2. Susan, I hadn't thought of that and didn't know that was how it worked legally. Thank you for sharing that insight, it adds another level of understanding.

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