Cutting the Cord: Help in the Right Direction?

Jackalgirl

Graduate Poster
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Aug 25, 2004
Messages
1,801
Hello --

Could any of you medical types give me a push in the right direction, in terms of searching medical databases? I've been finding lots of articles talking about the pros and cons of cutting a newborn's umbilical cord right away, which is essentially what my doctor wants to do (I'm having a baby, hopefully, sometime in August). The majority of them state that delaying cutting the cord has better long-term benefits to the baby, primarily in the reduction of anemia and better long-term iron stores. I've also seen an article that stated there was a significant decrease in post-birth hemmorage on the part of the mother in those cases where cord cutting was delayed.

What the doctor is saying, though, is that if he delays cutting the cord, he will have to hold the baby below the level of my uterus, otherwise the baby's blood will flow back into the placenta. The analogy he gave me is that this is like siphoning gas out of a car (in other words, it's a hydraulics/gravity situation). He says that because of this, the baby will get cold, possibly run into other problems, won't be able to be on my chest, etc.

Now, I'm absolutely no scientist and I'm certainly not a doctor, but this doesn't seem right to me. For one thing, the analogy fails to take into account that there are two pumps attached to this particular fuel tank (i.e., mine and the baby's hearts) -- at least, until the placenta detaches, of course. I'd like to argue this point, but what I really need is medical reference to back up my suspicion (or to back the doc's). My doc is cool in that he's open to read whatever material I can find.

So, although finding the articles urging delayed cord cutting is cool, what I'm really looking for is reference material that talks about the actual physiological setup and process of the mother->placenta->baby connection -- something that will explain that the analogy of fuel tank->gas container is either a good one or is not, and to explain that the doctor really does or does not have to hold the baby lower than the level of my uterus to keep the baby's blood from rushing out.

Can any of you medical types point me in the right direction, maybe help me out with a good search phrase, and help me avoid the woo-doo out there?

Thanks!
 
I tried the Cochrane Collaboration, but the relevant review is still in the protocol stage. I used "delayed umbilical cord clamping" (without the quotes) in Google and got a systematic review in JAMA from March 2007 that looks ideal. The relevant paragraph where they discuss the position of the baby states:

"The favorable effect of late clamping on neonatal hematocrit at age 6 hours remained significant whether newborns were kept at the level of the placenta or placed on the mother's abdomen. The subgroup analyses for data collected for hematocrit at 24 to 48 hours and at age 5 days showed significant differences in favor of late clamping, irrespective of the level of the infant during the delayed time (hematocrit at 24-48 hours in infants kept above level of placenta [3 trials, 311 infants]: WMD, 6.08%; 95% CI, 4.63% to 7.54%; in infants kept at level of placenta [1 trial, 30 infants]: WMD, 16.00%; 95% CI, 12.05% to 19.05%. Hematocrit at 5 days in infants kept above level of placenta [2 trials, 60 infants]: WMD, 9.03%; 95% CI, 6.46% to 11.60%; in infants kept at level of placenta [2 trials, 60 infants]: WMD, 15.00%; 95% CI, 12.35% to 17.65%)."

(WMD = weighted mean difference)
The references for this conclusion are:

http://pediatrics.aappublications.o...jkey=5660e859c83bf8dad006f29ccc7aef22e36d905f
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=15510946&dopt=Abstract
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=8333451&dopt=Abstract
http://www.obgyn.net/women/women.asp?page=/pb/articles/cordclamping_aziz_0699
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=8950732&dopt=Abstract
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=1421876&dopt=Abstract

Linda
 
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Ah hah! Okay, so at least the conclusion here states that there doesn't seem to be much of a difference in the level of the baby. That's a good start. Thanks very much!
 
Umm, since umbilical cords have both an artery, and a vein. wait, arent't they both some kind of vein, like 'portal vein'? Did anybody try clamping the return line first, then later the out put line, thereby trapping blood in the baby? A minute or two would be enough, and baby elevation wouldn't matter. Like doing a vasectomy, one tube only? Or do they still just whack it with an axe, like 'fixing' a dog?
 

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