Valerie Gommon Midwife’s Blog

Archive for the ‘umbilical cord’ Category

The idea that the umbilical cord should not be cut immediately after the birth but left to pulsate giving the baby extra blood, oxygen and stem cells is not a new idea to myself or many of my colleagues.  I have long believed that the baby should remain “attached” via the umbilical cord to his/her mother and my usual practice is to await “delivery” of the placenta before asking the mother or father to cut the umbilical cord.  I believe that early cord clamping interferes with the normal physiology of birth.

Recently Dr David Hutchon, a retired consultant obstetrician from Darlington, wrote in the British Medical Journal that maternity staff should wait for several minutes before cutting the cord and has also called for further research into leaving the cord intact.  http://topnews.co.uk/216535-expert-calls-hospitals-change-practice-clamping-newborns

The National Institute for Health and Clinical Excellence (NICE) still advocates active management, which includes early clamping and cutting off the cord. These guidelines mean that doctors and midwives are sometimes reluctant to change their practice.  This is despite the fact that both the World Health Organisation and the International Federation of Gynaecology and Obstetrics advise doctors to refrain from early cord clamping.

In summary, it is definitely worth thinking about whether you would prefer your baby’s umbilical cord to be left to pulsate and indeed possibly left intact until you have delivered your placenta.

Midwife Gloria Lemay also comments on this issue on her website.

www.gentlebirth.org/archives/lateClamping.html

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Another guest blog by Sarah:

Harlow Zen’s Birth Story

Harlow is my third baby having had Rohan 9 years previously and Nayt almost 8 years ago.  With Rohan I was induced at 10 days late, in hospital, with an epidural given as I was told he was back to back and it would be too painful, I ended up after 17 hours flat on my back, with a nasty tear and a pretty miserable painful experience to tell but a beautiful baby nonetheless.  I had Nayt 16 months later and keen to never set foot in a hospital again, we used 2 Independent Midwives and had an amazing natural home water birth, in less than 4 hours with no pain relief, no stitches and 23 days late! I was out and about within days, a completely different experience to my first. Both babies were reasonable sizes at 8lb 13oz and 9lb 2oz respectively.

With Harlow, because he was my husbands first and I was a bit rusty having had a good few years off baby making, we decided to use another Independent Midwife as the 1-2-1 care is like nothing else, and gives you the confidence that you will get the best birth outcome and overall experience possible, as they really get to know and understand you.  As my pregnancy progressed it was clear this baby was going to be on the large size, which I had kind of expected. I was advised to cut down on sugar but with a massive cake craving, this didn’t really happen, so I tried damage limitation by continuing to ride as long as I could and towards the end to swim daily and keep up with walking the dog.

I think my confidence in giving birth was knocked a bit towards the end because I had to have a series of late scans to check the placental position, as was slightly lying low at the 20 week scan. This showed up that at 34 weeks the baby was the size of a full term baby. I am reasonable at simple maths, and that added up to one BIG bubba!!

Because of this, I was told to expect an early baby. Unlike my other two pregnancies where I had no pre-labour signs whatsoever, I was starting to get runs of proper contractions about 3 weeks prior to my due date. I had so many signs in fact that I have decided there are no signs until the baby is literally crowning!! Along with contractions, I was nesting, had a show,  had a permanently bad tummy, babies head engaged….never happened to me before labour with the other two, bump shifted down….and then my due date came and went…and my bump un-engaged and shifted up!!!

On Tuesday 18th May after my husband Adam had taken the kids to school I started to get decent contractions. I really felt like today was the day. By midday they had gone, and annoyed I took my dog on a hill walk hoping to jolt the baby out with some gravity! Nothing! I was really sure that was it too, as my dog Phoebe had been all over protective, following me around and sleeping beside me wherever I went.

They started again around 11pm, but having sent our midwife numerous ‘I think its started’ texts over the last few weeks, decided to sleep on it.  At 1.55am Wednesday 19th May I woke up with a jolt as my waters literally burst all over the place. I managed eventually to wake my husband up who had fallen asleep on the sofa downstairs and after a massive clean up operation we called our midwife Valerie and she came out straight away.

The contractions had stopped but restarted around 3am and were roughly every 3 mins, reasonably painful (a 5-6) but not lasting too long. We all tried to get some sleep at 6am, but the contractions slowed down a lot.  By the time my kids woke up and we had agreed they could take the day off school, they were back to quite painful and we all thought finally ‘this is it!’. By about 9.30am I got into the birth pool my husband had busied himself filling and my labour ground to a halt and slowed down. My parents came and took the kids out for lunch as it was my Dads birthday, and gave me a bit of space and peace. At 1pm-ish we asked Valerie to examine me and I was disappointed to find I was barely dilated, and all that pain and hard work had merely helped Harlow to get into a better position.  Valerie left for home and me and Adam went for a walk, had some lunch and then at 5.20pm decided to get some sleep.  My kids were sent off to their rooms to watch a film.

At this point I was feeling despondent and was sure my pain threshold was rubbish. I started soon after to get contractions every 8-9 mins, lasting almost 2 mins and they were really painful. The peaks seemed to last for 40 seconds before subsiding. By almost 7pm I was crying and convinced I was still about 3 cm dilated.  I got very emotional and was convinced I would end up in hospital with a c-section. Adam was amazing and really supported me. He suggested we call Valerie, who had just text me. She came out with the entonox and as soon as she arrived I was getting the urge to push. I was on all fours and could not move into any other position…how I got downstairs I have no idea!!!

I managed to get downstairs and Adam re-filled the pool which we had drained down partially earlier.  I got in, and contractions were very close, strong and the peak lasted ages. Adam was great and helped me get the gas and air when I needed it, and provided emotional support as well as an arm for me to dig my nails in (sorry Adam!!), and Valerie helped me to get past the panicky ‘I cant do this’ with encouragement that I could really trust in.  At 8.20pm I could feel Harlow move down and he was born in the birth pool at 8.40pm. Valerie had called my kids down and they both watched their little brothers entrance into the world.

Harlow was born behind me, so with some jigging I was able to climb over my cord and hold him.  He cried a little and had a feed quite soon afterwards.  He was covered in vernix and his skin felt so soft.  He looked just like 3d scan picture and apparently my first words were ‘Hello Harlow’.  Adam cut the cord after it stopped pulsating and Valerie tied the cord with a cord tie I made specially for the event, and as I delivered the placenta naturally an hour later, Adam, and the kids had all taken turns to hold Harlow and make their introductions. It was the most special sight ever and something they will never forget, nor will I.

At 10.30pm we sent the kids to bed, and after a glass of champagne with Valerie; myself, Adam and Harlow settled down for our first night together. Perfect.

We were all a bit shocked that Harlow tipped the scales at 10lb 6oz, and I got away with a tiny tear and a graze and no stitches!! It was a more painful labour than Nayts birth, and the longest overall labour, but an amazing experience that 5 days after the event makes me ask ‘when can I do it again’???.

A birth plan is optional – it enables you to devise your own personal plan of care if this is your wish, and can be helpful to health professionals in knowing your thoughts.

It is also an opportunity to make a decision about your care on the basis of informed choice.  By compiling a birth plan, it does not imply that you want a ‘natural’ or ‘alternative’ labour and a birth plan can be changed at any point, it is just an indication of your wishes.

Whether you decide to make a birth plan or not, your care should be discussed with you and no treatment or procedures performed without a full explanation and your consent.

The following are some suggestions of things you might like to include in your birth plan:

Who you want with you for the birth (e.g your partner, a friend or both)

Pain relief (you may be keen to manage without drugs or keen to have as pain free a labour as possible, do you plan a waterbirth)

Positions for labour and birth (you may wish to be able to move around during labour and encouraged to try different positions for the birth)

Monitoring of the baby’s heartbeat (e.g. using a hand-held sonicaid to monitor the baby intermittently or being monitored continuously)

Students (whether you are happy for students to participate in, or witness your birth)

After the birth (do you want pick up the baby yourself/be given the baby or do you want the baby wrapped, do you want to discover the baby’s sex yourself, would your partner (or you) like to cut the cord)

Management of the third stage or placenta (do you want a ‘natural’ third stage or to be given the drug syntometrine

Vitamin K (do you wish your baby to receive Vitamin K either by injection/orally/not at all)

A Birth Plan is just that – a plan, it can be deviated from according to your wishes at the time!

Following a posting of mine about Lotus Birth http://www.midwifevalerie.wordpress.com/2008/12/04/lotus-birth/

There have been some interesting items posted recently about delayed cord cutting;  whilst I am not going to say that most babies whose cords were cut early were in danger, I do feel that the ideas expressed merit serious consideration, particularly for premature babies.  I think that the medical professional should reconsider the practice of early cord clamping.  Why is it being done?  I think the argument of expediency stands up!

http://www.nursingbirth.wordpress.com/2009/05/17/the-deal-with-delayed-cord-cutting-or-%E2%80%9Chey-doctor-leave-that-cord-alone%E2%80%9D/

http://articles.mercola.com/sites/articles/archive/2009/05/28/Are-Doctors-Causing-Infant-Brain-Damage-by-Clamping-the-Umbilical-Cord-Prematurely.aspx


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