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

Takin' A Shot With Vitamin K

TRUTH: I have only ONCE hired a babysitter that was not my mom or siblings in my four years as a mom. WHY? Because I am terrified of the “what ifs”.

My two little monkeys are my entire life, my entire heart. When it comes to making decisions for them, it is my responsibility as their mother to learn the facts, weigh the risks and benefits and make a solid and educated decision for what is best for them. They can’t yet do it for themselves.

As a nurse, it is my honor and my privilege to be able to provide facts and evidence for you to help you make important decisions for your baby.

Which brings me to the point of this post…

After delivery, completing that sweet skin to skin golden hour, and learning how to nurse your baby, the baby care team will then perform an assessment on your newborn, administer a Vitamin K injection, a hepatitis vaccine, and erythromycin eye ointment. While each one of those things is important and highly recommended by the American Academy of Pediatrics, the Vitamin K injection is probably most important to have administered at birth.

Vitamin K is a… well, it's a vitamin, and a very important one at that! It is crucial for activating certain molecules, called clotting factors, that are responsible for blood clotting. We don’t make it ourselves. We get almost all our Vitamin K through leafy green vegetables and a small amount of another type of Vitamin K (called Vitamin K2) through the bacteria that lives in our intestines. If we do not have enough vitamin K, we cannot activate the clotting factors when necessary, resulting in inability to stop bleeding.

While the baby gets everything they need from the mother during pregnancy, a very small amount of vitamin K transfers to the baby through the placenta, and after the baby is born, there is not enough bacteria in his/her intestines to make the other form of vitamin K. So basically, their levels are critically low.

Since babies have a critically low level of Vitamin K, they are high risk for suddenly bleeding anytime from the first 24 hours of life to 3-8 weeks post delivery. If your delivery included forceps or a vacuum, than the risk for a bleed is super high.  The most common time is 2-7 days after birth when the levels of Vitamin K are the lowest. Bleeding that occurs from Vitamin K deficiency in babies usually occurs in their brain, gastrointestinal system, umbilical cord site, skin, nose, and circumcision site and can be deadly if not treated right away.

What is the treatment for Vitamin K Deficiency Bleeding? The Vitamin K Injection.

How often does this even happen? Well, thankfully because of the availability, the need, and increase in education regarding Vitamin K, the incidences have become rare in countries that have access to it. Incidences in the Unites States range from 0.25 1.7 cases per 100 births…

While that may not seem like many, that does mean there STILL are babies that suffer from this. And, according to the CDC, one out of every five babies with VKDB dies. 

Please know, I am not trying to scare you by providing this information, I just want you to be aware of the seriousness and the reality of it.

Okay, Jessica are there any other ways to give my baby(ies) Vitamin K without the shot? What about breastmilk? That has, like, everything!!

GAHH, unfortunately Vitamin K is probably the only thing that breastmilk does not contain enough of. Most of the cases of severe vitamin deficiency bleeding have occurred to babies who have not been given the Vitamin K injection and are exclusively breastfeeding. On the other hand, formula is has a very high concentration of Vitamin K.

The best way to make sure your baby is protected against bleeding is through the Vitamin K injection. The Vitamin K injection is a very concentrated injection to your baby’s thigh, that will slowly release enough Vitamin K to protect your baby throughout the first few MONTHS of life.

*** UPDATE: While Oral Vitamin K has been shown to be effective in certain regimens, there NOT currently an oral form of vitamin K in the United States for newborn/infant use. Actually the availability of oral Vitamin K, is diminishing in other countries as well. Possibly because the injection route is a definite, one-time, preventative, and fool-proof method of protecting babies from Vitamin K deficiency bleeding. While you may find oral vitamin K on the internet, you should be aware that they are not regulated, meaning there is no third party testing these products to make sure they contain the proper dosage, that they contain exactly what they need to and exactly what they say they do, and that they are safe for newborn/infant consumption. Check out Evidence Based Birth's information on oral Vitamin K.

While the thought of injections to your sweet delicate baby can be heart wrenching, remember that the injection itself is fast and can save your baby’s life. In fact, the anticipation of the entire experience is harder on us parents than it is for our babies.

One of the best ways to comfort your baby during injections, heel pricks, or actually anytime they are fussing is to hold your baby, bring him/her to your chest for skin to skin, breastfeed, or allow sucking on a pacifier or clean finger... and then take a deep breath.

Parenting isn’t always easy, but I can promise it is worth every ounce of worry.

You’ve got this! From one parent to another, Happy Nesting!

 

References

Dekker, R., PhD, RN, APRN. (2018, February 19). Evidence on: The Vitamin K Shot in  

         Newborns. Retrieved March 01, 2018, from https://evidencebasedbirth.com/evidence-for-

        the-vitamin-k-shot-in-newborns/

Vitamin K Deficiency Bleeding. (2017, September 15). Retrieved March 01, 2018, from

         https://www.cdc.gov/ncbddd/vitamink/facts.html