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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Risks of Premature Cutting of the Umbilical Cord

I was hoping for advice, info, or opinions on something.  I have a dr appt in 2 weeks and want to find out if I can wait to cut the cord till the blood stops flowing through it.  I don't know exactly why one does that, but have heard it is better.  I would like any info out there, please.  Of course, it might not be an option, as I have to deliver in a hospital, albeit a birth center hospital.  They still have some rules. Or, it might not be an option if I have problems again.  BUT, I would like to know.  Thanks in advance.

Premature cutting of the umbilical cord carries some serious risks:

• Asphyxiation - Oxygenated blood in the umbilical cord and placenta will sustain the newborn for many minutes after birth; this may prevent brain damage or death if your baby is unable to adapt to breathing immediately upon birth.
• Inadequate pulmonary perfusion - As your baby tries to breathe for the first time, additional blood volume is needed to fill the blood vessels that go to the lungs to pick up oxygen. If there's no blood flowing in from the umbilical cord, your baby may become hypovolemic, meaning it doesn't have enough blood.
• Increased need for blood transfusions to the newborn
• Increased need for heart surgery - Normally, your baby gradually reroutes its circulatory system to take advantage of oxygen in the lungs as it gradually reduces its reliance on oxygen from the umbilical cord.  Abrupt reduction in oxygen levels caused by premature cutting of the umbilical cord may interfere with the way your baby closes valves in the heart at the time of birth.

Regarding their rules: Regardless of their rules, you have absolute legal right to say what does and does not happen to your baby. Ideally, one wouldn't have to make legal threats in order to obtain the best medical care for one's baby, but . . . the best way to do it is to discuss it beforehand, providing research citations from the above web page.  Then, remind them shortly before the baby is born that you want the cord left intact and that you want the baby resuscitated with the cord intact if necessary.  (Hospital providers show a disturbing lack of imagination on this point.  It's the babies who need resuscitation who most need the intact umbilical cord, but these are the babies where they're quickest to cut it because they haven't figured out how to resuscitate the baby in situ.  Give your care providers an opportunity to use their brains to solve this puzzle!  An added complication is that most hospital protocols follow outdated research regarding the need to "visualize the vocal cords" of babies born with meconium.  The most recent research shows that doing this to vigorous babies causes more problems than it solves.  Anyway, this is the most likely reason they'll give for "needing" to cut the umbilical cord, as meconium occurs in about 15% of births.)

If you have educated yourself better than your care providers are educated, and you are convinced that your baby does not need to be "resuscitated" if it's already breathing fine on its own, then you can refuse to have your baby's umbilical cord cut just so your baby can be taken to the baby warmer to be "resuscitated".

Your best legal position would be to videotape yourself giving your instructions to the care provider during a prenatal appointment, shortly before the birth, and then again right as the baby's born. You might even remind them to cover the umbilical scissors with a sterile cloth just to prevent any reflex reactions on their part.

Medical people that you talk with may try to give you the impression that they have the legal right to do whatever they want with your baby, but they don't.  Sometimes you have to remind them about this.

P.S. It's often very difficult to be your own advocate at a birth, and it's often tough for dads to be an effective advocate at such an emotional time.  Some people hire doulas to do this.  Or you might try offering the birth attendant a $100 bonus if they manage to leave the umbilical cord intact for 20 minutes.  [Grin]