Thursday, 18 July 2013

Cord Clamping

There have been a lot of articles out there recently discussing the benefits of delayed cord clamping versus early cord clamping. What exactly is the difference?  In most research papers, early cord clamping is the clamping and cutting of the umbilical cord within 60 seconds of birth. While delayed clamping, involves waiting at least 60 seconds or until pulsation ceases before clamping the cord.

After birth, the placenta continues to function, providing oxygen to baby and filtering off waste until the baby has transitioned to extrauterine life. As this transition occurs, the cord ceases to pulsate. Eventually, the hormones of the mother’s body kick in again, and the placenta detaches from the uterine wall and comes out the vagina. This natural process ensures the baby is assisted as much a possible into their transition into extrauterine life. It also ensures that baby received their entire required blood volume, and thus their iron stores. This also means that the placenta is less bulky so therefore easier for the uterus to contract and expel.

The intervention of clamping and cutting the cord before these processes happen has become mainstream (particularly in the Western World). It is part of most hospital policies for ‘active management of the third stage’ and ‘getting accurate cord blood gasses’ is not a good enough reason in my mind. In my experience, it is done with more haste and urgency when a baby has been compromised during the birthing process (for example the use of forceps or a non-reassuring foetal heart rate). To me, this is completely illogical. In these cases, it seems even more urgent to leave the cord intact so the mother’s body can assist in restoring acid-base balance and ease the transition into extrauterine life. Most resuscitation measures can be performed on the mothers abdomen (or at the very least in-between her legs at the foot of a bed) and it seems logical for health care professionals to work with the life support system nature made rather than against it.

There are stories of midwives in isolated areas leaving pulsating cords of very premature babies intact until help arrives some hours later. There are also stories of Doctors hanging the connected placenta above babies like an IV bag following a haemorrhage. So the physiology obviously makes sense to some.

The research tells us that babies who have ‘delayed cord clamping’ have higher haemoglobin levels between one and two days after birth and were less likely to be iron-deficient three to six months after birth.  There is a slight increase in hyperbilirubinemia (also known as jaundice) however some studies show this increase is not associated with an increase in treatment, while others show a slight increase. These babies also had a statically higher birth weight. These babies’ mothers did not show any difference in postpartum blood loss or haemoglobin levels.

So, the research backs up what nature and physiology have been telling us – not intervening and leaving the cord to cease pulsating naturally gives the best possible outcomes for babies.

If you are choosing to have active management of your third stage of labour, you are completely able to decline early cord clamping and cutting in favour of evidence-based delayed cord clamping. You are of course able to decline cord blood gasses also.

It’s your baby, your body and your birth.

Shows how much blood transfers to baby over time if the cord is left intact. This took about 15 minutes! 
Thanks to Birth Dance for the image.


The most recent study (2013) has been published by the Cochrane Collaboration.
McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD004074. DOI: 10.1002/14651858.CD004074.pub3.

Thursday, 11 July 2013

Why do parents choose to have a Homebirth?

As a home birthing Mum myself and a midwife, I often find myself asked the question “why do women choose to have a homebirth?” There is no one or simple answer to this question. Birth in itself is a complex issue and chosen place of birth is an individual as the birthing woman herself.

Firstly, it’s probably a good idea to define exactly what I mean by the term ‘homebirth’. I mean the planned choice to labour and birth at home accompanied by a Registered Midwife. This includes women who transfer out of the home before, during or after labour.  For women who choose to birth at home unattended, the usual term is ‘freebirth’. For women who planned to birth in a hospital or birth centre and got caught short, the usual term is ‘unplanned-homebirth’ or ‘unplanned-freebirth’.

So, what are some of the most common reasons parents give for choosing to plan a homebirth?

 It’s safer. When a woman’s pregnancy is considered to be low-risk, it is statically safer to birth at home with an experienced Registered Midwife.
 Less likely to have interventions like an induction, caesarean section, epidural, forceps or episiotomy and my baby is less likely to need admission to the Special Care Nursery or have problems with breastfeeding.
 It feels more comfortable at home and I’m free to labour and birth my way.
 My husband, children, mother, sister, doula and birth photographer can be there to assist me during the labour and birth.
 Not tempted to use medical forms of pain relief.
 I can have a waterbirth if I want. I can have candles. I can use aromatherapy. I don’t have to conform to hospital policies.
 Traumatic previous birth (or hospital) experience that makes me fearful to return.
▪ Previous birth didn’t happen the way it should have (e.g. Induction as Obstetrician going on holidays, leading to a cascade of intervention, ending with an emergency caesarean section) and I want something different for this birth.
▪ I had my last baby in the car on the way to the hospital – it seems safer to stay at home and have the Midwife come to me.
▪ My private Midwife knows me, my husband, my children and my history. She spends an hour with me at each appointment and knows my pregnancy. She will be there for me and only me while I am labouring (and not have another labouring woman to care for and countless women to assess). I trust her.
▪ My husband won’t have to fight for me in the hospital; he can labour with me and trust our Midwife to tell us if we need to be concerned.
▪ I am not separated from my baby or my husband and other children. We add to our family in private, in our own home and life continues as normal.
▪ Pregnancy, labour and birth are normal. Our baby was created in private at home, and will be born in privacy at home. We believe in a woman’s ability to birth her babies.
▪ Birth is normal – if we need help, our Midwife is highly trained and experienced and comes with oxygen, syntocinon and other things needed to help us in an emergency.

There are many other reasons - feel free to leave a comment here or on my Facebook Page with yours.

For me, the most compelling reason is safety. The research is compelling and wouldn’t want the best possible chance for the safest birthing experience and the healthiest baby? Having said that, the woman MUST FEEL SAFE in her chosen place of birth.

Do your research. Look at for the statistics of your local hospital. Your first appointment with a care provider is for you to get to know them and ask them questions. If you don’t feel comfortable, keep interviewing until you find someone who fits.

Knowledge is power. It is your body, your birth and your baby. Trust in your body and trust yourself. Women are amazing J