Optimal Cord Clamping the Culture of Medicine
Expectant parents are increasingly aware of the benefits of delaying the clamping and cutting of their newborn’s umbilical cord, and they are insisting on it for their births. This is great news because there are no benefits to early cord clamping without a specific medical indication. Whereas, there are abundant benefits to delaying; in fact, the best term for it is “optimal cord clamping.” The question becomes, how long do you wait? More importantly, how long do you wait if baby seems to be having difficulty taking his first breaths? It turns out that, contrary to common practice, it is important to keep the cord open and baby attached to the placenta until baby is breathing well on her own. The fact that this is not common practice tells us something important about the culture of medicine.
First, here is a very simple explanation of the physiology of newborn transition. (For a detailed discussion of this transition, visit the brilliant Midwife Thinking.) In the womb, one-third of the baby’s blood volume is outside of him, in the placenta and umbilical cord, so that baby can exchange nutrients and waste products with the mother, through the placenta. When he his born, the placenta transfuses the entirety of the newborn’s blood volume, and stem cells from the umbilical cord, into him. This blood is needed for the full, independent function of the baby’s organs – notably the lungs, which must now accomplish the gas exchange that the placenta was completing in utero. After birth, you can see this transfusion in the pulsing of the umbilical cord. It takes 2 – 10 minutes for complete transfusion. As long as the cord pulses and baby is not held aloft, he is receiving this transfusion and continues to be oxygenated by it. This means that he does not have to rely solely on breathing air to get the oxygen he requires. If baby is not breathing well on his own, assistance can be given by the mother or by staff while baby remains in mother’s arms or beside her, attached to the placenta.
Now that you know something about the science of newborn transition at the time of birth, you can confidently insist on optimal cord clamping when your baby is born. But I’d like to take this post a step further and let the issue of early cord clamping – a harmful intervention regularly practiced on babies – teach us something important about maternity care in general. It teaches us something about the culture of medicine and the importance of your physician’s practice style and philosophy. In The Thinking Woman’s Guide to Better Birth, Henci Goer says that “whether you have a c-section or any other procedure or medication during your labor has little to do with your or your baby’s condition. What happens to you depends almost entirely on your caregiver’s practice style and philosophy.”
Doctors are human, like the rest of us. Humans tend to like to feel in control. This leads us to value predictability and routine over change, even if the change is an improvement. In our busy lives, we don’t always make time to keep up with the latest wisdom – until we’re in trouble and searching for help. (When was the last time you read a parenting book? Compare that with how many you read when you were pregnant or a brand new parent.) With those observations in mind, it’s easy to see how physicians would favor doing what they always do, even if their knowledge is outdated. And if things go well for them – if these practices cause them no obvious trouble – they don’t go looking to change the formula that seems to work!
Furthermore, as medical anthropologist Robbie Davis-Floyd reminds us, “Doctors are socialized to find pathology.” What we look for, we tend to find, and when we find it, our pre-existing belief is reinforced. Because of their socialization in disease and intervention, physicians don’t necessarily believe that birth, just because it is “natural,” is necessarily “healthy.” Cancer is natural, too, they point out. Many physicians have never not manipulated a birth, so it is outside their comfort zone. (I’m reminded of the pre-Columbian map of a flat earth: beyond the horizon, “There be dragons.”)
Finally, medicine is a high-prestige profession. Studies show that even the most well-informed patients can find themselves tongue-tied and uncomfortable when they try to question their doctor. But question you must. Despite a mountain of evidence, the American College of Obstetrics and Gynecology (ACOG) still refuses to admit that early cord clamping is a bad practice. To do so would be to admit that they have been wrong and cast doubt on their authority. This is a counter-cultural act!
If change will not come from within, it must come from without: from you parents. Ask questions of your provider. You are looking not only for answers that align with your own philosophy but for her comfort with having a conversation with you about your care! If you sense arrogance, it really is best to find another provider. But if she is open, cultivate the relationship. She may be willing to step outside her comfort zone to accommodate your preferences. By doing so she may discover a new way to practice and even adjust her philosophy to allow the idea that Nature’s design for birth and newborn transition is actually a good one. Thus you pave the way for the mothers and babies who come after you.