November 17, 2009,
R.C. asks from Portland, OR on November 16, 2009
Delay Cord Clamping, and Pain Delivering Placenta
I have a two part question. I was wondering if women could share their experiences they may've had in these areas.
Has anyone done delayed cord clamping at a hospital delivery? Or, did you plan on doing it and then were not able to (and why not)? How did it go, and did you have to remind them to do it? I'd like to do this. I hadn't heard of it when I had my son, but I'm not sure if they would have respected the wish because he was taken away to be resuscitated (though I now think it would have been better to let him have the oxygen through the cord while they got him breathing).
Also I had a very painful and traumatic delivery of the placenta. I didn't expect this as I'd heard it was generally very mild. I wasn't told of any complications. How was it for others, and why? I'm wondering if the midwife delivering was in hurry and was pulling on it. Mine was the 8th baby of the night and she stayed late to finish (it was at Kaiser Sunnyside where they use midwives to deliver). I'd like to avoid the trauma this time if possible, by alerting my husband and doula to not let them do any pulling, pushing on my uterus, etc but to let the placenta deliver naturally.
Thanks for sharing, and any advice.
M.S. answers from Portland on November 17, 2009
You are right, that it is best to wait to clamp/cut the cord until the blood stops pulsing. It usually only takes a minute or two. With my first, she wasn't breathing, and they had to cut it right away to whisk her off. I did try to stop them to remind them I wanted to wait, but they said it was necessary to cut it immediately. They absolutely have to get those babies into the heat and suction them immediately. There would be no benefit to waiting for them.
My second, They agreed to wait to cut the cord, but they always forget all special requests and you have to remind them.
I also had them wait to put in the eye ointment because the babies are most alert right after delivery. They can't see through the ointment. I preferred to have my baby see me during our first binding moments. I did this with both kids, and they put the ointment in as soon as they fell asleep. Again, you have to remind them, but it is well worth it. Plus, you get those first pictures without the goopy eye stuff.
As for the placenta delivery, I didn't have any problem with either kid. Pulling can be dangerous, and shouldn,t be done unless you are refusing to push it out. I was surprised that it really took a strong push, but there was no pain or complications. It is essential for them to push and massage your uterus in the 24 hours following delivery, but that is something different. My aunt was my nurse and told me a little secret. If you tighten your tummy muscles every 10-15 minutes or so, you can shrink your uterus on your own without all the painful massages from the nurses. If your uterus is shrinking faster than required (from your exercises), they will just check you and leave you be.
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T.N. answers from Portland on November 17, 2009
Congratulations on your upcoming birth! Also, congratulations to you for finding a doula. I can only offer advice as a birth doula in the Portland area who has worked as Kaiser Sunnyside with success at delaying cord clamping. I would suggest that you stipulate in your birth plan, if you are using one, that you do not wish to have the cord cut until baby is breathing on it's own AND it stop pulsing. There are pro's and con's to it. If the baby is held below the cord, an unlikely event, they could recieve too much blood, in theory. When a baby is placed directly on mother's abdomen that is unlikely. To delay the cord clamping with provide him/her with needed oxygen while they are learning to breath, so taking a few minutes to learn and clear their lungs isn't a big deal, they are still oxygenated. I would also make it clear that you want to delay the cord clamping every time you visit your provider.
Now then, I wasn't there, so I can't speak directly to your placenta delivery, BUT I can say there are times that they put traction on the placenta which can take up to 1/2 and hour to release. The best way to get your placenta to naturally relase, as I am sure your doula will have told you, is to nurse your baby because it releases oxytocin whcih makes the uterus contract, which causes the placenta to detach naturally and cut off the blood supply that had been present for 9 months. The down side to that is that you have to encourage your infant to nurse sooner than they might want to. The alternative it to roll your nipple between your thumb and forefinger to stimulate contractions and then allow your baby to latch on when they are ready. If you have a birth without a lot interventions this is generally before an hour has passed that they get interested in nursing. I do know that putting traction on the placenta can cause hemmoraging and tearing and is in general a BAD idea. I am sorry that your last experience was traumatic, and I will hope for you a better experience this time. I would also include your wishes for placental delivery in your birth plans and make it clear to your provider that you do NOT want traction placed on the placenta.
If you have any further questions you may of course email me directly.
T. Nelson CD
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T.O. answers from Portland on November 17, 2009
I can't comment on the delayed cord clamping, but I had a very traumatic placenta delivery with my first daughter. To be quite frank if I had not been in the hospital and had my dr not immediately known what to do, I would have lost my uterus , they were calling the OR to rush me into an immediate surgery and possible hysterectomy. I had an inverted uterus, as the placenta was delivering my uterus started coming out as well...my dr had to literally put her entire arm inside to keep it from coming out, it finally did and she saved my uterus. It was extremely scary and very traumatic. I was grateful that my dr knew what to do-- in her 27 yrs of practice that had never happened to her, she only knew what to do from reading it in her textbooks! The nurse -37 years experience had never seen it either!
So be very specific in your birthing plan what you want, don't want, who to help you, etc. If they do any pulling on the placenta this can happen as well. Mine just spontaneously did it.
My second birth, no complications at all...every birth is different so hopefully that won't happen this time!
Regardless if you are delivering baby #1 or baby #10 you should get the same level of care!
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A.Z. answers from Portland on November 17, 2009
Having given birth only in out of hospital settings, I hope my advice will be relevant. Delaying cutting the cord would be benefitial especially if they are struggling to get your baby breathing. The drugs given at the hospital do cross the placenta and can cause delays with both breathing and breastfeeding. So I would be sure you mention this repeatedly and have your husband and doula watch carefully for this and advocate for you.
For the placenta, it should not hurt and there is no need to rush it in normal circumstances. Your midwife or doula should give you the baby to nurse and this will encourage delivery of the placenta naturally by causing contractions which you should feel some, but being tired, won't register too much. Rushing and tugging on it can cause tearing and pain, so it is possible that is what happened before.
Best of luck to you - we are also expecting to give birth in about 4 weeks! But we are doing it at home with our midwives.
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O.A. answers from Portland on November 17, 2009
As a midwife, I just want to confirm that the previous advice you received from the doula was very good and accurate. Generally, I prefer to delay cord clamping until after it has stopped pulsing. There are occasions when extenuating circumstances require an earlier clamping, however (a very short cord, a cord wrapped tightly around the baby's neck, preventing delivery, or a baby who is severely compromised and needs immediate, extensive resuscitation and the cord is getting in the way). Under normal circumstances, though, I agree that delayed cord clamping is a good idea. As far as the placenta is concerned, it is surprising to me that it was so traumatic for you. That is unusual. Again, as a general rule, applying traction to the cord is not a good idea and can cause some very serious complications, but there are times when GENTLE traction is warranted. (If the placenta has partially separated and you are bleeding, gentle traction can encourage complete separation, or if the placenta has completely separated, but is just sitting in the uterus, gentle traction can help ease it out.) Also, as painful as it may be (and I remember how uncomfortably it was, myself), some pressure/rubbing on the uterus immediately after delivery of the placenta is usually necessary to ensure that the uterus has clamped down sufficiently to prevent hemorrhage. Normally, it shouldn't last long, though. However, if you were bleeding more than normal, they may have had to apply more pressure for a longer time. Since I wasn't present for your birth, I really can't make a direct comment on how any of it was handled. I can only tell you what I would do under normal, healthy circumstances. All the best to you with the birth of this baby!
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