Doctor doesn't want to allow delay of cord cutting -- WWYD?

[AmyKate]

After researching the benefits of delaying cutting the umbilical cord, I asked my Dr. if he would allow me to wait three minutes before clamping & cutting. He basically blew me off, saying there is no scientific evidence that it does any good, & that it's just one of those things they like to print in Ladies Home Journal. Yeah, he can be a real condescending prick. He said it's more important to take the baby right away to make sure he's breathing fine & everything is OK. I really don't see why they can't do that with baby on my chest.

I am 6 days overdue, so it's a little late to switch doctors, & as it is there is a Dr. shortage here, so I don't really know if I could find someone else. He is also our family Dr., so I don't really want to piss him off.

I guess my question is, should I insist on the delay? Is it worth it, or is he right? I don't do confrontation well, but if I decide that it is worth it, I'll stand firm about it.

Thoughts?

Thanks!!

[Crabbie]

I believe that as long as the baby is born healthy and doesn't need to be whisked away right away that the doc should allow you to delay the cutting of the cord. It isn't his birth. It wont harm the baby so why would they rebuke it?

[Sunnie]

I agree Crabbie. But at the same time, this is not something I'd really fight either.

[Monkeytoes]

All 4 of my kids were fine without a cord delay. I wouldn't fight it. I mean if it's something you have your heart set on then maybe but I don't see it being a "have to" thing. :)

[nicurn]

AmyKate, I do not think you should fight it. At your own delivery, it shouldn't be your job to fight anything at all. Do you have a nosy, bossy family member who really wants to be there? Make her your birth plan advocate.

If it's important to you to delay cord cutting, then have your advocate ready to ask why the cord is being clamped (she'd better be ready, because it's done during the delivery as a matter of course in many hospitals). Have her remind the nurses prior to delivery exactly what your wishes are, and ask why your wishes aren't being followed if at any time the staff ignore them.

Understand, there may be very good reasons for disregarding them. I asked that my baby be caught by my DH and laid on my belly until he crawled up and nursed. After about 30 seconds on my belly, the cord was cut and he was carried off to the warmer...for oxygen therapy. He was happily looking in my eyes and turning purple because he'd forgotten how to breathe.

Anyway, if you have an advocate who doesn't take "it's our policy" for an answer, then you will have a better experience than if you expect to fight all the important battles mid-delivery.

Happy birthing!

[Psyche]

Anyway, if you have an advocate who doesn't take "it's our policy" for an answer, then you will have a better experience than if you expect to fight all the important battles mid-delivery.

Happy birthing!

Yes. I had a doula for that purpose since there were things important to me that were not standard (first hour on my chest, no nursery time, no bath for baby, no eye drops, etc). Pretty much I wanted my answer to be "no" to all standard procedures, b/c I wanted to be asked first (except in emergency situations).

During L&D you just aren't going to feel up to arguing or fighting and the really assine doctors count on that. Frankly they could tell you they're going to adopt your first born and your answer (especially in a contraction) will probably be "Whatever"

Ultimately though, your body, your choice.

[foxinsocks]

I had 5 children whose cords were cut immediatly and they all turned out perfect. I would concentrate on having a healthy baby and try to find another doc after your baby is born. Condescending doc's suck.

[KerryS]

Unless your baby needs resuscitation, there's no reason why they can't do all transitional care on your belly/chest. I agree with others who said to find an outspoken family member step in and intervene on your behalf. If your baby has a short cord and cannot reach your belly/chest, they may have to cut it anyway.

[cream_city]

It's too bad that it's too late to switch doctors -- I ended up switching doctors in part because of that. I just felt she wasn't sympathetic to the type of birth I wanted.

That said, I am not sure I'd get into it at this point (6 days past due date). The baby will be fine either way.

[Babyblue]

I would tell him unless there is a emergency situation, too bad for him, its your birth your baby. I honestly believe drs can be condescending pricks to begin with, but over time they get so use to never being challenged that they automatically say no to everything outside their little world of normal.

[HammBugga]

I had 5 children whose cords were cut immediatly and they all turned out perfect. I would concentrate on having a healthy baby and try to find another doc after your baby is born. Condescending doc's suck.
As do condescending message board members who say crap like the first couple sentences of your post. Just because your babies "turned out perfect" doesn't mean they wouldn't have benefited from delayed cord clamping.

OP, I agree with others that you should have an advocate. Tell your Dr. what you want and don't make it sound like there is any other option. If he refuses, well there is nothing you can do. Try to be open minded but also state what you want. That way if you don't end up getting it, you can still be confident you tried and let your voice be heard.

[PrincessEmilysMommy]

I had 5 children whose cords were cut immediatly and they all turned out perfect. I would concentrate on having a healthy baby and try to find another doc after your baby is born. Condescending doc's suck.

And instead of formula or breastmilk I was fed powdered milk. But I'm fine.

[AuLait]

If it were me, I'd have DH or another person present at the birth step in and prevent the cord from being cut in the actual moment. You don't need your doctors permission to delay the cutting. Have someone standing right there next to the doctor who will state firmly, "We're gonna just wait on that cord cutting for a little bit, ok?". Or even talk to your nurses and have them bring the baby to your chest immediately after birth, where you can hold your baby and prevent the cord from being cut.

I found in my last delivery that the less I asked permission and the more I just did what I thought is best had good results. They seemed to respect someone who had a clear plan and idea of what they wanted and were unlikely to step in over small stuff when we were concise and involved. Besides, I don't really like the dynamic of me having to ask my doctor for permission about my own care or that of my child. They are there to advise and assist. Not grant permission.

If you feel bold enough, you could just tell your doctor at the next visit that you've decided to delay the cord cutting and that it won't be done until you've granted permission (and you can say this sweetly and with a smile). Don't be afraid to boldly state your intentions. What can he do, really?

[MrsKitty]

I don't think it matters what your doctor wants. Is this his child? Is he pushing the baby out his hoo hah? No? Well then I would think that his wants are not very important.

[KerryS]

I don't think it matters what your doctor wants. Is this his child? Is he pushing the baby out his hoo hah? No? Well then I would think that his wants are not very important.

That's all well and good, but the doctor's the one that's going to be holding the baby and the scissors. So yeah, his preferences ARE going to make a difference.

[foxinsocks]

Not meant to sound condescending... The woman is 6 days overdue and in a situation where most likely the doc will make the decision of cord cutting. I would not choose to fight this battle and would not recommend it to one in her situation.

[KerryS]

I don't understand why being six days overdue is relevant to whether or not her wishes should be respected. As long as it's not harming the mom or baby and it's not interfering with measures that the baby might need for his/her health after birth, what's the big deal? The doctor's being an ass because he can. She needs to have a strong advocate there, because she likely won't be in a position to argue right after she's just pushed the baby out.

[foxinsocks]

Well, I think its stressful to argue with docs, especially soon to be in labor. If I felt about my MD the way she feels about hers, I would have switched. But now is not the time so my advice is deal with it.

I know how little docs listen to nurses and even less to patients on the medical floors. I have fine tuned the way I communicate so that it sounds like their ideas- so it flies better.

I would recommend that she have this baby and enjoy it, then find another doctor. I would doubt that the doc will delay the cutting even with a strong advocate.

[Babyblue]

Well, I think its stressful to argue with docs, especially soon to be in labor. If I felt about my MD the way she feels about hers, I would have switched. But now is not the time so my advice is deal with it.

I know how little docs listen to nurses and even less to patients on the medical floors. I have fine tuned the way I communicate so that it sounds like their ideas- so it flies better.

I would recommend that she have this baby and enjoy it, then find another doctor. I would doubt that the doc will delay the cutting even with a strong advocate.

Its people who say “ok do whatever you want” to their docs that have made it so ok for patients to be pushed around and ignored. She researched and put time into knowing what is best for her and her baby, how dare you say she needs to just let it go and enjoy the baby. She wont be enjoying it if the baby becomes severely anemic will she?


amy its YOUR BABY and YOUR BIRTH, which your dr just happens to be lucky enough to attend, telling him that baring medical emergency its your way or another on call dr can deliver your baby. Trust me, once you get to the hospital there is not only one dr in the whole place that can deliver your baby. You will need a very strong willed advocate but you can get your needs met and you can have the birth and health care you want.

[KerryS]

Trust me, once you get to the hospital there is not only one dr in the whole place that can deliver your baby.

Actually, you don't know that for sure. At our hospital, you get whatever doctor is on call for that practice, and each practice only has one doctor on call at a time. So no, you don't have a choice of different doctors.

[newbie]

All 4 of my kids were fine without a cord delay. I wouldn't fight it. I mean if it's something you have your heart set on then maybe but I don't see it being a "have to" thing. :)


Why jump all over foxinsocks she is not the only one who said they wouldn't fight it, or that her kids were born fine w/o cord delay. I guess it depends on your post count................

[Indigo]

I dont' think it depends on post count, the other comments were discussed/disagreed with too, she just suggested that we not advise her to fight this battle. It doesn't need to be a fight but asking her dr to respect her wishes it's her body/baby and her birth. I would let the dr know ahead of time that this is an issue for you and your dh or whoever will be reminding him at the birth that this will be delayed.

[Babyblue]

Actually, you don't know that for sure. At our hospital, you get whatever doctor is on call for that practice, and each practice only has one doctor on call at a time. So no, you don't have a choice of different doctors.

sorry perhaps I am use to a large hospital. the place I deliver at has docs from each practice and docs who strictly work for the hospital on call. there is a lot of babies born there:)

[Psyche]

Why jump all over foxinsocks she is not the only one who said they wouldn't fight it, or that her kids were born fine w/o cord delay. I guess it depends on your post count................

Oh, Gawd, the martyr complex. What a joke.

Her post was condescending not because of what she said but how she said. In context of this discussion it doesn't matter that her kids are "fine" with immediate cord cutting. The way she said her piece discounted the OP's feelings and wishes. The OP wants what is best for her baby and based on her research that includes delayed cord cutting.

[HammBugga]

Oh, Gawd, the martyr complex. What a joke.

Her post was condescending not because of what she said but how she said. In context of this discussion it doesn't matter that her kids are "fine" with immediate cord cutting. The way she said her piece discounted the OP's feelings and wishes. The OP wants what is best for her baby and based on her research that includes delayed cord cutting.


Exactly. It was the way in which she said it.

[Nipple_nectar]

It is not too late to present a WRITTEN BIRTH PLAN. I would write down my wishes and present it to the DR, even if it is in L & D, I am sure your request will receive more merit, if it appears as a well written document before the actual event, and not last minute changes.

If you can present it in his office before you are actually in labor, that would be optimum. What are his intentions WRT you being overdue? Does he want to induce you? Do you have an appt. set with him?

[minxs]

Not to be mean, but I feel that if you have very strong ideas on how you want things to be done you will have to discuss this in advance with the Dr. Just before -or after- you are due is a bit late IMO. I you feel that it is worth switching Dr over, than one should take care to discuss it well in advance.
There are many reasons to switch Dr, and being talked down to would absolutely rank high on my list (actually made me switch dr). If it were my dilivery, i'd put it in my birthplan, speak to the nurses about it, state it again to the Dr, have someone to advocate for me and let it go.

[KerryS]

I guess my question is, should I insist on the delay? Is it worth it, or is he right?

In answer to this question, IMO it's not a huge deal. Immediate cord clamping can put the child at risk for iron deficient anemia later. Delayed cord clamping can put the child at risk for hyperbilirubinemia sooner.

Like others have said, almost all babies do just fine being clamped and cut right away. The only time babies have a bit harder time is when the cord is cut on the perineum (before the entire body is birthed) - those babies tend to be a bit "shocky" and less vigorous for several minutes after birth (but then generally pink up and become fine after that).

[foxinsocks]

OK, if you saw it as condescending than that must be how I intended it...

My intent was to show that many children are born without delayed cord clamping and are OK. Like I said before, not a battle I would choose to fight.

[HammBugga]

Not to be mean, but I feel that if you have very strong ideas on how you want things to be done you will have to discuss this in advance with the Dr. Just before -or after- you are due is a bit late IMO. I you feel that it is worth switching Dr over, than one should take care to discuss it well in advance.
There are many reasons to switch Dr, and being talked down to would absolutely rank high on my list (actually made me switch dr). If it were my dilivery, i'd put it in my birthplan, speak to the nurses about it, state it again to the Dr, have someone to advocate for me and let it go.


She said in her OP she just found out the benefits of delayed cord clamping. Not everyone can have all the information all the time. She JUST found out this info, so therefore she has a right to request what she wants.

[PrincessEmilysMommy]

Oh, Gawd, the martyr complex. What a joke.

Her post was condescending not because of what she said but how she said. In context of this discussion it doesn't matter that her kids are "fine" with immediate cord cutting. The way she said her piece discounted the OP's feelings and wishes. The OP wants what is best for her baby and based on her research that includes delayed cord cutting.

Yup!

[The_Market]

That's just bullshit. Assuming you're expecting a healthy baby, there is no evidence to support what he's asserted and hordes of evidence to show that the healthiest practice (for normal, full term babies) is to let the cord pulse (for at least 1 minute) while the baby goes straight to the mother, has sustained skin to skin (for hours, not minutes), nurse on demand and w/o supplementation, and never be separated from its mother.

Evidence also shows that -while in arms- the baby should be monitored (APGARs being the initial stage of this), including temperature checks, breathing checks, and other basic assessment. Evidence would include a few other tests, such as biliruben checks and PKUs for all babies and blood sugar monitoring for some. Vitamin K is debatable, although generally supported in both the midwifery model and medical model of care.

What surprises me is that he is a family medicine doctor, to boot. The AAFP actually supports guidelines that are far more evidence based than ACOG. They even support (evidence based) out of hospital birth. I'm going to see what their stance is on delayed cord clamping, as well as find some studies you can bring, or send, to your uncompromising doctor.

See, I'm not opposed to appropriate monitoring, technology, or prudence. I do feel strongly that every mother and baby deserves evidence based care. What you're receiving is just bullying.

Check this out, from this website, (http://www.emtala.com/)about your rights. It is illegal for him to perform a (esp non-life saving) procedure to which you object. If you object at 30 seconds, but agree at 3 minutes, that is not only your prerogative as a mother, it is evidence based choice making.

"The federal Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to admit women in active labor and to abide by their treatment decisions until after the baby and placenta are delivered. The act was originally designed to prevent hospitals from "dumping" patients who couldn’t pay but has since been widely used to hold hospitals accountable for violating other patient rights, including the right to refuse treatment. If your hospital threatens to perform a procedure despite your refusal, notify them that they are in violation of your rights under EMTALA and that you plan to file a complaint." (bold mine)

This man is nothing more than a bully and it's not okay for you to allow that. You definitely need protection as you go about the process of laboring. As others have said, you will not be of a mind to think straight or assert yourself while in labor. You need to feel safe to labor productively. I really hope you have someone that can provide this role for you.

And you don't want to piss him off? Do you really plan to continue seeing him for anything after this?

[vulturemom]

Will the DR let your DH cut the cord?

If he will then you DH could always stall for a minute or two.

[AmyKate]

Thanks for all the replies, everyone!

I realize that I should have brought it up with the Dr. sooner, but I didn't really think that it would be an issue. My thoughts were that they can check him over just as well on my belly, as in the corner of the room. I should have realized that he might not be on board, as this is the Dr. who told me that breastfeeding my first son past 3 or 4 months was pointless, & then warned me to immediately wean him when I got pregnant with this baby when DS was 15 months. However that was easy to ignore. As Kerry said, when he's holding the baby & the scissors, it'll be a bit harder. My plan at this point is to make my wishes known to the nurses, & my DH knows & will try to have cutting delayed, if it doesn't happen, I'll know I tried.

Nipple Nectar-- I think it was you that asked about his plans for induction. Thank God the Dr. thinks my due date is the 23. (Due to regular periods & implantation bleeding I say the 12.) As long as I have baby b/f about the 24, I should be able to avoid a confrontation over that, because there would be one, LOL. I feel way more strongly about induction for a few days overdue baby than the cord cutting issue. With DS, he wanted to induce me the day after my due date, but we put him off, & delivered at 10 days overdue -- a 9 lb., dried out, but oh so alert, & healthy boy!

Thanks again everyone! I often read on here, & have learned much from you ladies, but seldom post because I never know when I'll make it back to reply again. I don't know too many IRL moms who feel as strongly as I about nursing, properly installed car seats, circumcision, etc., etc., so it's nice to know you are out there!

[vulturemom]

I had 5 children whose cords were cut immediatly and they all turned out perfect. I would concentrate on having a healthy baby and try to find another doc after your baby is born. Condescending doc's suck.


I had five childern that were born c-section. They are healthy and perfect. That doesn't mean that I would suggest that everyone else do the same thing.

[AmyKate]

Market,

Thank-you! I am in Canada, so I don't know that we have something similar to the EMTALA, but I will look. The thing is, we have a major Dr. shortage here, & I guess I'm worried that even if I can find another Dr., I'll end up liking them less. I don't think he's a *bad* Dr., I just think he rushes through things, & tends to have views that were probably popular 10-20 years ago. I did however, love the nurses I dealt with during & after DS's birth. They let me labour however I wanted, treated me kindly, encouraged breastfeeding, rooming in etc. All in all his birth was a very, very positive experience.

Vulturemom -- yes, DH cut the cord with DS, so I will try to get him to delay the Dr. a bit (after he's holding the scissors, of course, LOL!)

[JudyJudyJudy]

In answer to this question, IMO it's not a huge deal. Immediate cord clamping can put the child at risk for iron deficient anemia later. Delayed cord clamping can put the child at risk for hyperbilirubinemia sooner.

I've read that the estimates are that about 50% of babies who end up being iron deficient later would not have been if cord cutting had been delayed. Also, there is evidence that delaying the cord cutting can help prevent antibody transfer to the mother when the blood types are incompatible (this is important to me because I had rh antibodies after Jacob was born). Of course, the hyperbilirubinemia is something to consider as well.

[BoobySnacks]

Unless it is hospital policy, I would stick to my birth plan no matter how rediculous the doctor thought I was. It is a matter of principle to me..If it is important to you, why does HE get to bully you into not doing it just because he thinks it is not necessary. It really does not matter if it is not necessary. Having an epidural was not necessary with DD, but I had it anyway. Some things are not necessary, but you want them anyway because it is your choice and it matters to you. I agree with the pushy advocate, my MIL loves to be in the middle of things, so she would have been the one for me. I am sure there is someone in your family who would be happy to step in. I doubt you will piss the doc off too much, he will just go home and complain about "one of those women" which he probably does all the time and it will be forgotten by your 6 week check up. Good luck and have a great birth! Personally, I do not know the benefits of keeping the cord for only a few minutes, so I would not care, but if you care then you should have the choice if there is no hospital policy making it impossible.

[Sameach]

I'm sorry you're having to stress about this so late in your pregnancy. Your doctor sounds like a real uneducated jerk, and I hope you can find a way to get the birth that you want.

[RaisingThemLeft]

It sounds like you are fighting an uphill battle with your Dr. There is no good reason for him to blow off your wishes as long as everything is fine with the baby. I had a birth plan that included delaying cutting and clamping, but both times was not able to follow through on it. In the first instance, ds 2 had shoulder dystocia and came out blue and not breating, and then with ds 3, I pulled him up onto my chest and the cord snapped and the midwife had to hurry up and get a clamp on it. It really would have bothered me if the Dr. were unwilling to honor my wishes at my birth, as long as those wishes were not putting the baby in jeprody. It sounds like you've got the type of Dr. who just likes to run the show. Frankly, if I could, I'd ditch the Dr. and get a midwife, even this late in the game, but that's me and my low tolerance for Dr.'s like that. I'd rather have a complete stranger who treated me with respect than a Dr. I'd been seeing for 8 months who was a condecending prick to me.

[The_Market]

In answer to this question, IMO it's not a huge deal. Immediate cord clamping can put the child at risk for iron deficient anemia later. Delayed cord clamping can put the child at risk for hyperbilirubinemia sooner.

The bold is debateable. IIRC he most recent study (the one that showed significant reduction in anemia through 3 years of age) did not actually find statistically significant increase in jaundice with delayed cord clamping.

The other benefit to delaying the clamping is that it allows be baby the benefit of continuing to receive oxygen through the cord for a few minutes as it adjusts to using its lungs. Keeping baby with mother makes far more sense, as well, since babies often respond with increased alertness to their mother's voice, and skin to skin contact significantly improves O2 stats, overall.

In fact, if there is concern about the baby's oxygen/breathing, the ideal would be to treat that while keeping the cord intact (and getting oxygen that way) for as long as it pulsed (or until the babe is breathing well), by performing needed proceedures on the bed between mom's legs. Unfortunately, we're not set up to do that and many mothers' natural panic would likely prove an interference, or at least distraction. And, of course, sometimes the mother needs treatment of some kind herself.

At any rate, I see the logic leaning heavily toward letting the cord pulse briefly. Here are some studies I just pulled up.

From Pediatrics (http://www.ncbi.nlm.nih.gov/pubmed/16567393?ordinalpos=14&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum)
Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials.
Hutton EK, Hassan ES.

Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario. huttone@mcmaster.ca

CONTEXT: With few exceptions, the umbilical cord of every newborn is clamped and cut at birth, yet the optimal timing for this intervention remains controversial.

OBJECTIVE: To compare the potential benefits and harms of late vs early cord clamping in term infants.


DATA SOURCES: Search of 6 electronic databases (on November 15, 2006, starting from the beginning of each): the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Neonatal Group trials register, the Cochrane library, MEDLINE, EMBASE, and CINHAL; hand search of secondary references in relevant studies; and contact of investigators about relevant published research.

STUDY SELECTION: Controlled trials comparing late vs early cord clamping following birth in infants born at 37 or more weeks' gestation.

DATA EXTRACTION: Two reviewers independently assessed eligibility and quality of trials and extracted data for outcomes of interest: infant hematologic status; iron status; and risk of adverse events such as jaundice, polycythemia, and respiratory distress.

DATA SYNTHESIS: The meta-analysis included 15 controlled trials (1912 newborns). Late cord clamping was delayed for at least 2 minutes (n = 1001 newborns), while early clamping in most trials (n = 911 newborns) was performed immediately after birth. Benefits over ages 2 to 6 months associated with late cord clamping include improved hematologic status measured as hematocrit (weighted mean difference [WMD], 3.70%; 95% confidence interval [CI], 2.00%-5.40%); iron status as measured by ferritin concentration (WMD, 17.89; 95% CI, 16.58-19.21) and stored iron (WMD, 19.90; 95% CI, 7.67-32.13); and a clinically important reduction in the risk of anemia (relative risk (RR), 0.53; 95% CI, 0.40-0.70). Neonates with late clamping were at increased risk of experiencing asymptomatic polycythemia (7 studies [403 neonates]: RR, 3.82; 95% CI, 1.11-13.21; 2 high-quality studies only [281 infants]: RR, 3.91; 95% CI, 1.00-15.36).

CONCLUSIONS: Delaying clamping of the umbilical cord in full-term neonates for a minimum of 2 minutes following birth is beneficial to the newborn, extending into infancy. Although there was an increase in polycythemia among infants in whom cord clamping was delayed, this condition appeared to be benign.


Here (http://www.cordclamp.com/ZICCthe%20PrimeInjury.htm)is an interesting article, with ample citation. I admit I only skimmed it, but I will read it further shortly.

From The Lancet

Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial

Camila M Chaparro PhD a, Lynnette M Neufeld PhD b, Gilberto Tena Alavez MD c, Raúl Eguia-Líz Cedillo MD c, Dr, Prof Kathryn G Dewey PhD a

Background
Delayed clamping of the umbilical cord increases the infant's iron endowment at birth and haemoglobin concentration at 2 months of age. We aimed to assess whether a 2-minute delay in the clamping of the umbilical cord of normal-weight, full-term infants improved iron and haematological status up to 6 months of age.

Methods
476 mother-infant pairs were recruited at a large obstetrics hospital in Mexico City, Mexico, randomly assigned to delayed clamping (2 min after delivery of the infant's shoulders) or early clamping (around 10 s after delivery), and followed up until 6 months postpartum. Primary outcomes were infant haematological status and iron status at 6 months of age, and analysis was by intention-to-treat. This study is registered with ClinicalTrials.gov, number NCT00298051.

Findings
358 (75%) mother-infant pairs completed the trial. At 6 months of age, infants who had delayed clamping had significantly higher mean corpuscular volume (81·0 fL vs 79·5 fL 95% CI −2·5 to −0·6, p=0.001), ferritin (50·7 μg/L vs 34·4 μg/L 95% CI −30·7 to −1·9, p=0·0002), and total body iron. The effect of delayed clamping was significantly greater for infants born to mothers with low ferritin at delivery, breastfed infants not receiving iron-fortified milk or formula, and infants born with birthweight between 2500 g and 3000 g. A cord clamping delay of 2 minutes increased 6-month iron stores by about 27—47 mg.
Interpretation

Delay in cord clamping of 2 minutes could help prevent iron deficiency from developing before 6 months of age, when iron-fortified complementary foods could be introduced.

This one (http://www.ncbi.nlm.nih.gov/pubmed/11783688?dopt=AbstractPlus) mentions hyperbilirubinemia

Current best evidence: a review of the literature on umbilical cord clamping.
Mercer JS.

Nurse-Midwifery Program, University of Rhode Island College of Nursing, Kingston 02881-2021, USA.

Immediate clamping of the umbilical cord can reduce the red blood cells an infant receives at birth by more than 50%, resulting in potential short-term and long-term neonatal problems. Cord clamping studies from 1980 to 2001 were reviewed.

Five hundred thirty-one term infants in the nine identified randomized and nonrandomized studies experienced late clamping, ranging from 3 minutes to cessation of pulsations, without symptoms of polycythemia or significant hyperbilirubinemia.

Higher red blood cell flow to vital organs in the first week was noted, and term infants had less anemia at 2 months and increased duration of early breastfeeding.

In seven randomized trials of preterm infants, benefits associated with delayed clamping in these infants included higher hematocrit and hemoglobin levels, blood pressure, and blood volume, with better cardiopulmonary adaptation and fewer days of oxygen and ventilation and fewer transfusions needed.

For both term and preterm infants, few, if any, risks were associated with delayed cord clamping. Longitudinal studies of infants with immediate and delayed cord clamping are needed.

Lastly, from Pediatrics (http://pediatrics.aappublications.org/cgi/content/full/117/4/e779[)(I don't think I'm repeating, but I'm swimming in studies right now).

ABSTRACT
TOP
ABSTRACT
METHODS
RESULTS
DISCUSSION
CONCLUSIONS
REFERENCES

BACKGROUND. The umbilical cord is usually clamped immediately after birth. There is no sound evidence to support this approach, which might deprive the newborn of some benefits such as an increase in iron storage.

OBJECTIVES. We sought to determine the effect of timing of cord clamping on neonatal venous hematocrit and clinical outcome in term newborns and maternal postpartum hemorrhage.

METHODS. This was a randomized, controlled trial performed in 2 obstetrical units in Argentina on neonates born at term without complications to mothers with uneventful pregnancies. After written parental consents were obtained, newborns were randomly assigned to cord clamping within the first 15 seconds (group 1), at 1 minute (group 2), or at 3 minutes (group 3) after birth. The infants' venous hematocrit value was measured 6 hours after birth.

RESULTS. Two hundred seventy-six newborns were recruited. Mean venous hematocrit values at 6 hours of life were 53.5% (group 1), 57.0% (group 2), and 59.4% (group 3). Statistical analyses were performed, and results were equivalent among groups because the hematocrit increase in neonates with late clamping was within the prespecified physiologic range. The prevalence of hematocrit at <45% (anemia) was significantly lower in groups 2 and 3 than in group 1. The prevalence of hematocrit at >65% was similar in groups 1 and 2 (4.4% and 5.9%, respectively) but significantly higher in group 3 (14.1%) versus group 1 (4.4%). There were no significant differences in other neonatal outcomes and in maternal postpartum hemorrhage.

CONCLUSIONS. Delayed cord clamping at birth increases neonatal mean venous hematocrit within a physiologic range. Neither significant differences nor harmful effects were observed among groups. Furthermore, this intervention seems to reduce the rate of neonatal anemia. This practice has been shown to be safe and should be implemented to increase neonatal iron storage at birth.

[Indigo]

Not to be mean, but I feel that if you have very strong ideas on how you want things to be done you will have to discuss this in advance with the Dr. Just before -or after- you are due is a bit late IMO. I you feel that it is worth switching Dr over, than one should take care to discuss it well in advance.
There are many reasons to switch Dr, and being talked down to would absolutely rank high on my list (actually made me switch dr). If it were my dilivery, i'd put it in my birthplan, speak to the nurses about it, state it again to the Dr, have someone to advocate for me and let it go.

I don't think that discussing things on an on going basis as they come up with your dr is out of line or that everything should have been squared away months ago. Because she is nearly at the end her wishes aren't worth discussing? I don't see why there is a time limit on this stuff things change in a pregnancy and even at the time of labor/delivery. I don't get this attitude.

[The_Market]

Will the DR let your DH cut the cord?

If he will then you DH could always stall for a minute or two.
It's clamped already by that time.

I knew one father who moved the clips off the tray while everyone was focused on mom pushing (doc wasn't in the room yet). I would not advise it b/c there could be an emergency, though.

ETA: If anyone wants to explore the issue, this site (http://gentlebirth.org/archives/cordIssues.html) has a lot.

[KerryS]

I knew one father who moved the clips off the tray while everyone was focused on mom pushing (doc wasn't in the room yet). I would not advise it b/c there could be an emergency, though.

OMGosh, that would be AWFUL if someone did that. I remember once the cord snapping when the doctor attempted to reduce it from the baby's neck. If I hadn't known EXACTLY where the clamps were and put them on quickly, the baby could have exsanguinated. Not to mention, that table with the instruments is sterile, and by anyone else touching it, you're breaking the sterile field.

[madelsmama]

I was going to post the same studies that Market posted. There's plenty of research that shows the benefit to cord clamping. If it were me, I'd take him the research and reiterate your request.

[Iconoclast]

After researching the benefits of delaying cutting the umbilical cord, I asked my Dr. if he would allow me to wait three minutes before clamping & cutting. He basically blew me off, saying there is no scientific evidence that it does any good, & that it's just one of those things they like to print in Ladies Home Journal. Yeah, he can be a real condescending prick. He said it's more important to take the baby right away to make sure he's breathing fine & everything is OK. I really don't see why they can't do that with baby on my chest.

I am 6 days overdue, so it's a little late to switch doctors, & as it is there is a Dr. shortage here, so I don't really know if I could find someone else. He is also our family Dr., so I don't really want to piss him off.

I guess my question is, should I insist on the delay? Is it worth it, or is he right? I don't do confrontation well, but if I decide that it is worth it, I'll stand firm about it.

Thoughts?

Thanks!!

I don't think it is a good idea to go looking for a new physician at this juncture. "Poaching" is highly frowned upon among professionals, so I doubt you would have an easy time getting anyone to accept you anyway. The only other option would be to present at a different hospital in labor and take whomever is on call for OB. I'd never do that, or recommend it. Better the devil you know than the devil you don't.

So, in order to foster a better working relationship with this devil, I'd just broach the subject again, calmly, pleasantly. I am inferring that he was merely saying it isn't his habit and that you shouldn't worry about something that is, probably, an insignificant detail. Let him know that it is not insignificant to you. I'd just say, "We respect your opinion, but do feel very strongly about this, and if, at the time, there is no immediate contraindication, we want... xyz." I'd try to iron it out in advance. The moment of truth is not time to begin wrestling, either actually or metaphorically, over proceedure or philosophy (and I'm aghast that someone would breach the sterile field and take an instrument!).

Well meaning, informed individuals can disagree on this subject. I sincerely doubt the physician will give it a 2nd thought once it's said and done. Generally speaking, we do not get personally invested in this sort of thing. Thinking that we go home and complain about or scoff at people is silly. Out of the door, out of mind. We all have our own busy lives and don't really get worked up about the choices patients make, even if we think those choices are downright dumb. Presumably you picked this provider b/c you had a trusting, respectful relationship up to this point. Rely on that report to work this out. If that is not the case after this, find a new provider.

[The_Market]

OMGosh, that would be AWFUL if someone did that. I remember once the cord snapping when the doctor attempted to reduce it from the baby's neck. If I hadn't known EXACTLY where the clamps were and put them on quickly, the baby could have exsanguinated. Not to mention, that table with the instruments is sterile, and by anyone else touching it, you're breaking the sterile field.

To be honest, I wasn't too worried about the sterile field, but it just did not seem like a good idea in case of emergency. The dad was telling the story, after the fact, laughingly, so it -fortunately- turned out well.

I did once have a couple whose birth I attended where the doctor had begrudgingly agreed (and signed a birth plan) to let the cord pulse for 60 second. Well, the nurse -who was uber cool- said that this doctor has agreed to do that several times and then clipped the cord out of habit immediately. So, she put them in a different place, on the tray, so that he couldn't do it from sheer muscle memory. It was very important to the couple (more important than even having a vaginal birth) and they were very appreciative of the support.

Since then, I've told others that story just to illustrate how you really have to play attention b/c it can be muscle memory for the doctor. In this case, he did -in fact- reach for the clips then got confused, "Where are the clips?!" at which poin the dad could say, "We were going to wait anyway, remember." They were right there on the tray, where the nurse would be able to hand them over if needed. They were just off in the far corner.

[The_Market]

Generally speaking, we do not get personally invested in this sort of thing. Thinking that we go home and complain about or scoff at people is silly. Out of the door, out of mind. We all have our own busy lives and don't really get worked up about the choices patients make, even if we think those choices are downright dumb.
I can't speak for everyone, but can absolutely say that plenty of doctors and nurses do exactly that. I am from a medical family. My mother was an L&D nurse and I heard scoffing and mocking and outrage expressed all the time. There was plenty at the nurses station, but also at home -over dinner- after a day's work, or at staff gatherings, or discussion when a colleague came over for drinks.

Medical professionals absolutely carry the choices of their patients with them after-the-fact, especially those found to be outrageous. There are plenty of things that I think that I am reluctant to share with my mother b/c I heard her scoff about them growing up (not vaccinating, wearing something other than a hospital gown while in labor, vaginal breech delivery, etc).

Most people talk about their work in their off time. When I did tech support we'd mock and scoff at outrageous calls. People who work in customer service often tell stories of crazy customers. I think it's unrealistic to think that medical professionals are somehow different. They're people, a detail unfortunately often overlooked.

[foxinsocks]

We do talk about some of the more memorable patients, but do not use names... for fear that they will come back... Almost as bad as the Q word.

I also check the obituaries daily to see who has died. I think about people after they are d/c or I wonder how long they were in hospice.

I had a family member tell me she was embarrased because she cried infront of her husbands oncologist. I told her he would probably remember it untill the next lady cried on his shoulder. He did infact make a few remarks about her later, but she doesn't need to know that. She thinks the world of that doc.

[KerryS]

FoxinSocks, are you a hospice nurse? My husband is a hospice nurse.

[Tweet]

I think I would take the research that Market presented to give to your doctor..maybe that would help a bit and I also agree with having a strong advocate present with you during your delivery. I just remember always being so focused on what was going to be in my arms in a few minutes to have the ability to argue or advocate much for myself. Thankfully I didn't need to, but still. Good luck!

[foxinsocks]

No, I am a med surg nurse. I take care of mostly medical patients and get a lot of people with terminal illness.

[The_Market]

FoxinSocks, are you a hospice nurse? My husband is a hospice nurse.
I didn't know that Kerry! You guys are at sort of opposite ends of the journey that way, huh?

[KerryS]

Yes, we frequently joke that I bring 'em in and he takes 'em out.

[Iconoclast]

I can't speak for everyone, but can absolutely say that plenty of doctors and nurses do exactly that. I am from a medical family. My mother was an L&D nurse and I heard scoffing and mocking and outrage expressed all the time. There was plenty at the nurses station, but also at home -over dinner- after a day's work, or at staff gatherings, or discussion when a colleague came over for drinks.

Medical professionals absolutely carry the choices of their patients with them after-the-fact, especially those found to be outrageous. There are plenty of things that I think that I am reluctant to share with my mother b/c I heard her scoff about them growing up (not vaccinating, wearing something other than a hospital gown while in labor, vaginal breech delivery, etc).

Most people talk about their work in their off time. When I did tech support we'd mock and scoff at outrageous calls. People who work in customer service often tell stories of crazy customers. I think it's unrealistic to think that medical professionals are somehow different. They're people, a detail unfortunately often overlooked.

In our circle, this would be highly unusual. I am a physician, as are my husband, one of my brothers, both brothers in law, and most of our friends. We rarely, if ever, talk shop and we certainly do not discuss particular patients in any detail. #1, it is unethical, #2, we have more interesting things to focus on. We talk about the news. the economy, the arts, the weather, our hobbies and children. :shrug: Work is just work, we come home and live the rest of our lives. If I have a particularily eventful day (such as I did last week, when I lost a 16 y/o due to a series of unfortunate events. as it were) I might outline the bare details to my dh, and vice versa. And then, it is on to "what do you want to do for dinner?." "Did you pay the gardener?" "Did ds find his ipod?" "Did you pick up the drycleaning?" In any case, even if her OB/GYN laughed at her in the privacy of his bathtub (this is where dh and I do all our venting) relaying the story to his oh so captivated wife (as if she even gives a damn, lol), why should the OP care?

She can adress the situation, try to sort it out and get on with her life, as he will undoubtedly get on with his. No one really dwells on these things outside of internet message boards. ;)

[madelsmama]

I didn't know that Kerry! You guys are at sort of opposite ends of the journey that way, huh?
I didn't know that either! Does he do home care or work in an in-patient unit?

I once had a co-worker who worked as a part-time hospital Oncology unit nurse and also as a part-time L&D nurse. Seemed like a pretty good balance, but I can't imagine having to shift gears like that.

[KerryS]

Speaking of talking about interesting cases - we had a woman come in the other night, dropped off from the ER in a wheelchair, with the baby in her pants leg.

[KerryS]

I didn't know that either! Does he do home care or work in an in-patient unit?

He does home care. His company owns a 7-bed unit and once in a while he'll pick up a shift there when it's available.

[madelsmama]

Speaking of talking about interesting cases - we had a woman come in the other night, dropped off from the ER in a wheelchair, with the baby in her pants leg.
Oh for the love of Pete.

[SingingMom]

DH and I are both software designers. We discuss work all the time, in general terms- but not, usually, people. Occasionally we put our heads together to try and figure out a good response to some personnel-related challenge.

[vulturemom]

Speaking of talking about interesting cases - we had a woman come in the other night, dropped off from the ER in a wheelchair, with the baby in her pants leg.


EEK! I hope everyone was ok and the baby wasn't to traumatized by being stuck in a her Mothers pants.

[cc1003]

Speaking of talking about interesting cases - we had a woman come in the other night, dropped off from the ER in a wheelchair, with the baby in her pants leg.


Okay, not to hijack but I haven't shared this story. When I was in labor I was already fairly traumatized as my appendix had ruptured and been removed only seven days prior so I was in SO much pain. My appendix was retrosecal, I had third spacing, I was so scared, etc.

A few minutes before my doctor was coming back to check me and let me begin pushing I was dosing and there was a LOUD commotion out side my room. People screaming, my nurses running out the door, my mom ran out the door, dad shut the door because several apparently thought there was a gunman or something. That is how the screaming sounded. There was a man yelling, several women screaming help!!

Well, apparently, a woman was coming to check in to be induced the following morning and went to move her panties under her dress because they were uncomfortable she said. When she moved her panties, her baby FELL OUT ONTO THE HOSPITAL FLOOR!! The umbilical cord snapped and the husband just grabbed the baby off of the floor. No one knew what to do, even the nurses. So my mom got the poor lady a wheel chair and all was well I guess. She swore that she never even knew she was in labor.

[Nipple_nectar]

snip> Frankly, if I could, I'd ditch the Dr. and get a midwife, even this late in the game, but that's me and my low tolerance for Dr.'s like that. I'd rather have a complete stranger who treated me with respect than a Dr. I'd been seeing for 8 months who was a condecending prick to me.

This is exactly what I would do, I am with you, lady!

[BeachMama]

Sounds like you need a doula.

[Indigo]

BTW it really bugs me that your dr has the idea that he is to allow or disallow something. It's your body, you take his recommendations and services but he is not the boss of you lol.

[AmyKate]

Thank-you for all the replies.

I'm still waiting on this baby, & have an appt. on Friday, so I'll take some of the research (thanks Market) & broach the subject again.

Indigo -- I agree that having the Dr. think it's up to him is annoying. I didn't bring it up sooner because I thought he'd be more receptive to my wishes, after all he is working for me.

Iconoclast -- I didn't actually pick this Dr. I got PG with my first DS shortly after I moved here & went to a drop-in type clinic, where I was assigned to him. I am in northern Alberta, Canada, & we are seriously short of Dr.s & nurses here, so unless you've lived here forever, choices are limited. If you're looking for a move... And no, you're right, I really don't care if he does go home & discuss what a crazy patient he had, I guess I'm just more worried that he will give our family sub-standard care in the future to retaliate. I know, probably a silly concern, but I can't help but think this might really piss him off.

Anyway, thanks again everyone!

[The_Market]

She can address the situation, try to sort it out and get on with her life, as he will undoubtedly get on with his. No one really dwells on these things outside of internet message boards. ;)
Huh...you seem... callous, about this.

I dwell on these things. How I was treated, how my baby was treated, those are things that stick with me. If you think that your patients do not internalize how they are treated during vulnerable moments, then you're wrong. I find it hard to believe that you really think that.

Do I spend my time mourning the separation from my first son that I implicitly said I did not want, but was made to have anyway? No. Does it stick with me, when I think of his birth, as I interact in similar situations? Absolutely.

It's not likely that how many seconds passed before the OP's baby had its cord clamped is going to haunt her. It's unlikely that the doctor will carry her advocacy to let the cord pulse with him further than rolling his eyes to his wife with a muttered, "That one was a pain in the ass" as he comes in the door.

But to think that most people do not talk about their work outside of work is ridiculous. Almost everyone I know does this (no matter what field they're in), along with discussing all those other (apparently more evolved) topics that you mentioned. Those that work in the medical field do not give identifying factors, but they will speak in generalizations and express frustrations, joys, and amusements. It's no different than my friend who is a bank teller talking about the woman who did not understand why she had to have an ID to take money out of her account.

[Iconoclast]

Huh...you seem... callous, about this.
That is strange interpretation. And here I thought I was being reassuring and supportive.

I dwell on these things.
This strikes me as unhealthy.
How I was treated, how my baby was treated, those are things that stick with me. If you think that your patients do not internalize how they are treated during vulnerable moments, then you're wrong. I find it hard to believe that you really think that.
Shrug. I just treat people cordially and professionally. I have never given much thought to how they felt about that. I go to work, I do my job to the best of my professional ability, and then I come home. My job is just a job. I leave it there.

Do I spend my time mourning the separation from my first son that I implicitly said I did not want, but was made to have anyway? No. Does it stick with me, when I think of his birth, as I interact in similar situations? Absolutely.
One of my births did not go the way I had hoped, but I have spent about one milllisecond dwelling on it over the past ten years. I'd expect that the OB that attended has spent even less than that, lol.

It's not likely that how many seconds passed before the OP's baby had its cord clamped is going to haunt her. It's unlikely that the doctor will carry her advocacy to let the cord pulse with him further than rolling his eyes to his wife with a muttered, "That one was a pain in the ass" as he comes in the door.
I agree. This, in fact, was my point.

But to think that most people do not talk about their work outside of work is ridiculous. Almost everyone I know does this (no matter what field they're in), along with discussing all those other (apparently more evolved)

I don't know where you got more evolved. It is just life.

topics that you mentioned. Those that work in the medical field do not give identifying factors, but they will speak in generalizations and express frustrations, joys, and amusements.
Sure, if something extraordinary happens (I already acknowledged this) Day to day trivia, not so much. I don't care how my dh's patients scars are healing, whom is noncompliant with post-op orders, which of his students forgot to iron their lab coat, yada yada yada. He doesn't care how may peas I pull out of ears and noses tonight. When someone dies from a pea up the nose, I'll talk about it, and I'm sure he'll pay attention. Short of that, it just isn't worth mentioning.

It's no different than my friend who is a bank teller talking about the woman who did not understand why she had to have an ID to take money out of her account.
That would not be interesting enough for me to bring up at dinner. Perhaps your friend needs a hobby. ;)

In summary, you infer a lot of things I do not imply. I think that says more about you than it does about me.

[pawprint]

Icono, just because your birth experience was not of real great importance to you, doesn't mean it's not important to other people. Birth is such a defining moment for some people. You can go into my gma's nursing home and talk to the ninety year old women who can barely remember their names but can tell you every detail about the births of their children.

My second birth was the VBAC I wanted, and while it lacked some of the things that were most important to me- I don't dwell on it. But if someone asks me? Yes I remember it. Every detail- the good and the atrocious. (LIke the OB who called me a walking petri dish. I actually still like that guy- but it was not the thing to say at the time.) And when I read an article about how pit might be assosicated with this or that it absolutely does get under my skin that I had so much pit I could have birthed a small farm animal. I don't lose sleep over it- but I do carry it with me.

[Iconoclast]

Icono, just because your birth experience was not of real great importance to you


Never said as much. I siad I've moved on from a dissapointing experience.

doesn't mean it's not important to other people. Birth is such a defining moment for some people.

you don't say? That is shocking. It is also entirely beside my point.

[foxinsocks]

While off topic...
Some women, when demented and coming to the hospital on their deathbed will believe they are there to give birth. I have seen it more than a few times. I wonder from where these thoughts come from. Are they spiritually somewhere closer to the birth experience in their life? Is she in pain? How low are the o2sats...? Is the hospital remeniscant of that hospital experience? I have thought about this a few times.

[Babyblue]

While off topic...
Some women, when demented and coming to the hospital on their deathbed will believe they are there to give birth. I have seen it more than a few times. I wonder from where these thoughts come from. Are they spiritually somewhere closer to the birth experience in their life? Is she in pain? How low are the o2sats...? Is the hospital remeniscant of that hospital experience? I have thought about this a few times.

at the er my x worked at and I brought many patients to, very often we would get very ill and demented older adults. sometimes they would be freaking out or angry or yelling for no known reason. if no one could get them calmed down, before they would get sedated the docs would have everyone clear the room and then a few min later have one nurse come back in and tell the patient " shhhushhh, you'll wake the babies" and 99% of the time the patient would say ok and relax.

I also wondered then if the hospital brought back memories of their children's or grand children's births.

[The_Market]

I think that birth is such a primal, integral part of our biology that it's really foundational. It makes perfect sense that the energy of birth would come to someone who has lost touch with the cerebral or analytical, and especially someone standing at the other end of the journey. It's also such an intense, emotional time for a woman, that other intense, emotional transitions could certainly trigger memories.

Then again, if you look at the women who are in the age group for that, right now, the time when they were giving birth was an appalling time in maternity care. Women were treated worse than animals. There was no dignity, little compassion, and the most incredible detachment from the process. Now, these women were under twightlight sleep, so they do not consciously remember all that. Unless shown otherwise, they think they slept through giving birth. However, during these same confusing times, I expect some flashbacks of that horrible experience probably come back to them. This explains why they may be thinking about and responding to birth related stuff, but acting less than happy about much of it.

All this just speculation, of course.

[maksmom]

My mom was twilighted for my older sister's birth, and she had nightmares for years afterwards about it. She refused to be sedated for my birth and had a much better experience. Of course she was called a freaky hippy for it, as well as for breastfeeding. She even argued with my Ped about delaying solids. This was in 1970, I love my mom. :)

[ColleenF30]

My mom was twilighted in 1970 for my brothers birth. She says it felt like they were pulling her apart. Grandma delivered all 3 of hers at home. Mom was awake for me. Honestly some hospitals still treat you bad, and think that you are out of it if you know what you want.