Cutting the umbilical cord: it is IMPORTANT to understand THAT every woman have the birth
Today we want to address a very important topic for all expectant parents: that it's important to understand every woman have the birth – what concerns the issue of clamping and cutting the umbilical cord.
We publish a translation of an interview with pediatrician mark Sloan (Mark Sloan M. D.), author of the book “birthday: science, history and the miracle of birth through the eyes of a pediatrician” (Birth Day: A Pediatrician Explores the Science, the History and the Wonder of Childbirth). Mark has more than 25 years of experience in Pediatrics, as well as higher education biologist, which probably explains his attention to detail, more open-minded and convincing explanation.
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We will talk about why it is impossible to overestimate the importance of delayed clamping of the umbilical cord. In principle, it is a matter of a few minutes, and to achieve compliance with this principle is almost everywhere, if you know your rights, but most importantly – why it's important.
In hospitals yet often clamp and cut the umbilical cord immediately after birth, despite the fact that the already established critical value the first 2-3 minutes, during which the blood returns from the placenta to the newborn.
It happens that in clamping the umbilical cord immediately after birth insist in connection with a misunderstanding of the physiological role of the placenta in the first minutes of life the newborn. And sometimes just triggered a peculiar people trust the old methods that they learned in their time, even if there are new and distinct data that contradict what they learned in his youth.
There are no studies that have clearly indicated the importance of immediate clamping of the umbilical cord, but the order established in the medical community, changes are particularly slow.
Consider the most common objections to delayed clamping of the umbilical cord, and that these arguments has to answer modern science:
1. In our hospital large flow, and this takes a lot of time!
M. Sloan: Almost a third of the total blood volume of the newborn at delivery is the placenta. And half of this amount is returned to the infant within the first minutes after birth! Three minutes to the newborn has returned to 90% of his blood.
2. Immediate clamping of the umbilical cord prevents strong postnatal bleeding.
M. Sloan: there is No convincing scientific data that would confirm this assertion. But there are several large papers, including the study of Cochran (Coshape 2009), in which 5 were analyzed for statistical studies that included 2200 women: no significant difference in the frequency of such cases, depending on the period of umbilical cord occlusion.
3. For a healthy and full-term baby there is no special benefit!
M. Sloan: This is a very common belief, and it is clearly wrong.
Regardless of, whether newborn or not, to an average of one third volume of his blood at the time of childbirth is the placenta. Approximately this amount would need to immediately after birth to fill the circulatory network of the lungs (pulmonary start small circulation), as well as the liver and kidneys of the newborn.
Besides the fact that the newborn then receives at birth an adequate amount of iron in infants the umbilical cord was clamped after 2-3 minutes after birth, and, accordingly, have a full blood volume, has a more gentle and confident start cardiopulmonary system compared to babies whose umbilical cord was clamped/cut immediately.
The third important argument is the stem cells, which play a crucial role in the development of the immune, respiratory, cardiopulmonary and nervous systems. Concentrate stem cells in the blood of a newborn is higher than ever in later life. Immediate clamping of the umbilical cord leaves the third available baby the number of stem cells in the placenta.
4. For example, delayed clamping of the umbilical cord gives the baby more blood and more iron. But iron deficiency is not such a big problem in developed countries?
M. Sloan: It's wrong. Up to 10% of children in the United States at the age of 1-3 years have iron deficiency, in separate groups, this figure greatly exceeds 20%.
Immediate clamping of the umbilical cord is just one of many factors causing the deficiency of iron in early childhood. But if the iron deficiency starts in early infancy, to make up for it later in life very difficult. Delayed clamping of the umbilical cord ensures your child's iron reserves, sufficient for the first 4-6 months.
5. From lack of iron the kids just get tired quicker.
M. Sloan: No. From lack of iron harm is much more.
Infancy is a time of rapid growth and development of the brain, and iron is a key element for these processes. Studies of infants with iron deficiency have shown that these children have specific cognitive difficulties, including difficulty in maintaining attention and memory, which can lead to the common (permanent) an underestimation of the mental faculties. In addition, children with severe iron deficiency often demonstrate “emotional lethargy” – they find it difficult to maintain emotional contact with their parents and the environment, which in turn could lead to protracted difficulties of socialization. For many reasons it is very bad to have an iron deficiency in early childhood.
6. But perhaps not enough iron in breast milk?
M. Sloan: unfortunately, not enough.
In breast milk amazingly a lot of nutrients for the baby's health, but iron not so much. Probably, physiologically, it is understandable that the mother has the recovery after the blood loss in childbirth, so she herself need to iron. Nature provides that your iron stores for first few months of life the infant will get with placental blood, and not from the mother, so that iron in the milk quite a bit.
7. But with delayed clamping of the umbilical cord has the opposite risk of the outflow of blood in the placenta!
M. Sloan: For normal childbirth without complications is extremely unlikely.
With rare exceptions, the blood, immediately after birth, is sent in one direction only, from the placenta to the baby. (Exceptions, for example – in the process of spasms of the uterus, or when a newborn chokes in the first cry of the newborn if the placenta raise above (or above the mother if the placenta has not moved away)).
Briefly here's the thing:
In the process, which begins during childbirth and increases in the koment, when a newborn begins to cry, blood filled vessels small (pulmonary) circle previously receiving minimal blood supply. They are “open” and full. This is a very dramatic change, in turn, causes blood pressure to fall below a newborn placental. Placental blood flows in the body of a newborn due to uterine contractions and due to the difference in pressure is sent through the umbilical cord to the baby.
As soon as the blood is filled with oxygen, the vessels of the umbilical cord, "closed", that almost completely blocks the flow of blood to the baby from the placenta. The umbilical vein is not sensitive to oxygen, so her permeability is maintained a little longer, allowing the last drops to get from the placenta to the circulatory system of the baby, after that Vienna is also “closed”.
The fact that cases of “reverse blood flow” is extremely rare is also confirmed by the fact that with delayed clamping of the umbilical cord postpartum blood volume in infants by an average of 30% more than and kids, past immediate clamping of the umbilical cord.
In addition, immediately after birth, the child is in the "double breath". That is, the umbilical cord from the placenta, it receives oxygen and gradually begins to breathe through the nose. If you pinch and cut the cord immediately, the baby will be forced to make sharp breaths, and it is painful because the lungs are not yet fully activated and aktiviziruyutsya gradually, as the filling of the pulmonary circle full blood volume, dedicated to the newborn nature.
8. Delayed clamping of the umbilical cord can lead to infant jaundice?
M. Sloan: Because bilirubin, which is the source of bile, formed from erythrocytes, at first glance, it seems logical that the increased blood volume associated with delayed clamping of the umbilical cord, as this, logically, can lead to hyperbilirubinemia. Although some studies show a moderate increase of bilirubin with delayed clamping of the umbilical cord, in most cases no significant difference between the children with different time restrictions.
At first glance, this seems paradoxical: a relatively stable level of bilirubin at a much larger volume of blood. This paradox may be explained by the fact that immediately after birth enough blood flows to the liver. It turns out that greater volume of blood means more bilirubin, which could provoke infant jaundice, however, a greater volume of blood enables the liver to better and more effectively process bilirubin.
9. Delayed clamping of the umbilical cord may contribute to increased blood viscosity, which can damage the kidneys and cause the blood clots and then the bleeding!
M. Sloan: Indeed, it may be a slightly elevated hematocrit (compared to the values at the immediate clamping of the umbilical cord), but this is not surprising, given the “extra” blood volume. Despite fears that the thick blood may form clots in the internal organs, for example, in the kidneys and in the brain, studies have found cases where such phenomena could be explained by only one fact delayed clamping of the umbilical cord.
In addition, the question arises, in terms of what the umbilical cord occlusion has historically calculated the rate on the hematocrit, considering the widespread practice of immediate clamping of the twentieth century.
10. It is impossible to use the advantages of delayed clamping of the umbilical cord and immediate initiation of breastfeeding / skin-to-skin. If you put the newborn on the abdomen of the mother, i.e. higher than the placenta, then gravity will prevent the blood to actively flow to the baby from the placenta!
M. Sloan: Gravity you need to consider, but mostly it affects the flow of blood.
The child who is being held below the level of the placenta, will get the entire volume of blood in three minutes, and the child is placed above the placenta (for example, on the abdomen of the mother) will also receive the entire volume of blood, but it will take about five minutes.
11. What if the baby needs resuscitation? Isn't it better to immediately transfer the newborn to a pediatrician?
M. Sloan: Additional I. V. fluids – one of the first measures, which in serious situations, newborns get.
They often get 20 to 40 ml of blood or saline per kilogram of weight, although exactly how much remains in the placenta from all the babies in the case of immediate clamping of the umbilical cord: about 30 ml per kg of blood. Collected a significant amount of materials in favor of the fact that among newborns with complications, as full-term and prematurely born, the more safely all evolved with delayed clamping of the umbilical cord, when the nature allow us to complete this physiologic transfusion.
Delayed clamping of the umbilical cord contributes to the successful launch of the cardiopulmonary system in the newborn, prevents iron deficiency significantly affects brain development, provides the newborn with a rich supply of stem cells and contributes to the most successful resolution of situations related to complications for newborns, and all this with minimal known risks to mother or baby.
The volume of evidence is so great and compelling that it would be worth on the contrary, to oblige the supporters of immediate clamping of the umbilical cord to defend their preference, and not those who are in harmony with the natural mechanisms, is inclined to wait until the completion of this important process.
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In addition, the translated material I want to add that in our country in 2011 was adopted the law "On basics of health protection of citizens in the Russian Federation". At the moment, it is the main law governing health and medicine in Russia.
In the second article of this law, there is a definition: "a Medical intervention performed by the medical worker in relation to the patient, affecting the physical or mental condition of the person and having prevention, research, diagnosis, treatment and rehabilitation-oriented types of medical examinations and (or) medical procedures, and abortion".
The clamping of the umbilical cord is a medical intervention. By law, before the intervention, the physician is obliged to obtain YOUR consent to intervention, or your rejection of interference.
Talk about it in article 20, paragraph 1: "A prerequisite of medical intervention is to provide informed voluntary consent of the citizen or his legal representative to medical intervention".
Your consent to the intervention or refusal of intervention must be documented in writing. This is evidenced by the same Article 20, paragraph 7: "Informed voluntary consent to medical intervention or rejection of medical intervention shall be in writing, signed by the citizen, one of the parents or other legal representative, health professional and contains in the patient's medical records".
In a milder form requirement delayed clamping of the umbilical cord can be made into a birth plan with which you can advance to inform your doctor and midwives or at admission to the maternity ward. Gradually the attitude of maternity hospitals for this practice is changing and it is happening now before our eyes.
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Another important point for such a plan to the newborn, in case of normal delivery, immediately put on a mum's breast contact: skin-to-skin not only starts the hormonal processes in the mother and child, contributing to the calm tab of the psyche of the baby start breastfeeding and attachment in the mother, but, equally important, microflora of the birth canal have to get on the mucous membranes of the baby and through them his internal organs, and all this before it will launder took place of the standard “sterile” (unfortunately, hospitals remain a breeding ground for pathogenic bacteria, and it is the mother's healthy flora should be protected as the first day of life and for many years, since this first contact plays a critical role in how the microflora will quickly gain a foothold in all the tissues of the baby).published