December 5, 2011
Should We Delay Clamping the Cord At Birth?
Should we?
The umbilical cord of the fetus is the lifeline to its mother. Not only does it carry nutrients from the mother, but it also removes waste products from the fetus. The cord, as it is referred to, plays a very important role in obstetrics. At birth, a sample of blood from the cord is obtained and tested to identify its blood type and make certain the baby has enough oxygen. Traditionally, the cord is clamped immediately after birth or within the first 15 seconds of life to reduce the incidence of jaundice. However, this no longer holds true. A recent article in the New York Times discussed a Swedish medical study that demonstrated waiting 3 minutes or more before clamping the cord reduced the chances of getting iron deficiency in the newborn four months later. The blood of a newborn is unique because it is in its most primitive state and has stem cells. Stem cells are important because they have the potential to grow into many different cells in the body. When clamping of the cord is delayed, the baby essentially receives a blood transfusion of its own blood.
The practice of delayed clamping of the cord is not new but it is usually done after premature births to reduce complications. Delayed clamping of the cord of preemies by 30 to 120 seconds reduced the need for blood transfusions and reduced brain hemorrhages. These benefits were seen immediately. However, in the Swedish study, the benefits of delayed cord clamping were seen at a much later time interval of 4 months. This is was very significant and paves the way for further studies to determine if this benefit will still prevail months or even years later. Should all babies have delayed cord clamping? No not all. Newborns who had fetal distress during labor should not have delayed clamping because there is a greater transfer of blood from the placenta to the baby during this type of crisis. Also, babies who were growth restricted during pregnancy and babies of diabetic moms should not have delayed cord clamping as well.
Delayed cord clamping might play a significant role in the prevention of newborn and infant anemia. It certainly deserves a discussion with your healthcare provider at your next prenatal appointment.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
November 23, 2009
A Day in the Life: The Humble Gift
Every time a baby is saved I am grateful to Boston University for my acceptance into medical school. Hollywood can keep its Academy Awards; my “Oscars” are healthy babies.
A few months ago, a patient in her early third trimester came for a routine prenatal visit. Her vital signs were good, the baby’s heart rate was normal and as I handed her an appointment slip, I asked whether she felt her baby move during the past two hours. She said no, she had not felt the baby move all day. Despite hearing the baby’s heartbeat, my antennas immediately went up and I referred her to the labor room to have further diagnostic tests.
A few weeks later, my assistant said, “Dr. Galloway, you’ve done it again.” I asked what was she talking about and she explained that our patient was seen in a follow-up clinic for the removal of her staples. The same day I sent her to the hospital, she had an emergency C-Section because her tests were extremely abnormal. Her baby was in trouble. When the on-call obstetrician delivered the baby, he noted an umbilical cord wrapped around its neck five times and once around its body. However, the baby did well and was eventually sent home in stable condition.
My most gratifying moment occurred when I saw the baby for the first time. “She’s my miracle, Dr. Galloway” said the patient, and of course, I agreed. “She was channeling me the night before I came to see you.” “What do you mean?” I asked. “The night before I had her, I dreamt that she had died but because you sent me to the hospital, she’s alive. She’s my miracle.” Tears swelled in my eyes as I struggled to maintain my composure. The miracle of life never ceases to amaze me.
