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Cutting the umbilical cord

One lively topic we discussed at the Stoke Mandeville Active Birth workshop today was when to cut the umbilical cord.

The typical approach in hospitals is to cut the cord as soon as the baby is born, before the placenta arrives. If the mother has been given Syntometrine or Syntocinon ( oxytocic drugs) to speed separation of the placenta the midwife will probably not wait for the cord to stop pulsing first, clamping and cutting the cord as soon as possible after the birth. Left alone, nature has provided a safety mechanism for the baby immediately after birth, when it may take a few minutes for breathing to be established. The cord continues to pulse, gradually phasing out as the cold air causes the cord to constrict and reduce the blood flow. The whole process takes a few minutes, although with a birth in water, the cord may continue to pulse for longer.

Once the cord stops feeding oxygen through to the baby, it is unimportant when it is cut: many midwives will leave it alone until after the placenta arrives, then clamp and cut. Others cut the cord earlier, leaving the placental end to drain a little, which reduces the pressure in the placenta and makes it easier to separate from the uterine wall.

The benefits of leaving the cord uncut until its work is done are now clear. The baby will get extra blood which is now known to be protective and important for preventing anaemia in babies. (Delaying cord clamping reduces anemia Pediatrics 2006; 117: e779-86). If the baby doesn’t breathe immediately, it still has a lifeline supplying oxygen. Earlier fears that delayed clamping will leave the baby with extra red blood cells that may precipitate jaundice are unfounded - some jaundice in the newborn is natural and excessive levels are more likely to be the result of the baby’s kidneys struggling to metabolise drugs such as artificial oxytocin and opiate drugs that were passed on from the mother during labour.

When the cord is wrapped tightly around the baby’s neck at birth, delaying the birth of the shoulders, the cord should also be left uncut. In this situation, a sudden surge of oxytocin (perhaps triggered by the baby’s potential distress signal) causes a big contraction and the baby will tumble out all at once, enabling the cord to unwrap itself from above. It is frightening for the midwife to wait when the baby appears to need help, but once again nature will take over and provide a rescue. Once the pressure is off the cord, the blood will again flow, giving oxygen to the shocked baby (who might also need a little oxygen via bag and mask). The cord should not be cut, and help should come to the baby, rather than taking t he baby away to be assisted.

There are always important biological reasons for the mechanisms involved in natural labour and birth an we should leave well enough alone. Cutting the cord provides a means to speed up the third stage of labour and gives the attendants something to do. Why not wait - what’s the hurry?

Posted by andrea at September 17, 2006 06:13 PM