« Perceptive midwifery | Main | That pesky language again.... »

Cutting the umbilical cord

The end of this week has me in Milton Keynes, a new city that is only 30 years old. It reminds me a lot of Canberra, but without the hills.

The hospital here is also relatively new, and resembles a collection of porta-cabins on the outside, although inside it has the usual NHS appearance. I had a quick look through the maternity unit after the first day of the workshop yesterday and although very functional, and not very comfortable, it did have a friendly air of bustle. They have a water birth pool in one room and a triangular bath in another, but I gather that despite a water birth training day, these pools are not used very much. We will tackle this issue today, as using water is a very good alternative to the use of pain killing drugs, all of which have implications and consequences for mothers and babies.

A topic for discussion yesterday was whether or not to cut the cord when it is tightly around the baby’s neck. In the past, feeling for the cord was a ritual carried out as soon as the baby’s head was born. Quite often, the cord will be found looped around the baby’s neck, loose enough to be lifted over its head, or for the body to slip through it. If the cord was very tight, delaying the birth, the practice has been to clamp and cut the cord. The consequences of this is that the baby needs to be born quickly as its oxygen supply has been severed. If further problems occur, such as tight shoulders (or shoulder dystocia) then the baby may suffer from a prolonged period without oxygen.

These days, the thinking has changed. It is no longer recommended that the cord be cut at all, and if left, even when it is tightly wrapped around the baby, the baby will perform a somersault manoeuvre, tumbling out rather rapidly. Its head will stay close to the mother’s perineum, while the baby’s legs end up away from her body. The cord can then unwrap from above. As soon as the pressure is released from the cord, the blood will start flowing again, providing the baby with oxygen while it recovers from its traumatic arrival.

Midwives have told me that they see this from time to time at waterbirths, where the water facilitates this action. A very tight cord is a rare condition, and most midwives will only see it a few times in their careers. Not jumping in with the scissors will be hard for many midwives, given their training, but if left alone, Nature takes over and the baby will be born, often very quickly.

Posted by andrea at April 16, 2005 06:47 AM