Delayed Cord Clamping

photo by: Elizabeth with www.elizabethashdown.com

Healthcare continues to evolve every day. No, seriously, there’s new evidence that comes out for EVERYTHING every day.

That is one of the reasons it is super important to stay up to date with these gold standards - as health professionals, but also as patients so we know what kind of care and what practices are best for us and for our family members… and in this case, our babies. A relatively new recommendation that became a standard of practice when it comes to labor and delivery, is delayed cord clamping.

Yes, it is exactly what it sounds like… delaying the clamping of the umbilical cord.

When I first started in nursing, the standard practice for cutting the umbilical cord was to clamp as soon as the baby was delivered, hand the scissors over to the partner, cut the cord… badda-bing badda-boom, pass the baby to the mom and wait for the placenta to be delivered. But since, that has changed…

Have you ever donated blood and sick afterward? I assume that is how babies feel after delivery, especially since the amount of blood they have after birth compared to the amount in utero depends on how long clamping was delayed. With every second that passes after the baby is born, more blood from the placenta can pass back to the baby. While holding the baby below the placenta will help this exchange faster, holding your baby on your chest or abdomen will have a slower, yet just as beneficial effect.

In 2016, the American College of Obstetrics and Gynecology released recommendations to delay cord clamping for at least 30-60 seconds because it has shown to be beneficial especially preterm infants, but also for term babies as well.  

These benefits include:

Increasing the baby’s hemoglobin volume.

Hemoglobin is the protein in red blood cells that circulate oxygen and iron throughout our bodies. An increased hemoglobin level will increase the baby’s iron stores for the first several months of life. This increase in iron can truly help the development of the baby in the months after birth.

For preterm babies, delayed cord clamping improves transitional circulation (when the responsibility of blood circulation changes from the placenta and umbilical cord to the baby’s heart, lungs, and blood vessels), and increases red blood cell volume.

In premature babies this is SO IMPORTANT because it reduces the need for blood transfusions and decreases the chances of premature brain bleeds (which a premie is at high risk for).

It reduces the risk of a very serious condition for premature babies, called necrotizing enterocolitis…which is actually a “medical emergency”.

The only known risk with delayed cord clamping is the increased risk for jaundice, which makes sense since the breaking down of red blood cells is what causes jaundice anyway.

Delaying cord clamping for as little as 30 seconds or up until the cord stops pulsing (usually 3-5 minutes) with your baby in your arms can truly benefit your baby. Talk to your care provider about your wish for delayed cord clamping BEFORE you deliver to  make sure you are on the same page. You’ve got this!

big hugs & belly rubs

 

Resources

Sloan, M., MD. (n.d.). Common Objections to Delayed Cord Clamping - What's The Evidence Say? Retrieved March 07, 2018,                from https://www.scienceandsensibility.org/p/bl/et/blogid=2&blogaid=526

Womens Health Care Physicians. (2017, January). Retrieved March 07, 2018, from https://www.acog.org/Clinical-Guidance-                and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Delayed-Umbilical-Cord-Clamping-After-Birth

10 Reasons To Take A Childbirth Preparation Class

I became a nurse so I could work in labor and delivery. It was “my thing”. I was always so amazed that, no matter how many births I had seen, not one was exactly the same. No matter how many births I had seen, the moment a new mom or especially a new dad would tear up, I would immediately start bawling with them.

I also began noticing which couples came in prepared, informed, and ready for delivery, and which ones …well… didn’t. Did the couples who came in prepared always get the perfect delivery they had planned? No. BUT, they did play an active role in their care. They were able to make informed choices so that they could make the best decisions for their care and their baby. Yes, I did my absolute best to educate and involve the couples who did not take any classes or were more passive about their care, but the amount of information I could give during a 12 hour shift or that they could retain while in active labor was not always enough.

Now, don’t get me wrong, I totally get why people don’t take “birthing” classes. I didn’t take one either. When my OB mentioned a “childbirth classe” I automatically thought of that whole scene from the movie, Baby Mama (click the link if you have no idea what I’m talking about) and was like, UMM “no, thanks I’m good”.

After all, I was a labor and delivery nurse, took many preparation classes, and my husband would be finishing his OB rotation in medical school... sooo, I figured we were solid, right? EEEERRRRRRR. WROOOOONG.

I always told my patients they would know when they were in true labor... yet, there I was second guessing every Braxton Hicks. Once labor really did come, and I needed that support to breathe, my husband couldn’t help me, he hated his OB rotation and checking cervixes was NOT his thing (and I definitely couldn’t reach mine anymore 🙄). Once I finally delivered and went home, I found myself getting annoyed that my husband (who had never been around babies before) wasn’t doing everything I had imagined him doing to help. It was something neither of us were prepared for.

Now, two babies, and an entire pediatric residency (for my husband) later, we still ask for help, we ask questions, and we have learned so much along the way. We recently sat down together and came up with.... 

1.     Answer all the questions about your third trimester.

There are so many things that happen during in your last trimester and so many things to remember such as hormone changes, weight gain, fetal kick counts, exercise, braxton hicks, etc. Pregnancy brain is REAL and even IF you discussed these things with your OB it is so easy to forget!

2.     Feel empowered and eliminate fears.

Childbirth can sound scary. There is pain, there is about to be a baby, and wrapping your mind around the entire process if you’ve only heard horror stories form “friends” or family can make anyone fearful. A childbirth preparation class will give you the opportunity to get answers to all your questions, as serious or as silly as they can be... and not only for yourself, but for your partner as well. 

You are not the first person to go through this, and I can promise you won’t be the last. You absolutely can do this. Learning what to expect during labor and delivery and empowering your partner to be the best support they could be is the first step.

It’s also good to know that with delivering in a hospital - a medical model delivery, there are certain standard procedures that come along with it. BUT with that said, if you are a low risk, healthy woman, some of these standard procedures are not completely necessary and learning about them can really help you progress in your labor.

3.     Learn ways to effectively deal with labor contractions until you can get relief.

There’s no hiding that labor is painful.  But pain doesn’t always mean that you suffer along with it. It’s important to realize that there is a difference between pain and suffering. Our bodies were made for this. Yes, it’s painful- but this is pain with a purpose. There are many things you can do to keep you from suffering during those contraction until you either get your epidural or until you are able to delivery your baby. There is never a reason to suffer during what should be the most beautiful day of your life.

4.     Learn how to actively participate in your care through learning informed decision making.

Things don’t always go according to “Birth Plan”, and that’s okay. Birth plans should reflect what you envision for a perfect birth but they should be flexible as well. Learn what questions to ask so that you can be sure you are making the best choices for you and your baby.

5.     Create a support team who will truly support, encourage, coach you, and hold your hand during labor and delivery.

During labor mammals will naturally hide to a dark quiet environment to allow their bodies to relax as much as possible and, in turn, will allow proper hormone secretion to advance in labor. It is so important that the people you choose to have with you, during this time, support you, encourage you, and have all the information they need to properly help you.

6.     Learn how to decrease your chance of having a cesarean section.

While, there are things, such as your anatomy, the position of the baby or your placenta, and other things that you cannot control, if you have a low risk and healthy pregnancy, there are definitely things you can do such as changing positions, walking, squatting, and putting direct pressure on your cervix during the first stage of labor that are proved to shorten the 2nd stage.

7.     Prepare for postpartum.

There are so many changes that happen to your body over the course of 40 weeks, but there are a lot of changes that happen to your body after delivery that you need to prepare for and understand as well- such as bleeding, hormone changes, healing if you had a perineal repair, if you had a cesarean delivery, if you get hemorrhoids, nutrition if you’re breastfeeding, and overall resources available to you. 

8.     Understand the benefits of breastfeeding.

Breastmilk provides complete nutrition to your baby from the moment of birth. There were times when a premature baby was born and we would have the mother pump to get whatever colostrum we possibly could to take to the NICU for her baby. It is filled with antibodies, fats, nutrients, and the exact amount of calories your baby needs!

You should absolutely take a breastfeeding class if available to you, but a good childbirth preparation class will teach you the benefits of nursing, the basics, and be able to provide you with resources should you get a little stuck. Involving your partner in breastfeeding can seem a little tricky, but it's so important to be on the same page, to have that encouragement, and to have that support.

9.     Learn the basics of newborn care.

There are many newborn assessments and procedures that happen after the baby is born. Get information on vaccines, bathing your baby, car seats, pediatricians, and even ways to prevent SIDS for your baby. It can also help to learn how to deal with the unwarranted advice from family and friends!

10.  Learn way to decrease your risk of postpartum depression and know how to get help before it gets worse.

The drop in your hormones after delivery are so drastic that it is no wonder many women feel the things they do. "Baby blues" are real, but so is postpartum depression. Learning the warning signs, learning ways to prevent exhaustion, how to ask for help with your newborn, and feeling prepared are only some of the ways you could prepare yourself.
 

I hope these reasons empower you to take that first step in looking for a class or for asking the questions you need answered to help you prepare for your new journey.

Big hugs and even bigger belly rubs, from one Mama to another.