Tuesday, 23 June 2009

Cutting the cord

Eons ago when I was training as a midwife (1979-1980) the whole birth process was over technical. I remember the birth pack which comprised of two layers of paper, gauze swabs, Gallipot, cotton wool swabs, plastic kidney dish, cord clamps, cord scissors and episiotomy scissors – OUCH! (I suspect with the passage of time I have forgotten some elements). These were all placed in a particular order of use to ensure that you made your episiotomy before the baby was born, and you didn’t cut the cord before clamping it!

I remember the speed at which you had to deliver the baby, clamp and cut the cord, dry the baby down, wrap it in a towel and hand it to the mother, it was always in a matter of seconds provided there were no problems to deal with like a baby not breathing or a haemorrhaging mother.

There was also the element of keeping a sterile field – the mother was discouraged from putting her feet on the paper, as this was where the baby would lie whilst the cord was clamped and cut- I always wondered about this ‘sterile’ field when the mother would regularly open her bowels during the birth process- that definitely wasn’t sterile. Having said that of course, she sometimes would be given suppositories or even an enema prior to the birth or induction of labour. There was also the matter of the ‘Shave’- What indignities. In addition to all of this she would give birth lying down or reclining – in order to give a good view and access for that all important episiotomy!

Thankfully, times have changed; no longer are women given suppositories, enemas or shaves, unless of course they request one! They can birth in any number of positions, and the episiotomy scissors are kept well out of sight. At the time of birth some women are asking that the cord be left until it stops pulsating to ensure that the baby receives its full quota of blood and has time to establish a regular breathing pattern. Whilst the cord continues to pulsate the baby is receiving oxygen via the placenta- this could be particularly useful when a birth has been complicated or traumatic and the baby is unable to breathe for itself. I have observed this myself when a baby was born making little or no effort to breathe- the cord was left intact and the baby received life giving oxygen for a matter of minutes whilst the midwives resuscitated the baby, the baby appears to have suffered no ill effects. Had the cord been clamped and cut at the time of birth I have no doubt that this baby would have suffered some degree of brain damage. Fortunately doctors and midwives are recognising the positive effects of late cord clamping and are even introducing this procedure into the operating theatre at caesarean sections.

There is still room for improvement on this area though, as resuscitaire’s are built with accessibility for the paediatricians and are designed to be chest height- too high for a recently delivered mother to remain attached to her baby by the umbilical cord. Perhaps the manufacturers of such equipment could develop a new, bed height one, which would enable doctors to work on the baby whilst leaving the cord intact to give life saving oxygen to the baby.

Apgar score / resuscitation
Lotus Birth

1 comment:

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