In the previous post, Faith Gibson gave us a run-down on the history and impact of premature cord clamping, including her assertion that this medical intervention “..is the most profound change in routine birth practices for babies in the history of the human species.”
Today, Faith concludes her discussion on the topic, and elaborates on the physics of the circulatory system, and the importance of evidence-based care.
Welcome back, Faith!
The Physics of Blood Volume & Heart-Lungs Machines:
An excellent example of blood volume physiology can be seen in the use of a heart-lung machine for open-heart surgery, which also sends the patient’s own blood through an external loop. This externalized blood is pumped out of its physical body to a mechanical device, or in the case of a fetus to an exogenous body organ (its own placenta). The machine (or placenta) is the sole source of the blood’s oxygenation and exchange of other gases.
To precipitously clamp and cut a neonate’s cord at the instant of birth has the same biological effect as clamping the tubing to a heart-lung machine at the end of surgery. If the 20, 30 or 40% of the surgery patient’s blood volume circulating through heart-lung machine’s filtration system were not returned to the patient’s body, a significant portion of vitally important blood will be left in the machine and its tubing and discarded as a waste product. Of course, no cardiac team would ever allow that to happen.
The intervention of early cord clamping has the same biological effect as pinching off tubing that connects the heart-lung machine to the surgical patient. For babies denied of their normal blood volume and its other benefits — warm, oxygenated, pH-balanced blood – the neonate’s body automatically routes remaining blood away from all biological functions not immediately critical to the baby’s survival. This means shutting down blood flow to its skin, muscles, liver, pancreas and small intestines so there is more blood to circulate through the lungs. This greater volume is used to open pulmonary blood vessels for the first time and fill capillary beds with blood that can absorb oxygen and expel carbon dioxide.
After a normal labor and spontaneous birth of a healthy term baby, early clamping of its cord apparently does not cause serious or long-term problems. Current research comparing prematurely-clamped vs. physiologically-clamped cords has shown that by 6 hours after the birth, there is no longer a discernable differences between the two groups of babies. The only exception is infant anemia in the months following birth in the ‘early’ cord clamping group.
But for pre-term and premature babies and term neonates who suffer an adverse event, physiological cord clamping can make the difference between an infant with no medical problems (or one that only needs a few hours or few days in the intensive care nursery) versus a severely ill or neurologically-damaged baby that will need to spend weeks or even months in the NICU. On rare occasions, this abnormally low blood volume and absence of the baby’s own warm, oxygenated, ph-balanced blood following a complication or emergency may reach a critical level, resulting in a preventable fatality. Distressed and premie babies in particular need their fully functional blood volume at birth and must be allowed to receive the exogenous blood in the placental end of the circulatory loop.
When Cesarean surgery is done before or during labor because the baby appears to be distressed, is not growing normally or is suffering lack of oxygen from an obstetrical emergency such as a cord accident or shoulder dystocia, it is critical that placental transfusion (minimum of 2-3 minutes) be allowed to take place before the connection between the baby and its placenta is severed. The only exception is when the placenta itself is not functioning or has detached from the wall of the uterus. During the two or three minutes required for a 50% level of placental transfusion, the protocol recommended for physiological cord care following a C-section is for the obstetrician to lay the newly delivered baby on the sterile drapes covering the mother’s legs. This is approximately level with the placenta. If the baby needs help breathing, this also provides a stable, sterile and easy-to-reach place for perinatology staff to provide immediate care.
The Evidence-Based Standard of Care:
Physiological cord clamping is an evidence-based practice. Making it the standard of care in all American hospitals, for all types of birth attendants, for both vaginal and Cesarean births, including all premature and distressed neonates, would save hundreds of millions of dollars in NICU care. It would also help reduce the number of life-long handicaps and learning disabilities associated with childbirth. This can save babies and their parents from the cost — both human and economic — of preventable complications.
For babies, the physiological treatment of the newborn’s pulsating umbilical cord in the few minutes following birth is the most cost-effective practice in the history of maternity care. It is certainly the least expensive, as simply eliminating the medically-unnecessary intervention of immediate cord clamping costs nothing at all.
Physiological management of the pulsating umbilical cord takes no special training, no special medical education, no special equipment, and no lengthy or costly research. One simply waits for the newborn’s cord to finish its normal process of placental transfusion. This is a win for the healthcare system, the parents, the baby and for society.
Viva the pulsating cord that gets to stop of its own accord after its work is done!