Guest guest Posted April 12, 2008 Report Share Posted April 12, 2008 Cord Clamping Delay Info http://www.geocities.com/total_mommy/umbilicalcord.html The Umbilical Cord Early cord clamping deprives the baby of 54-160 mL of blood, which represents up to half of a baby's total blood volume at birth. " Clamping the cord before the infant's first breath results in blood being sacrificed from other organs to establish pulmonary perfusion [blood supply to the lungs]. Fatality may result if the child is already hypovolemic [low in blood volume] " . -Morley, G. (1998, July). Cord closure: Can hasty clamping injure the newborn? OBG Mgmnt: 29-36. Early clamping has been linked with an extra risk of anemia in infancy. -Grajeda, R. et al. (1997). Delayed clamping of the umbilical cord improves hematologic status of Guatemalan infants at 2 mo. of age. Am J Clin Nutr 65:425-431. Premature babies who experienced delayed cord clamping--the delay was only 30 seconds--showed a reduced need for transfusion, less severe breathing problems, better oxygen levels, and indications of probable improved long-term outcomes compared with those whose cords were clamped immediately. -Kinmond, S. et al. (1993). Umbilical cord clamping and preterm infants: A randomized trial. BMJ 306(6871): 172-175. Some studies have shown an increased risk of polycythemia (more red blood cells in the blood) and jaundice when the cord is clamped later. Polycythemia may be beneficial in that more red cells mean more oxygen being delivered to the tissues. The risk that polycythemia will cause the blood to become too thick (hyperviscosity syndrome), which is often used as an argument against delayed cord clamping, seems to be negligible in healthy babies. -Morley, ibid. Some evidence shows that the practice of clamping the cord, which is not practiced by indigenous cultures, contributes both to postpartum hemorrhage and retained placenta by trapping extra blood (about 100 mL) within the placenta. This increases placental bulk, which the uterus cannot contract efficiently against and which is more difficult to expel. -Walsh, S. (1968, May 11). Maternal effects of early and late clamping of the umbilical cord. The Lancet: 997. Clamping the cord, especially at an early stage, may also cause the extra blood trapped within the placenta to be forced back through the placenta into the mother's blood supply during the third stage contractions. This feto-maternal transfusion increases the chance of future blood group incompatibility problems, which occur when the current baby's blood enters the mother's bloodstream and causes an immune reaction that can be reactivated in a subsequent pregnancy, destroying the baby's blood cells and causing anemia or even death. -Doolittle, J. & Moritz, C. (1966). Obstet Gynecol 27:529 and Lapido, O. (1971, March 18). Management of the third state of labour with particular reference to reduction of feto-maternal transfusion. BMJ 721-3. ==== The above are excerpts from Buckley's " A Natural Approach to the Third Stage of Labour, " Midwifery Today Issue 59 ==== Several types of cord problems can affect blood flow to the baby and cause fetal distress. " Cord nipping " means the cord is being pinched between the head and pelvic bones, causing variable decelerations in the fetal heart tones (FHTs). During first stage, repositioning the mother usually eases pressure on the cord and brings the FHT to normal, but in second stage nipping may easily progress to cord compression. One trick for remedying variable decels in second stage is to gently press on the mother's abdomen where the baby's back is located. This frequently shifts the baby off the cord and improves FHTs. Cord compression may be due to occult prolapse, meaning that the cord is low in the pelvis and is being compressed by the head as it descends with the force of contractions. If cord compression is severe, bradycardia is likely to develop. There is also a possibility that the FHT will return to normal if the head moves past the cord entirely. Persistent bradycardia constitutes a crisis with very little leeway. Try repositioning the mother and give oxygen by mask at 6 L/min. Check FHT with each contraction. If there is no improvement after four or five contractions, transport to the hospital. Cord entanglement may inhibit descent and you may hear cord sounds over the FHT. A very tight cord around the neck may also deflex the baby's head. This may result in persistent bradycardia, necessitating transport. Complete cord prolapse can occasionally be diagnosed by internal exam in the last weeks of pregnancy with the discovery of pulsations at the cervix or through the lower uterine segment that are synchronous with the FHT. This finding necessitates immediate hospitalization and cesarean section. If the membranes rupture during labor and the cord prolapses, call the paramedics and place the mother in a knees-chest position with your fingers inside her cervix, holding the head up and away from the cord. Place the cord gently back inside the vagina if it is exposed. If there isn't room, wrap it in gauze or a washcloth soaked in warm water with a pinch of salt and cover with a plastic bag. Rough handling of the cord or exposure to air can cause spasm and constriction. If you must transport the mother yourself, lay a chair back-down on the floor and ease her onto it, then lift and tip her slightly backward until her head is lower than her hips. Keep her in this position in the car with fingers inside to alleviate pressure on the cord until the cesarean is performed. - , Heart and Hands, Celestial Arts 1997 ARTICLES: How Cord Clamp Injures Your Baby's Brain http://www.mercola.com/2002/mar/20/clamp.htm The Dangerous Practice of Early Clamping of the Umbilical Cord http://www.gentlebirth.org/archives/cordIssues.html " Not So Fast, Doc! " The Facts About Early Umbilical Cord Clamping http://www.empoweredchildbirth.com/articles/birth/noclamp.html ************ http://www.mercola.com/2002/may/4/birth_disorders.htm Autism, ADD/ADHD, and Related Disorders - Is a Common Childbirth Practice to Blame? By Malcolm Morley, MB ChB Introduction Autism is one of several behavioral and developmental disorders exhibiting defects in learning, language and behavior that merge, in the more severe cases, into mental deficiency. No specific brain lesion, anatomical or metabolic, has been defined as causal and the diagnosis is purely clinical. However, children with brain lesions due to the disorder tuberous sclerosis are at particularly high risk of having autism.[1] This indicates that brain lesions, regardless of the cause, may induce autism-like symptoms. The diverse symptoms of these disorders involving " higher " human faculties indicate diverse cerebral lesions, probably cortical, involving memory ability, storage and recall. This article presents compelling evidence that autism and related childhood disorders can result from brain damage caused by birth asphyxia - more specifically due to interruption of placental oxygenation at birth by premature umbilical cord clamping. Asphyxia at Birth Over thirty years ago, Windle produced spastic paralysis (cerebral palsy) in monkeys that were asphyxiated at birth by interrupting placental oxygenation and delaying pulmonary oxygenation; specific brain lesions were demonstrated at autopsy. [2] Monkeys with minor degrees of neurological defect recovered much function (adapted to the permanent neurological defect) but showed a persistent defect in memory ability. When offered food placed in one of two containers, these primates very often could not remember the correct container when access was denied for one minute - they were correct only 50% of the time. Normal monkeys that had not been asphyxiated at birth chose the correct container over 90% of the time. The asphyxiated monkeys, in effect, had learning disabilities and could not keep their attention focused on a food container for one minute. At natural (normal) birth with natural closure of the umbilical vessels (no cord clamp used), neonatal asphyxia is avoided because placental oxygenation continues - the cord pulsates - until pulmonary oxygenation is established. During this time, a large amount of placental oxygenated blood is transfused into the child; this additional blood volume is used to establish pulmonary circulation and pulmonary oxygenation. After the lungs are functioning, the cord vessels close reflexively. Cord clamping before the child has breathed and while the cord is still pulsating causes a period of asphyxia until the lungs begin to function; it also aborts placental transfusion leaving the child hypovolemic (low blood volume) and prone to anemia as a large amount of iron is left in the placenta. Deficient pulmonary blood flow may delay pulmonary oxygenation. The " bottom line " is that immediate cord clamping followed by sufficient delay in pulmonary oxygenation will produce permanent hypoxic brain damage. [2] Anemia - Cause or Effect? Lozoff and others have numerous publications correlating infant anemia with childhood and grade school learning and behavioral disorders to the point of mental deficiency. [3] The degree of infant anemia correlates with the degree of mental deficiency. [4] Unfortunately, the early diagnosis and correction of infant iron deficiency anemia do not prevent the appearance of these grade school mental problems. [5] Premature infants, who routinely have their cords clamped immediately, almost universally become anemic in the NICU, where the anemia is promptly corrected, sometimes by blood transfusion. However, despite prompt treatment they have poor mental achievement outcomes through young adulthood. [6] This strongly indicates that asphyxia due to immediate cord clamping, not anemia, causes mental impairment. At normal birth, no newborn has iron deficiency anemia; adequate iron is supplied from the mother regardless of her iron status. Any newborn that receives a full placental transfusion at birth has enough iron to prevent anemia during the first year of life. [7] It is, therefore, reasonable to conclude that full placental transfusion (continuous oxygenation during birth, natural cord closure) will prevent the autism, mental retardation, behavioral disorders and learning disabilities that occur following infant anemia. In other words, infant anemia and autism are both caused by immediate cord clamping - the anemia by loss of blood volume and the autism by asphyxia. How to Prove an Association Exists Between Birth Asphyxia And Autism Immediate cord clamping is now a very common practice and occurs in almost all modern obstetrical births. It is routine when an NICU team is present at an " at risk " birth and is mandated by ACOG for cord blood pH determination. [8] In current obstetrical practice, natural (physiological) cord closure is almost never allowed to occur; obstetricians and pediatricians in general are completely unaware of any danger incurred by immediate cord clamping. In general, the incidence of autism has paralleled the incidence of immediate cord clamping, and supports the conclusion that autism results from birth asphyxia caused by immediate cord clamping. Additional proof should be available from birth records: * Autism should correlate with birth records of premature cord clamping or with circumstances that confirm immediate / early cord clamping. * Autism should not correlate with natural cord closure or with a newborn that cries quickly and has a five-minute Apgar score of 9 or 10. Despite the fact that time of cord clamping is not normally recorded, many factors at the birth indicate that the child was subject to some degree of asphyxia from early cord clamping, and many parents can recall the event of cord clamping: 1. Was a cord pH sample taken at birth? 2. Was an NICU team present at birth? 3. Was there any fetal distress during birth? 4. Was there meconium staining of the fluid? 5. Was the child resuscitated immediately after birth? 6. Was the child given oxygen? 7. Did the baby start crying after being separated from the mother? 8. Was the baby born by Cesarean section? 9. Did the baby become anemic? 10. Did the baby receive a blood transfusion or a blood volume expander? 11. Was the five-minute Apgar score less than 8? 12. Was the baby born prematurely? 13. Was the child admitted to the NICU? A predominance of " yes " answers to the above questions for autistic children, compared to the general population, would strongly indicate that autism and related childhood developmental and behavioral disorders can result from hypoxic brain injury at birth caused by immediate cord clamping. Discussion A recent Japanese study found an increased risk for autism in NICU babies, particularly with meconium staining of the fluid. [9] Meconium staining indicates fetal distress / in-utero asphyxia and these babies typically have immediate cord clamping for resuscitation. The study provides very positive " YES " answers to the above questionnaire and is very compelling evidence that neonatal asphyxia and immediate cord clamping can cause autism. Summary: * Brain lesions are associated with autism and related disorders[1]. * Hypoxic brain lesions in monkeys are associated with intelligence/memory defects similar to autism. [2] * Immediate cord clamping causes newborn hypoxia. * Placental oxygenation until the lungs are functioning prevents newborn hypoxia. * Placental oxygenation until the lungs are functioning should prevent autism that is caused by hypoxic brain lesions. Articles with full references that explain statements in this article are available at: www.cordclamping.com RedFlagsWeekly.com Dr. Mercola's Comment: Cleary cord clamping is a central issue related to optimal functioning. My personal belief though is that the deficiency of omega-3 fats maybe one of the most significant contributing factors to the out of control autism epidemic we have in the US. You can review my comments on omega three in the other article in this issue for further information. It is also likely the increase in the number of vaccinations is another central issue. ********** http://www.fsneo.org/JourClub/1-024.htm FSN Journal Club 1-024 | Additional Comments | Previous Article | Next Article | List of Articles | Submit Comments | Index | FSN Home Page Delayed Cord Clamping Placental transfusion: Umbilical Cord Clamping and Preterm Infants. Ibrahim HM, Krouskop RW, DF, et al. J Perinatol 2000; 20:351-354. This study investigated the clinical effects of early vs late cord clamping in preterm infants. 32 preterm infants, 24-28 weeks gestation, were randomized to receive either early (immediately after delivery) or delayed (20 seconds after body delivered) umbilical cord clamping. The delayed cord clamping (DCC) group exhibited a decrease in the frequency of blood transfusions (p < .001), and also a decrease in albumin transfusions over the first 24 hours (p < .03). The mean blood pressure in the first 4 hours was higher in the DCC group (p < .01), and there were statistically significant increases in Hct (21%), Hgb (23%), and RBC count (21%) vs the early cord clamping group. The incidence of PDA, hyperbilirubinemia and IVH was similar in both groups. Comment. Delayed cord clamping seems like a simple therapeutic maneuver with several beneficial effects in small premature babies. In addition to the benefits mentioned in the abstract, it is useful to note that the DCC group also had significantly higher 5-minute Apgar scores. The reduction in the number of blood transfusions needed in the DCC group was impressive (1.2 transfusions vs 3.6 in the control group). This is much greater than the effect on this variable seen in the Epogen studies. Also the hemodynamic benefits of DCC were significant, as these babies had higher mean blood pressures and required fewer volume boluses. While potential adverse side effects of DCC (ie IVH, polycythemia, jaundice) were not increased in the study group, a much larger sample size will be needed to draw any conclusions about the safety of this practice. Please note that the delay in cord clamping in this study was only 20 seconds, and that the infant was held at the level of the introitus during this period. Just because a little placental transfusion may be good, it doesn't mean that a lot is better. More aggressive efforts to increase placental transfusion into premature infants (such as a longer delay in cord clamping, " stripping " the cord toward the baby, or holding the infant at a lower level than the mother) will probably result in a higher incidence in these adverse side effects. B. Kairalla MD Return to top Additional Comments: Sent: 21 Oct 2001 at 09:23:58 This study lacks a physiological control group and comment is based on two fallacies: 1. That placental transfusion is pathological 2. That the cord clamp is physiological. During physiological birth, (no cord clamp) placental oxygenation and transfusion continue until pulmonary oxgenation and an optimal blood volume are established; the child then reflexively closes the umbilical vessels permanently. This physiology has been honed to perfection over millions of years by natural selection for optimal newborn survival and avoids neonatal asphyxa. Premature cord clamping interrupts placental oxygenation and transfusion, producing hypoxia/asphyxia and hypovolemia/ischemia which result in HIE, IVH & NEC (hemorrhagic infarcts of the germinal matrix and gut from hypovolemic vasospasm,) RDS (hypovolemic shock lung,) pallor, hypotension, hypothermia, oliguria, metaboic acidosis and anemia. Physiological cord closure produces a physiological (healthy) newborn, term or preterm. Cord clamps disrupt physiology and produce iatrogenic pathology. The rational way to treat extreme immaturity is to deliver the intact cord and placenta into a warmed, oxygenated, isobaric nutrient solution in the attempt to maintain some placental function and to allow some maturing of the immature lungs. Amputation of a normally functioning placenta at any gestational age is not rational care. UserName: G. M. Morley, MB ChB, FACOG Institution: retired obstetrician telephone: 1(231) 386 9655 email: gmmorley@... -------------------------------------------------------- Sheri Nakken, former R.N., MA, Hahnemannian Homeopath Vaccination Information & Choice Network, Nevada City CA & Wales UK Vaccines - http://www.wellwithin1.com/vaccine.htm Vaccine Dangers & Childhood Disease & Homeopathy Email classes start April 18 Quote Link to comment Share on other sites More sharing options...
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