Waiting for cord to stop pulsating before clamped & cut

mother/babyRN, RN · Jun 16, 2004

So they say but we don't do it unless a parent requests it. Our docs don't think it makes a difference nutrient or anemia wise one way or the other...

mother/babyRN, RN · Jun 16, 2004

I have never had a pt specifically request this...

memphispanda, RN · Jun 16, 2004

I did a lot of reading up on this when I was prego with my last (it's been 5 years...)

At that time it seemed to be a great "natural" thing to do. However, I also found info that the extra blood (usually 30-90cc) can cause problems in infants who are already prone to jaundice. We made an informed decision to NOT wait to clamp the cord. In my opinion, it puts a lot of stress on a not quite mature liver.

missnurse01, MSN, RN · Jun 16, 2004

hey, i was thinking about asking my doc to wait to clamp it after this pregnancy. I had read the positives but didn't know of any neg. my last baby was a 36 weeker, received pit thru me (late decels and they wanted to get the baby out...i thought that pit was also hard on the baby but better than c-sec?) and was anemic (and jaundiced-which could be from a couple of factors i take it)-i thought maybe the anemia wouldn't have been so bad if we had waited to cut the cord...whatcha think?

BittyBabyGrower, MSN, RN · Jun 16, 2004

I guess I never really thought about it. To the last poster...were you ABO setup or Rh setup? That can cause anemia and jaundice together.

Being polycythemic isn't good either...the baby could end up needing exchanged transfused with NS or Albumin to lower the crit.

memphispanda, RN · Jun 16, 2004

missnurse--

My understanding is that it would depend on the cause of the anemia and jaundice. If it was an rh or ABO problem, the additional blood could quite possibly have caused those to be worse--more of the blood would have been available to be attacked, and that would cause additional work for the liver. That is the situation we had with my children--ABO incompatibility caused jaundice in my first two, so the third was at risk for having it even worse. It turned out he had my blood type unlike the other two, so had we let the cord stop pulsating with him it probably wouldn't have mattered.

missnurse01, MSN, RN · Jun 17, 2004

hey guys,

nope-no abo/rh compatability prob that i ever new about. i thought preemies were more at risk for anemia/jaundice anyway and that pit increases the jaundice prob? baby #2 wasn't anemic, just jaundice, also on pit-another 36 weeker, come to think of it baby #1 was a 32 weeker and jaundiced -no pit-but i don't recall him being so anemic. #3 was the one i was talking about that was both...i thought maybe the extra bld would have helped...maybe that would have made him more jaundiced though? thanks for all the input!:)

rdhdnrs · Jun 19, 2004

I can't think why the normal use of pitocin to augment labor would cause anemia. Can anyone else?

Dayray, RN · Jun 19, 2004

Clamping the cord after it stops pulsing sounds good and seems very romantic however, there are no benefits to it.

It can actually cause the baby to get too much blood. It can also cause hypovolemia. It depends on if the baby is above or below the placenta.

When you read about it in home birth stories or natural child birth books they make it sound as if this is more natural and that cutting the cord robs the baby of the last few pulses of blood from the placenta. When you read actual studies it shows that the circulation is stopped within a few seconds after the baby is born. Any blood exchange after birth is only due to gravity. The placenta holds about 1/3 of the babies total blood volume threw out gestation, they are not meant to be born with all of that blood. They come out with just about the amount they are supposed to have. So if the baby is below the placenta extra blood flows to them , if they are above it some of the blood they are supposed to have flows back. Babies can get very sick from having too many red blood cells or from having to few.

It's really hard to explain this to parents because the idea of it sounds so nice. Unlike many of the other natural child birth ideas this one has no benefit. I think it was dreamed up by someone because "in nature no one clamps the cord" however, in nature the first thing the mother does is bite off the cord, the child doesn't die because the circulation shuts off quickly after birth. Now of course I'm not suggesting that cords not be clamped (this is one of the ways that medicine has improved outcomes) because sometimes babies can bleed out like this.

Having to little blood obviously is not desirable but having too much is even worse. It causes problems with the babies lungs, kidneys, liver, heart and makes for some pretty grotesque looking splotches and reddened eyes.

The other natural child birth recommendation that is dangerous is when they ask you not to dry the baby. Babies get cold fast and that fluid act as a conductor and evaporates their heat. Again the idea is that in nature "there isn't a nurse to dry the baby" but if you watch any animal they quickly lick the baby dry and put them on their belly to warm them. This is another area where medicine has improved outcomes.

Hospital births have taken allot of the spiritual and emotional aspects out of child birth but they have also greatly increased the chances of survival of both mom and baby. Ask your grand mother how many children she or her mother had and she is likely to tell you that at least one of them died in infancy. It's a struggle to retain some of the spiritual and emotion aspects while making sure everyone is safe but it can be done.

As nurses we are often torn between honoring the patients wishes and promoting safety. Remember a patents choices are only as good as the information they receive. While they of course have the right to make choices we have the responsibility to educate them and not simply say "because that is the way we do it".

PegRNBSN · Jun 20, 2004

Actually it can be beneficial to the baby to delay cutting the cord until baby is dried and (if no meconium) stimulated. Babies were not meant to be born with someone standing by with clamps and scissors. Even if there is need for resusitation it is beneficial to let baby get some extra blood especially with a tight cord or cord compression at the end of the second stage.

The baby should be held lower than the placenta. Our neonatolgists tell us they are always glad when the OB takes that extra time even though they are anxious to get the baby.

Jolie, BSN · Jun 20, 2004

Clamping the cord after it stops pulsing sounds good and seems very romantic however, there are no benefits to it.
It can actually cause the baby to get too much blood. It can also cause hypovolemia. It depends on if the baby is above or below the placenta.
When you read about it in home birth stories or natural child birth books they make it sound as if this is more natural and that cutting the cord robs the baby of the last few pulses of blood from the placenta. When you read actual studies it shows that the circulation is stopped within a few seconds after the baby is born. Any blood exchange after birth is only due to gravity. The placenta holds about 1/3 of the babies total blood volume threw out gestation, they are not meant to be born with all of that blood. They come out with just about the amount they are supposed to have. So if the baby is below the placenta extra blood flows to them , if they are above it some of the blood they are supposed to have flows back. Babies can get very sick from having too many red blood cells or from having to few.
It's really hard to explain this to parents because the idea of it sounds so nice. Unlike many of the other natural child birth ideas this one has no benefit. I think it was dreamed up by someone because "in nature no one clamps the cord" however, in nature the first thing the mother does is bite off the cord, the child doesn't die because the circulation shuts off quickly after birth. Now of course I'm not suggesting that cords not be clamped (this is one of the ways that medicine has improved outcomes) because sometimes babies can bleed out like this.
Having to little blood obviously is not desirable but having too much is even worse. It causes problems with the babies lungs, kidneys, liver, heart and makes for some pretty grotesque looking splotches and reddened eyes.
The other natural child birth recommendation that is dangerous is when they ask you not to dry the baby. Babies get cold fast and that fluid act as a conductor and evaporates their heat. Again the idea is that in nature "there isn't a nurse to dry the baby" but if you watch any animal they quickly lick the baby dry and put them on their belly to warm them. This is another area where medicine has improved outcomes.
Hospital births have taken allot of the spiritual and emotional aspects out of child birth but they have also greatly increased the chances of survival of both mom and baby. Ask your grand mother how many children she or her mother had and she is likely to tell you that at least one of them died in infancy. It's a struggle to retain some of the spiritual and emotion aspects while making sure everyone is safe but it can be done.
As nurses we are often torn between honoring the patients wishes and promoting safety. Remember a patents choices are only as good as the information they receive. While they of course have the right to make choices we have the responsibility to educate them and not simply say "because that is the way we do it".

Thank you, Dayray for a very thorough answer. As a NICU nurse, I can assure you that giving the baby a little "extra" blood is NOT desirable. I've seen kids with oxygen sats of 85 due to polycythemia have to under go partial exchange transfusions. Even for preemies who are likely to become anemic at some point in their hospital stay, starting out with a Hct > 65 is problemmatic. Polycythemia can lead to respiratory problems, unstable glucose, congestive heart failure, etc. Not a pretty picture.

If parents want to keep the cord unclamped until it stops pulsating, so be it, but PLEASE keep the baby and placenta at the same level so that blood does not flow by gravity one way or the other.