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

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.