Many of you might not realize that I personally read every comment that is posted to my blog. Why you ask? Because I love reading what the people following my blog have to say! I love when people engage in great discussions that have been stimulated by something I have written. I love when women post comments seeking advice, information, or camaraderie and other readers respond! And I love reading about other women’s birth experiences that they share via this forum. Often, a reader will post a question to me under the comments section, a question so great that I take hours or days to research and write a response. And I am such an information/research junkie that if I don’t know the answer, I’ve got to find out!! Other times a reader will post a comment with some really great information or resources to share with other readers. Unfortunately, many of these “super comments” often go unnoticed by readers who only read the posts and not each “comments” section. So I have been inspired to create a new category for my blog entitled “Super Comments” to pay homage to all of the great super comments and questions that my readers post!
Today’s Super Comment is in response to May 17th’s post entitled The Deal with Delayed Cord Cutting or “Hey! Doctor! Leave that Cord Alone!”
Dear Nursing Birth,
I have a student nurse question. In nursing school we were taught that clamping/cutting the cord stimulates respirations. This comes from our textbook, Maternity, Newborn, and Women’s Health Nursing by Susan Orshan, specifically this quote “…clamping of the umbilical cord affects chemoreceptors sensitive to changes in arterial oxygen and carbon dioxide content, contributing to the onset of respirations.” This sentiment was echoed by our faculty to the tone of *this is why cords are clamped and cut immediately after the birth*.
I guess my question is this: Is the above quote enough to justify swift cord-clamping? Or not?
Thanks so much for this post. I’m enjoying the research you’ve done!
That is a really great question! What you (and I) both learned in nursing school is right on one hand, but wrong on another. Let me explain a bit further. I would like to first address the statement you found in your textbook.
Your textbook reads “…clamping of the umbilical cord affects chemoreceptors sensitive to changes in arterial oxygen and carbon dioxide content, contributing to the onset of respirations.” This is true in the fact that clamping the umbilical does stimulate the baby to breathe…BUT the act of clamping the umbilical cord is NOT necessary for the baby to take his first breath! Clamping of the umbilical cord in a way actually forces the baby to take his first breath! In the textbook Respiratory Physiology author John B. West writes:
“The emergency of a baby into the outside world is perhaps the most cataclysmic event of his or her life. The baby is suddenly bombarded with a variety of external stimuli. In addition, the process of birth interferes with placental gas exchange, with resulting hypoxemia and hypercapnia. Finally, the sensitivity of the chemoreceptors apparently increases dramatically at birth, although the mechanism is unknown. As a consequence of all these changes, the baby makes the first gasp.
The fetal lung is not collapsed but is inflated with liquid to about 40% of total lung capacity. This fluid is continuously secreted by alveolar cells during fetal life and has a low pH. Some of it is squeezed out as the infant moves through the birth canal, but the remainder has an important role in the subsequent inflation of the lung. As air enters the lung, large surface tension forces have to be overcome. Because the larger the radius of curvature, the lower the pressures, this pre-inflation reduces the pressures required.” (page 152, chapter 9)
Also (and this is a bit technical so bear with me!) an excerpt from the article “Cord Closure: Can Hasty Clamping Injure the Newborn?” by George M. Morley, MB published in OBG Management in July 1998 tell us:
“Very early clamping results in less than physiologic blood volume. The normal, term child routinely survives, but clamping the cord of a compromised child before ventilation is riskier. Initial aeration of the lungs causes reflex dilatation of pulmonary arterioles and a massive increase in pulmonary blood flow. Placental transfusion normally supplies this volume. Clamping the cord before the infant’s first breath results in blood being sacrificed from other organs to establish pulmonary perfusion. Fatality may result if the child is already hypovolemic.” (Thanks to gentlebirth.org for the reference!)
And to answer your second question…
Homebirth midwife from Mountain View, CA and author of the website http://www.gentlebirth.org/ Ronnie Falcao, LM MS writes in a post entitled “Some comments about ‘Anatomy of A Fetus: Circulation and Breathing’” :
“It is not air hunger that causes the newborn to take a first breath, and it is certainly not necessary for the cord to be cut in order for the baby to start breathing. …I am quite certain that nature didn’t assume that a birth attendant would be standing nearby, scissors in hand. In reality, babies start to breathe right away even if the cord is left untouched. It is not air hunger that stimulates a baby to take its first breath. It is likely the stimulation that comes from the shock of cold air and the sudden exposure to light and noise. Even dim lights and low noises seem very startling to a baby who’s only used to life in the womb.
Both Williams Obstetrics and Varney’s Nurse-Midwifery concur: ‘The phenomenon that occurs to stimulate the neonate to take the first breath is still unknown. It is believed to be a combination of biochemical changes and a number of physical stimuli to which the neonate is subjected, such as cold, gravity, pain, light and noise, which cause excitation of the respiratory center.’
Beyond the question of what stimulates the baby to take a first breath, we can look further at the triggers for the changes in the foramen ovale and ductus arteriosus. The delicate process of rerouting the circulatory system depends on the intricate interplay of blood gas levels that occurs naturally as there is a gradual shift from reliance on umbilical cord oxygen to reliance on air breathed into the lungs. Sudden severing of the umbilical cord is an unnecessary and dangerous meddling with this process. Some people refer to this as premature amputation of the placenta because the baby is still using oxygen carried through the cord from the placenta.”
As an L&D nurse, I have witnessed births where the birth attendant practiced early cord clamping and some where the birth attendant practiced delayed cord clamping. And guess what!? These normal, healthy, uncompromised babies took their first breath and started to cry whether the cord was clamped early or late! (When I first personally witnessed a few of the delayed cord clamped babies breathing just fine I started to wonder if the impression that I was given in nursing school (i.e. that babies needed their cord to be clamped to take their first breath) was really totally true. Both experience and research have shown me otherwise! Pretty cool huh!
Thanks for your great question!