Category: pospartum

Delayed cord clamping

June 10, 2020

 

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Unclamped cord over the course of 15 minutes.
photo nurturingheartsbirthservices.com

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Delayed cord clamping is a birth practice where the umbilical cord is not clamped or cut until after pulsations have ceased, or until after the placenta is delivered. A growing number of parents are choosing delayed cord clamping for their baby.

The timing of clamping the umbilical cord, and practices have a sizeable impact on the outcomes or mother and baby. Research has shown that when we delay cord clamping the neonate will receive up to 30% more of the fetal-placental blood volume than it would have with immediate cord clamping.

When your baby is born, the cord and placenta system will contain about one third of your baby’s blood, whilst the remaining two thirds is in the baby.

Benefits

The benefits of delayed cord clamping for the baby include a normal, healthy blood volume for the transition to life outside the womb; and a full count of red blood cells, stem cells and immune cells. For the mother, delayed clamping keeps the mother-baby unit intact and can prevent complications with delivering the placenta.

The placenta

Before birth, the baby and placenta share a circulating blood supply that is separate to the mother’s. Inside the uterus, the placenta and umbilical cord provides the baby with oxygen, nutrients and clears waste. During fetal life, the baby’s organs only need a small flow of blood while the placenta performs the role of lungs, kidneys, gut and liver for the baby. This is why a significant portion of the baby’s total blood volume is in the placenta at any given time. The blood circulating the placenta and cord is not ‘extra’ blood or waste – it belongs to the baby.

Immediately after birth, the cord pulsates as the placenta continues to provide essential oxygen and nutrients, and begins to deliver blood back to the baby. This transfer of blood is called placental transfusionand it is a vital part of the birth process.

Placental transfusion is the system that provides the baby with red blood cells, stem cells, immune cells and blood volume. Delayed cord clamping allows time for the placental transfusion, ensuring safe oxygen levels and blood volume in the baby.

The World Health Organisation states the “optimal time to clamp the umbilical cord for all infants regardless of gestational age or fetal weight is when the circulation in the cord has ceased, and the cord is flat and pulseless (approximately 3 minutes or more after birth).”

Risks of immediate cord clamping 

For many decades, various studies have shown that immediate or early cord clamping disrupts normal physiology, anatomy and the birth process – it severs the baby from the still-functioning placenta and halts the circulation of blood.

Large studies have shown that immediate cord clamping can result in lower iron stores in the baby for up to 6 months after birth. While not all the implications of a reduced iron status are understood, iron deficiency in the first few months of life is associated with neurodevelopmental delay, which may be irreversible.

Early cord clamping can cause complications for the mother, too. There is some evidence that early clamping increases the risk of post-partum hemorrhage and retained placenta by engorging the placenta with the baby’s blood. This makes it harder for the uterus to contract and expel the placenta.

Risk of delayed cord clamping

Small studies have shown that delaying cord clamping increases the risk of jaundice. A study found that 3% of babies who experienced early cord clamping, compared to 5% of babies who experienced delayed cord clamping required treatment for jaundice.

In summary

Delayed cord clamping leaves the cord alone after birth and avoids disrupting the normal birth process. While the cord is pulsating, placental transfusion is supplying the baby with oxygen, nutrients and an increased blood volume to support the transition to life outside the womb.

Delayed cord clamping confers many benefits to the newborn baby including higher number of red blood cells, stem cells and immune cells at birth. In premature or compromised babies, delayed cord clamping may provide essential life support, restore blood volume and protect against organ damage, brain injury and death.”

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This is the recommendations from the ACOG website : 

The American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice makes the following recommendations regarding the timing of umbilical cord clamping after birth:

  • In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes.
  • Delayed umbilical cord clamping is associated with significant neonatal benefits in preterm infants, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage.
  • Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30–60 seconds after birth.
  • There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing delayed umbilical cord clamping. Consequently, obstetrician–gynecologists and other obstetric care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor and treat neonatal jaundice.
  • Delayed umbilical cord clamping does not increase the risk of postpartum hemorrhage.

Read the next article about Lotus birth & Placenta

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Breastfeeding

June 10, 2020

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Here is a great article from www.kellymom.com – This website is FULL of the best informations about breastfeeding. You can also reach out your local Leche League Leader who organize FREE meetings once a month, I encourage you to also participate to the meetings during your pregnancy if your goal is to breastfeed. There is many leaders and meetings in Los Angeles. Contact me for the list ! Please note that your insurance might cover 100% of the cost of your pump. Talk with your care provider or contact me for more infos.

The First Week

How often should baby be nursing?

Frequent nursing encourages good milk supply and reduces engorgement. Aim for nursing at least 10 – 12 times per day (24 hours). You CAN’T nurse too often–you CAN nurse too little.

Nurse at the first signs of hunger (stirring, rooting, hands in mouth)–don’t wait until baby is crying. Allow baby unlimited time at the breast when sucking actively, then offer the second breast. Some newborns are excessively sleepy at first–wake baby to nurse if 2 hours (during the day) or 4 hours (at night) have passed without nursing.

Is baby getting enough milk?

Weight gain: Normal newborns may lose up to 7% of birth weight in the first few days. After mom’s milk comes in, the average breastfed baby gains 6 oz/week (170 g/week). Take baby for a weight check at the end of the first week or beginning of the second week. Consult with baby’s doctor and your lactation consultant if baby is not gaining as expected.

Dirty diapers: In the early days, baby typically has one dirty diaper for each day of life (1 on day one, 2 on day two…). After day 4, stools should be yellow and baby should have at least 3-4 stools daily that are the size of a US quarter (2.5 cm) or larger. Some babies stool every time they nurse, or even more often–this is normal, too. The normal stool of a breastfed baby is loose (soft to runny) and may be seedy or curdy. 

Wet diapers: In the early days, baby typically has one wet diaper for each day of life (1 on day one, 2 on day two…). Once mom’s milk comes in, expect 5-6+ wet diapers every 24 hours. To feel what a sufficiently wet diaper is like, pour 3 tablespoons (45 mL) of water into a clean diaper. A piece of tissue in a disposable diaper will help you determine if the diaper is wet.

Breast changes

Your milk should start to “come in” (increase in quantity and change from colostrum to mature milk) between days 2 and 5. To minimize engorgement: nurse often, don’t skip feedings (even at night), ensure good latch/positioning, and let baby finish the first breast before offering the other side. To decrease discomfort from engorgement, use cold and/or cabbage leaf compresses between feedings. If baby is having trouble latching due to engorgement, use reverse pressure softening or express milk until the nipple is soft, then try latching again.

Call your doctor, midwife and/or lactation consultant if:

  • Baby is having no wet or dirty diapers
  • Baby has dark colored urine after day 3(should be pale yellow to clear)
  • Baby has dark colored stools after day 4(should be mustard yellow, with no meconium)
  • Baby has fewer wet/soiled diapers or nurses less frequently than the goals listed here
  • Mom has symptoms of mastitis (sore breast with fever, chills, flu-like aching)

Weeks two through six

How often should baby be nursing?

Frequent nursing in the early weeks is important for establishing a good milk supply. Most newborns need to nurse 8 – 12+ times per day (24 hours). You CAN’T nurse too often—you CAN nurse too little.

Nurse at the first signs of hunger (stirring, rooting, hands in mouth)—don’t wait until baby is crying. Allow baby unlimited time at the breast when sucking actively, then offer the second breast. Some newborns are excessively sleepy—wake baby to nurse if 2 hours (during the day) or 4 hours (at night) have passed without nursing. Once baby has established a good weight gain pattern, you can stop waking baby and nurse on baby’s cues alone.

The following things are normal:

  • Frequent and/or long feedings.
  • Varying nursing pattern from day to day.
  • Cluster nursing (very frequent to constant nursing) for several hours—usually evenings—each day. This may coincide with the normal “fussy time” that most babies have in the early months.
  • Growth spurts, where baby nurses more often than usual for several days and may act very fussy. Common growth spurt times in the early weeks are the first few days at home, 7 – 10 days, 2 – 3 weeks and 4 – 6 weeks.

Is baby getting enough milk?

Weight gain: The average breastfed newborn gains 6 ounces/week (170 grams/week). Consult with baby’s doctor and your lactation consultant if baby is not gaining as expected.

Dirty diapers: Expect 3-4+ stools daily that are the size of a US quarter (2.5 cm) or larger. Some babies stool every time they nurse, or even more often–this is normal, too. The normal stool of a breastfed baby is yellow and loose (soft to runny) and may be seedy or curdy. After 4 – 6 weeks, some babies stool less frequently, with stools as infrequent as one every 7-10 days. As long as baby is gaining well, this is normal.

Wet diapers: Expect 5-6+ wet diapers every 24 hours. To feel what a sufficiently wet diaper is like, pour 3 tablespoons (45 mL) of water into a clean diaper. A piece of tissue in a disposable diaper will help you determine if the diaper is wet. After 6 weeks, wet diapers may drop to 4-5/day but amount of urine will increase to 4-6+ tablespoons (60-90+ mL) as baby’s bladder capacity grows.

Milk supply?

Some moms worry about milk supply. As long as baby is gaining well on mom’s milk alone, then milk supply is good. Between weight checks, a sufficient number of wet and dirty diapers will indicate that baby is getting enough milk.

 

Read next article about eating dates fruit during the third trimester

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