Thursday, May 26, 2011

What do orangutans, dolphins, cats, and horses have to do with delayed cord clamping?

I'm often reading through blogs in a time and/or place that I can't watch videos - particularly long ones - and when I put them aside for later viewing, they tend to pile up. I finally sat down to watch Dr. Nicholas Fogelson, who writes at Academic OB/GYN, do a Grand Rounds talk on delayed cord clamping. I wish every OB, midwife, and pediatrician would watch this! I still hear from doula clients that they are told the OB doesn't want to wait to clamp, or will only wait [45 seconds, 60 seconds, etc.] out of concern for polycythemia, jaundice, or some other pediatric concern. I think this talk effectively addresses those concerns, and very nicely lays out the evidence that we do not benefit babies, and instead create potential harm, when we - as standard practice - routinely phlebotomize babies of 40% of their blood volume (as Dr. Fogelson so succinctly puts it).

One thing he did not discuss - although he did touch on the topic - was the connection between breastfeeding, delayed cord clamping, and the "need" for supplemental iron in breastfed infants. While there is very good information and research out there to debunk the idea that breastmilk is "low" in iron and that all breastfed babies need routine iron supplementation, there is a small percentage of babies who become anemic and require supplementation. But when we look at one of the studies he cited, Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial, you can see that early clamping had a greater detrimental effect on the iron levels of 6-month-old babies who were exclusively breastfed; the breastfed babies who had delayed clamping had iron levels closer to those of the infants getting iron-fortified formula or milk. It makes sense to ask that if a breastfed infant DOES end up needing supplemental iron (based on a check of hemoglobin levels), could we have caused its anemia by early cord clamping, given that we have interfered with the normal system of providing a baby's iron in its first months of life?

Enough talk from me! I put off watching this in part because it's about 40 minutes long, but they were a very fast 40 minutes (and you can just listen, with an occasional glance at the slides, if you need to do something else while you're at it).

Here's Part 1, the following segments should pop up as you finish. If you have trouble finding them, you can take a look at Dr. Fogelson's original post; I recommend also reading the comments for discussion of various related topics including the practicalities of delayed cord clamping for preterm infants. (Oh, and all those animals in the title of this post? You'll have to watch to find out!)

When you're done watching, please share this video! I think Dr. Fogelson does a very good job making the argument that delayed cord clamping should not be a nice "add-on" that someone gets if they put it on their birth plan, or be seen as a hindrance instead of a help to neonatal resuscitation; it should be the standard of care in all but rare cases. But it cannot become the standard of care unless more people are aware of the evidence!

1 comment:

Anonymous said...

Ooo, thanks for this. I needed to be reminded of this video. I've been researching DCC for the past few weeks, and you know what else I'm seeing . . . a connection between immediate cord clamping and disruption in oxytocin transfer between mom and baby. I read about this at an autism site. Interesting stuff.