delayed cord clamping and epidrual

[Hollo]

i just read that if you delay cord clamping then the baby gets more nutrients and blood as well as more of any drugs you have had during labour. so does that mean it is not a good idea to delay cord clamping if you have had an epidural?

also, can you have the injection (to hurry the delivery of placenta) but still delay cord clamping? and what is the injection?

[sneakysparkle]

hmmm interesting questions! Not sure about delaying clamping cos of epi, or delaying with injection - but Im pretty sure the injection is syntocinon (artificial oxytocin)

[Tegam]

Yes its syntocinon, I had it with both my girls and still delayed the cord clamping....it only stimulates the uterus to contract not make your placenta come out straight away. I didnt plan to have the injection with my 3rd but the placenta came out (flopped on the floor) almost at the same time as the baby...scarey but it was a quick birth, so we didnt really get a chance to delay LOL


And a VERY good question re the drugs....i dont think that epis do anything to the baby but it would be interesting to see if the pros out weighed the cons if it was a pethidine shot??? You really dont want the baby being born flat from too much drugs but then you want the baby to get all the good stuff in the cord...... I HAVE NO IDEA, but would love to hear more

[visitor1]

Im not sure on the epi side of things. Ive not ever had one and my last birth was the first time ive delayed clamping.

I know for my DS i had delayed cord clamping, which also delayed the injection Once the cord was clamped i was then jabbed and a short time after delvied the placenta.

[briggsy's girl]

do the meds from the epi cross the barrier from your spinal canal to the rest of your circulatory system? i didn't think it did to be honest. i am guessing unless it crosses that barrier, it would not be able to be transmitted to the baby. in which case, delaying clamping would be no drama... more research for me i think!

[Cyathea]

Yes, an epidural does cross the placenta and affect the baby, just like everything else which goes into the mothers body. It is a completly indiscriminate process.

Read more here: http://www.naturalchildbirth.org/nat...ventions23.htm

However, I still think the benefits of delayed cord clamping would still outweigh any detriment to the baby of having drugs in the system. We are talking about quite a lot of blood volume here, imagine being born, and trying to make it in the world with a less than full complement of your own blood, what a less than auspicious start.

For me drugs are simply not an option (homebirther) but if you are serious about delayed cord clamping, then using a minimum of drugs would also I guess be a priority.

[Hollo]

well i had an epi last time, going to try not to this time but who knows how it will turn out. i am not opposed to having another one, but am gonna try my hardnest not to. i might ask at my next appointment. ta.

[Heva5]

I spoke to the Ob about this today and he told me that there are new studies that show that cord clamping may be detrimental to the baby. He didn't say much more so I was wondering if anyone had any idea what these "new studies" might be and what they said? It's so confusing, I never know if Im getting all the information or not from either side, I just want to know whats best for my baby!

[Tanya]

Heva, Without speaking to your Dr, he may be talking about the increased incidence of jaundice? Because of the increase in blood volume that goes to the baby there is more bilirubin.... However this increase is not detrimental to bub, infact jaundice in this form is perfectly normal for bubs.

[Heva5]

he did say to do a bit of research of my own, but aside from bellybelly i dont really know where to look, and everything on bb that i could find only has positive outcomes so i dont know whether its a little biased or not - no offence.
as well as that he said they were new studies and all the articles and threads are old.

what exactly is jaundice?

oops, kinda hijacked the thread, sorry

[visitor1]

I had delayed claming and my DS did get juandice but only K2 (which from what ive been told only means half of the body, head to belly button) by day 4 it had gone to K1 which is minimal, was mainly just his neck and face. Never hurt him at all. Increased feeds helped him get rid of it.

[Schmickers]

Originally Posted by Heva5

I spoke to the Ob about this today and he told me that there are new studies that show that cord clamping may be detrimental to the baby. He didn't say much more so I was wondering if anyone had any idea what these "new studies" might be and what they said? It's so confusing, I never know if Im getting all the information or not from either side, I just want to know whats best for my baby!

I would go so far as to say that what your Ob has told you is not in fact true. I've followed the research fairly closely in recent years and there is not any new research I am aware of that indicates that there is any detriment to the baby.

For your own research, I have posted some links to a number of articles below, based on a brief Google Scholar search for recent research on "delayed cord clamping". All published in the last 4 years:

1. A Systematic Review and Meta-Analysis of a Brief Delay in Clamping the Umbilical Cord of Preterm Infants
2. [Delayed cord clamping in the interest of the newb...[Ned Tijdschr Geneeskd. 2008] - PubMed Result
3. The Influence of the Timing of Cord Clamping on Postnatal Cerebral Oxygenation in Preterm Neonates: A Randomized, Controlled Trial -- Baenziger et al. 119 (3): 455 -- Pediatrics
4. A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short-term clinical and laboratory endpoints
5. Delayed cord clamping or immediate cord clamping?: A literature review

...the last one being the most telling.

I would strongly encourage you to push for delayed cord clamping. The research is clearly in favour of it, despite what your OB has said; given that there is so much favourable research about delayed clamping, it would have to be some pretty significant "new studies" to be able to overturn all that!

[Heva5]

Schmickers- thanks heaps, thats exactly what i was looking for.

[OceanPrincess]

Unfortunately can't get to the last article without paying 30 pound for it...

The interesting thing I notice is that all the other articles seem to talk about the benefits for preterm infants. What about a baby that is term?

I asked my Obs about this yesterday at my 38wk appt and she said that the baby can get too much cord blood and cause jaundice, as mentioned above by a PP.

She said that a new study is about to start at the Royal Women's about delaying the cord clamping for premmie babies, but that she said the evidence just isn't there to support delaying the clamping for term babies.

[Schmickers]

The whole cord blood leads to jaundice thing is a myth, not to mince words. It's been done to death, and there are tons of studies that disprove any link between delayed clamping and jaundice.


And while what your OB is saying is true, it's only half the truth; while there is not much evidence to say that there is any benefit to term babies, there is also no evidence (at all, really) that might indicate that is a risk. And lets face it, if it's beneficial to premmie babies to have some extra iron, why not to term babies?

Here is one theory I have heard about how delaying clamping can help a term baby. When your baby takes it's first breath, it will be expanding it's lungs for the first time. The lungs are like big sponges with a very rich blood supply. That blood has to come from somewhere - if the cord has been clamped, the blood has to be drawn from the rest of the circulation, which leads to a drop in blood pressure. If the cord is not clamped, then the baby has a rich blood supply it can draw on.

I still don't agree with your OB, and I don't think they are really presenting a lot of evidence. It is worth keeping in mind, too, that delaying cord clamping also means that your baby will be skin-to-skin at birth, and not moved away from you to a heater by a midwife. Lots of babies are moved to a heater for an "examination" as soon as they are born when they are fine and there is just no need for it; the appropriate thing to do when a baby is born is give it to the mother and put it straight to the breast. I have even heard of babies being resuscitated while still attached to the cord - after all, if the baby is still attached and the cord is still pulsating, then it is still receiving oxygenated blood. I know of one case where a homebirth baby was born not breathing and they resuscitated it for 40 minutes, still attached. During that entire time the cord continued to pulsate and the placenta remained attached; once the baby was breathing the cord stopped pulsating and the placenta was born.

Good luck in making your final decision.

[Schmickers]

Originally Posted by OceanPrincess

Unfortunately can't get to the last article without paying 30 pound for it...

Yeah, sorry about that. The article summary really tells you all you need to know, though, unless you want to really go into the ins and outs of how they did the research (and in this case, it wasn't really research, just a review of the literature).

[christy]

Originally Posted by Schmickers

The whole cord blood leads to jaundice thing is a myth, not to mince words. It's been done to death, and there are tons of studies that disprove any link between delayed clamping and jaundice.


And while what your OB is saying is true, it's only half the truth; while there is not much evidence to say that there is any benefit to term babies, there is also no evidence (at all, really) that might indicate that is a risk. And lets face it, if it's beneficial to premmie babies to have some extra iron, why not to term babies?

Here is one theory I have heard about how delaying clamping can help a term baby. When your baby takes it's first breath, it will be expanding it's lungs for the first time. The lungs are like big sponges with a very rich blood supply. That blood has to come from somewhere - if the cord has been clamped, the blood has to be drawn from the rest of the circulation, which leads to a drop in blood pressure. If the cord is not clamped, then the baby has a rich blood supply it can draw on.

I still don't agree with your OB, and I don't think they are really presenting a lot of evidence. It is worth keeping in mind, too, that delaying cord clamping also means that your baby will be skin-to-skin at birth, and not moved away from you to a heater by a midwife. Lots of babies are moved to a heater for an "examination" as soon as they are born when they are fine and there is just no need for it; the appropriate thing to do when a baby is born is give it to the mother and put it straight to the breast. I have even heard of babies being resuscitated while still attached to the cord - after all, if the baby is still attached and the cord is still pulsating, then it is still receiving oxygenated blood. I know of one case where a homebirth baby was born not breathing and they resuscitated it for 40 minutes, still attached. During that entire time the cord continued to pulsate and the placenta remained attached; once the baby was breathing the cord stopped pulsating and the placenta was born.

Good luck in making your final decision.

I couldn't agree more. I did heaps of research when I was pregnant with DD1 (4 1/2) and DD2 (2). Everything I read said that delaying cord clamping was beneficial to the baby, I could not find anything that said the opposite. I guess I wasn't looking for it either! With DD1 I wasn't aware that you could delay cord clamping with a caesarean birth, but you can. Its worth knowing when you can or can't let the cord continue to pulsate. Matilda's was left for 2-3 minutes before clamping, but unfortunately being a c/s it was clamped. Jovie's was left and it took 10-15 minutes before it was finished. Neither of my girls have had issues with jaundice.

[OceanPrincess]

Thanks for all this info guys. I think I want to delay it as much as I can - I am curious as to when it will stop pulsing. Schmickers I like the thought that my baby will still get blood from the cord when it takes its first breath.

More to think about...