As promised, a guest post from Faith Gibson! Faith and I began corresponding when I included her video in a prior post about birth history. Faith is a former Labor & Delivery and ER Nurse, professional midwife, birth educator, and after serving as the Chair of the Midwifery Advisory Council for the California Medical Board for 3 years (2007-2010), she remains a currently seated member of the Midwifery Advisory Council. Faith shares my fascination with birth history and lends an authoritative perspective, having experienced some of the ramifications of phallocratic birthing models first-hand. Thus, her passion for advocating for the normalization of childbirth.
In this post, Faith explains the history behind premature cord clamping, and the physiologic ramifications that such an obtrusive intervention has. In fact, she explains why this intervention has the most profound impact on the newborn of any medical intervention to date.
Physiological Management of a Newborn’s Umbilical Cord at the time of Birth
“Early” cord clamping (within 30 seconds of the baby being born) was introduced very early in the 20th century by American obstetricians. It was directly associated with the obstetrical profession’s redefining normal childbirth in 1910 to be a surgical procedure performed by physician-surgeons. Mothers-to-be were routinely given general anesthesia, which passed through the umbilical cord to the unborn baby. This set the stage for a profound respiratory depression of the newborns so doctors quickly clamped and cut the umbilical cord to prevent the baby from receiving any more of the chloroform or ether being given to its unconscious mother.
Immediate cord clamping and cutting has been the standard protocol for normal childbirth in the US since the early 1900s. It was taught to every new generation of medical students and continues to be the standard protocol for both vaginal and Cesarean births in American hospitals.
As a medical intervention, immediately clamping the newborn’s pulsating cord at delivery is the most profound change in routine birth practices for babies in the history of the human species.
In moments immediately following birth the newborn must breathe for the first time, making this a critical period of transition. Unfortunately for the majority of Americans born since 1910, clamping the still-pulsating cord disrupts the normal flow of blood between the placenta and the baby and unintentionally deprives the neonate of a significant amount of its own blood volume.
Through out pregnancy, the mother’s and baby’s blood streams are two entirely separate cardio-vascular systems that never mingle or mix the blood of either one with the other. The blood of the fetus is circulated through the placenta by the beating of the baby’s own heart. With each fetal heartbeat, its blood pulses through the vessels and capillary beds of the placenta, absorbing oxygen and other vital elements by osmosis from the mother’s blood stream. The baby’s heartbeat continues to circulate its freshly oxygenated blood as it flows back through the umbilical cord and into the baby’s body.
At term, 30 to 40% of the blood volume of the fetus is in the placental-umbilical cord end of its circulation. For premature babies, the proportion of blood volume in the placenta and cord is even higher — as much as 50%. Without its normal blood volume, a newborn experiences the biological equivalent of an internal combustion engine that is suddenly two or three quarts low in oil – that is, an inadequate quantity to do a critical job.
In contrast to early clamping, the physiological management of the baby’s cord at birth does not interrupt the active circulation between the newborn and its placenta. Within 3 to 5 minutes, the undisturbed cord naturally provides the baby with its normal, good-to-go blood volume. Clamping and cutting are purposefully delayed by the birth attendant until the blood vessels in the cord are no longer circulating blood. The formally fat purple cord (as big around as one’s thumb) slowly becomes smaller (size of your pinkie) as it turns white, flaccid and no longer pulses with each beat of the baby’s heart. This is how the umbilical cord of human babies were treated at birth from the beginning of the human race until the early decades of the 20th century.
Physiologic care of the umbilical cord at birth is described by modern birth attendants as a process of ‘3rd stage’ or ‘placental’ transfusion. Fetal blood in the circulatory loop spontaneously flows into the baby’s body and the expanded blood volume is used to perfuse the baby’s lungs.
In the case of a newborn, the critical issue is perfusing the baby’s lungs for the very first time, a situation that calls for a greater percentage of its endogenous (internal) blood than it required as a fetus. During its nine months in utero, fetal blood normally by-passes the lungs in a unique short-circuit between the two sides of the baby’s heart, a situation that only occurs during fetal life. This is because fetal blood is pumped outside of its body to be oxygenated by the baby’s placenta instead of its lungs. Under these circumstances, having only 60% of its total blood volume in its physical body is appropriate and not a problem.
However, at birth the baby’s body has to switch from this external process of placental oxygenation to an internal process of breathing room air and exchanging oxygen and carbon dioxide through its own lungs. The newborn baby requires a greater internal blood volume than it needed as a fetus because its circulatory load is significantly expanded. This need is naturally met by having the part of the baby’s blood in its cord and placenta be allowed to flow back into the baby’s body, where it will be used to perfuse the lungs without having to deprive the baby’s skin and abdominal organs of their normal circulation.