What about the cord?

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updated post, first published 19/12/2015

 

One of the biggest questions surrounding birth is ‘What about the cord?’

Many people have a sense of urgency that the cord must be clamped and cut in a dramatic and special way.  This is not the case.  Far from it in fact.

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Another thing very injurious to the child, is the tying and cutting of the navel string too soon; which should always be left till the child has not only repeatedly breathed but till all pulsation in the cord ceases. As otherwise the child is much weaker than it ought to be, a portion of the blood being left in the placenta, which ought to have been in the child.
1801 Erasmus Darwin, Charles Darwin’s grandfather

 
Did you know that some people opt for a lotus birth? 
This means that the cord is never cut, and you keep the placenta with the baby until the cord (and placenta) come away after a few days.  
 
According to Odent (p.71 Childbirth in the Age of Plastics (exsaguine means bloodless)):

some hours after the birth the cord is thin, dry, hard, and exsaguine. It can then be cut without any special precaution

 
Basically, once the cord is thin, dry, hard and bloodless…then you don’t need to worry about the tie. You can keep the placenta in a bowl next to baby. The first few hours are about skin to skin contact, rest and breastfeeding. So if you are comfortably in bed, holding your baby, the placenta can be in a bowl next to you. No drama, no worries. Uninterrupted.

Some people choose to leave the cord intact. This does involve more considerations (as described by lotus birth).  After a few days the cord and placenta come away from the baby. 

And yes, this means that the baby remains attached to the placenta.  It is useful to have a bowl ready for it.  Once the cord is white (after a few hours) it can be cut without need for tying (about 10cm away from the baby.).  The cord will continue to dry out and come away from the baby after a few days.  The placenta can be encapsulated, printed, eaten, planted or frozen.  With this in mind, you can relax. Leave your shoelaces in your shoes, and put the scissors away while you #waitforwhite.  
 

If you find yourself birthing without assistance (as you may in the event of a fast birth), simply leave the cord alone.  Don’t pull on it, don’t clamp it, don’t cut it.


BUT WHAT IF THE CORD IS AROUND THE BABY’S NECK!

There is a lot of misunderstanding about nuchal cords (cord around the neck).  The cord around neck is rarely a problem, and the ‘somersault manoeuver’ (see below) is useful to know about. Understanding nuchal cords and this manoeuver can be very reassuring in the event of an unassisted birth.  It is also helpful to understand even when being assisted, as you will be more aware of the language and less likely to feel anxious or confused about this situation.  Knowledge is Power!

Midwife Thinking has written an excellent article discussing nuchal cords. This includes a description of the somersault manoeuver (also shown in the video below).

PictureWHAT IF THERE IS A KNOT IN THE CORD?

You may have heard that in very rare situations a baby has a ‘true knot’ in the umbilical cord.  For this, I encourage you to read this article by midwife, Jane Palmer.

AND WHAT IS THE DEAL WITH DELAYED CORD CLAMPING?

At some point you are likely to heard about ‘delayed cord clamping’, or Optimal Cord Clamping.  The evidence supports it, and it is increasingly becoming standard practice (to varying degrees).  You still need to request it, however, and discuss it with your care provider to find out just what they consider standard.  If this differs to what you want, you will need to discuss this with them to ensure your needs are met.  For example, if you simply state you’d like ‘delayed cord clamping’, this could mean 30 seconds, or it could mean up to 3 minutes depending on the institution you are in or the attendant you have.  You need to be implicit about how long you want to wait if you intent to sever the cord.

An excellent resource and campaign is #waitforwhite  and (as stated above) knowing that it is not absolutely necessary to clamp the cord, or even cut it.

WHAT ABOUT CORD BLOOD BANKING?
You can read about that here.

The video below demonstrates the somersault manoeuver. As you watch it, keep in mind that demo is using a dummy.  In real life, the mother would (ideally) not be on her back.  The baby would be expelled by contractions and slip out (you absolutely do not need to tug at the baby or separate the mother’s labia.).  If you see the cord is around the neck, this manoeuver helps to avoid pulling the cord.  The baby can then be passed onto the mother’s body.  Keep in mind the length of the cord.  Sometimes, you may only be able to have the baby low (if the cord is short), sometimes the baby can reach the mother’s chest.  If the cord is short, once the placenta is birthed, you can adjust the placement.
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