Delayed Cord Clamping is Best for Babies

Delayed Cord Clamping Should be Standard Practice in Obstetrics

The photo to the left is of my 9 year-old son cutting his newborn brother's umbilical cord, at least 30 minutes after birth. The placenta had been delivered and wrapped in a chux pad and placed at the baby's feet while I held him and we bonded before cutting the cord. It was very peaceful and nothing felt rushed or hectic. Notice that the cord is white because there isn't any more blood going through it at that point.

The article above discusses clinical findings that support delayed clamping of the umbilical cord after birth. I've read other books and articles on the subject which have supported this as well, and with all three of my un-medicated births we waited to cut the cord. From what I've read, it generally takes 8-20 minutes for the umbilical cord to stop pulsating after birth, and it's best to wait until the pulsating stops before clamping and cutting the cord. This is because there is vital blood being pumped from the placenta, through the cord, to the newborn, and early clamping can rob the baby of this precious blood and potentially cause problems. I'm happy to see more research being done on the subject.

Here is an excerpt from the article:

"For the majority of my career, I routinely clamped and cut the umbilical cord as soon as it was reasonable. Occasionally a patient would want me to wait to clamp and cut for some arbitrary amount of time, and I would wait, but in my mind this was just humoring the patient and keeping good relations. After all, I had seen all my attendings and upper level residents clamp and cut right away, so it must be the right thing, right?

"Later in my career I was exposed to enough other-thinking minds to consider that maybe this practice was not right. And after some research I found that there was some pretty compelling evidence that indeed, early clamping is harmful for the baby. So much evidence in fact, that I am a bit surprised that as a community, OBs in the US have not developed a culture of delayed routine cord clamping for neonatal benefit."

Upright Position Shortens Birth Canal by 1/3

Did you know that being in an upright position for the third stage of labor (pushing stage) can shorten the birth canal by one-third?

As a simple example: if the birth canal is 3 inches long in a lying-down position, when you are upright it will only be 2 inches long. That's 1 inch less the baby has to go through!

Being upright also provides a straight downward pathway for your baby to come through. Lying down on your back actually creates more work for you and your baby, because the position of the tailbone creates an upward slope that the baby must pass through.

Suggestions for upright positions for pushing your baby out:

• Squatting on the bed, holding onto a squat bar (many hospitals have a bar that attaches to the bed, but you have to ask for it).
• Squatting on the floor, supported by your birth partner or other birth attendants. The birth partner can stand or squat behind the mother and support her by holding her under the arms and allowing her to lean back into him/her. Or one person can be on each side of the mother to support her.
• Squatting on a birth stool (such as the one pictured). Click here for more information about birth stools.
• Upright in a tub. You can lean against the back or side of the tub and allow your body to rest against it. The water also helps reduce some of the pressure and weight of your body, and can provide a soothing effect. Check with your care giver and/or hospital about their policy on water birth and what your options are.
• Any upright position that is most comfortable to you in the moment. You may choose to lean forward against a person, bed, or other piece of furniture or birthing ball while squatting, or whatever feels most comfortable to you.
  
• Toilet sitting. Naturally, you wouldn't want to birth your baby on the toilet, but sitting on the toilet during labor can provide comfort and help move labor along in the second stage (transition).

In general, being in an upright position during childbirth at any point is helpful. During the first stage it can help labor progress more quickly, as in the second stage as well. Movement and changing position throughout the labor process is highly recommended for comfort and progress. Any upright position is particularly helpful in shortening the birth canal in the third stage of labor to help shorten the passage the baby must go though.