Wisdom Birth

During a heart bypass operation do you think it would be wise to stop the heart BEFORE switching on the bypass machine?

No?

So why is it common pactice to immediately cut the cord of a compromised baby before taking it away to be resuscitated? How many valuable minutes are lost to the baby? This practice has become commonplace over the 20th century for reasons I shall not go into here.

Dr Sheena Kinmond co-presented the lecture on 'Avoiding immediate or early cord clamping' with Dr David Hutchon and explained to us the importance of the baby receiving its full blood volume from the placenta. Cutting the cord too soon can cause up to 40% of the baby's blood to be retained back in the placenta. This can cause a dramatic reduction in blood pessure which impacts on the ability of the lungs to inflate and transition into beathing air. Thus, you have a baby who is already compromised in a situation where her ability to revive is shockingly reduced. It makes absolutely NO sense!!!

Dr Hutchon told us, with passion, that babies should NOT have their umbilical cords cut EVEN when the baby needs resuscitation. He was very tearful at the thought of his own early practice and the damage he had been unwittingly doing before he learned about the physiological benefits of waiting. But I say to him, and all parents who accepted procedures they may have doubts about now, you can ONLY do the best you can, in the situation, with the information you have at the time.  

Robin Lim talks about when the cord should be cut on this You Tube video:

I am intrigued by the BASICS trolley that has been devised and feel that it may be a useful tool. Sadly for many of the delegates, Dr Hutchon did not have a trolley to show us, or any further information about its dimensions. However, the best place to resuscitate a baby, in my opinion, is the mother. 

Dr Nils Bergman, a doctor in South Africa who specialises in Kangaroo Mother Care, says "The mother's skin is the baby's natural environment, and both physically and emotionally the healthiest place for the baby to be".

So, we need to keep ALL babies connected to their mother until long after the umbilical cord has stopped pulsating and been cut.

What is surprising, pehaps, is that this knowedge about timing of cord cutting has been known long before we had the modern scientific research to back it up.

“Another thing very injurious to the child, is the tying and cutting of the navel string too soon; which should always be left till the child has not only repeatedly breathed but till all pulsation in the cord ceases.  As otherwise the child is much weaker than it ought to be, a portion of the blood being left in the placenta, which ought to have been in the child.”

                                                                        Erasmus Darwin, Zoonomia, 1801.

It really doesn't matter if it is a healthy term baby or a compromised premature baby.... no, scap that. It matters EVEN more to the compromised premature baby. We need medical professionals to be taught how to resuscitate a baby on the mother's abdomen. We can fundraise to get BASICS trolleys in every unit and/or we can get wall mounted resus units installed with oxygen hoses that can be taken to the baby wherever the mother is resting immediately after birth. But most of all we need to ensure that resuscitation is done to baby without separation from the mother.

Again, as in my previous post, it may be that it will be a ground swell from parents that drives the change from immediate clamping to waiting until the cord stops pulsating. Many mothers are now even waiting until the cord separates from the baby naturally. This has been termed Lotus Birth.

But also, the time is long overdue for medical professionals to stop looking at procedures for short term gain. They need to look at the bigger picture and ensure that research also focuses heavily on long term outcomes.

"Everybody doing it together" - Sheena Byrom, 26/04/12 Troon in Scotland