Mama's Got a Plan:

Maternity Care, Health Insurance, and Reproductive Justice

Separation anxiety

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You wouldn’t cut the rope of someone rappelling down a mountain, would you? The umbilical cord fulfills a similar lifeline function for a newborn: it delivers oxygenated blood to the baby until Junior’s lungs expand and begin to function. With her usual wisdom, Nature has provided this backup because she knows that newborns do not always breathe immediately. So why the widespread and persistent belief that the cord must be cut, or at least clamped, immediately after birth?

The medical record

A 2012 article1 describes the origin of early cord cutting:

The first records of cutting before placental delivery hail from the 17th century. It has been suggested that changes in third stage management accompanied the emergence of male midwives; it became normal practice to deliver women in bed, thereby decreasing the likelihood of spontaneous delivery of the placenta …

In other words, the prone position demanded by new-fangled male birth attendants caused a slower or problematic delivery of the placenta, which then dispensed with the need to wait for the placenta to cut the cord. It makes as much sense as anything else.

Providers also believed there to be little benefit in preserving the umbilical cord because the blood flow was so brief:

The contribution of the umbilical arteries was considered to be minimal as it was thought that arterial flow stopped within 25–45 s[econds]. However, no explanation for this cessation of flow was provided …2

One reason that practitioners might have believed blood flow to stop within 45 seconds after birth is that by clamping and cutting the cord immediately after delivery of the newborn, they caused it to stop! Other scientific rationales for early cord cutting included:

  • The desire to prevent analgesic or anesthetic medications administered to the mother from reaching the infant. Of course, these medications would already have crossed the placenta to the prenate* in utero, but it’s hard to argue with a harm reduction approach.
  • As early as 1938, placental and umbilical cord blood began to be used in transfusions.1 The value of this particular blood was recognized again in the 1990s after the function of stem cells became better known. Costly services offering “cord blood banking” cropped up; they persuaded anxious new parents to collect this blood and store it against the possibility of their newborn developing diseases years in the future for which stem cells might be the cure.
  • Newborn resuscitation in contemporary medicine is facilitated by very specialized tools. The baby is typically removed to a surface on or near a crash cart; an intact umbilicus is a hindrance to this removal. 
  • The outdated belief that blood from an uncut cord will flow backwards, out of the newborn, continues to find traction among medical professionals.
  • One also cannot discount the effect of institutional inertia, the perceived need to preserve hospital routines that promote speed and consistency (which then frees up expensive and in-demand physician time), and an inclination on the part of some medical professionals to invest the results of their early medical education with a carved-in-stone quality.

Whatever the rationale, premature clamping and cutting of the cord causes one very distinctive harm: It deprives the newborn of approximately one-third of its total blood volume. This puts the infant at risk for iron deficiency, which in turn may have neurological consequences.3 With many young children in the United States already at risk for iron deficiency from other causes, such as premature birth or lead poisoning, the need to transfuse as much blood as possible into the newborn seems particularly important.

That’s the roundup on premature cord cutting from the medical community. But really …

We blame Hollywood

Fictional representation of birth on the silver screen and TV always features:

  • labor beginning with water breaking (8% in reality!) and sudden, immense pain
  • birthing person screaming in pain
  • the phrase (directed at male partner) “You did this to me”
  • whether in or out of hospital, birthing person lying on her back
  • someone telling birthing person to PUSH (or occasionally “don’t push!”)
  • and, of course, immediate clamping and cutting of the umbilical cord following birth of baby

The photo below, that shows an elevator birth in a 2004 episode of Joan of Arcadia, is typical of precipitous birth depicted onscreen.

For whatever reason, people seem to fixate on the shoelace. Even Embezzler Home Birth Dad, who surely should know better, feels the need for one. With such depictions so ubiquitous, it’s hardly surprising that parents, first responders, and even medical providers believe that immediate clamping and cutting of the cord is an urgent necessity.

Fortunately, care of the cord following a precipitous birth is remarkably simple: Do nothing. 

Want to know more? The 2016 article How to Deliver a Baby (If You Absolutely Have To) provides an excellent set of instructions for supporting a birthing person through a birth in an unplanned location at an unplanned time. We take issue with the headline “You birthed a baby!” since it seems to attribute that accomplishment to the person assisting, rather than to the one who has just produced a new person, but in the face of so much otherwise sound information, we’ll forgive the article’s editors that small oversight.

*Prenate. We use this term, coined by Rebecca Todd Peters4 as a neutral descriptor of the being in utero.

Bibliography

  1. Candice L Downey and Susan Bewley, “Historical Perspectives on Umbilical Cord Clamping and Neonatal Transition,” Journal of the Royal Society of Medicine 105, no. 8 (August 2012): 325–29, https://doi.org/10.1258/jrsm.2012.110316.
  2. I Boere et al., “Umbilical Blood Flow Patterns Directly after Birth before Delayed Cord Clamping,” Archives of Disease in Childhood – Fetal and Neonatal Edition 100, no. 2 (March 2015): F121–25, https://doi.org/10.1136/archdischild-2014-307144.
  3. Judith S. Mercer et al., “Effects of Delayed Cord Clamping on 4-Month Ferritin Levels, Brain Myelin Content, and Neurodevelopment: A Randomized Controlled Trial,” The Journal of Pediatrics 203 (December 2018): 266-272.e2, https://doi.org/10.1016/j.jpeds.2018.06.006.
  4. Rebecca Todd Peters, Trust Women : A Progressive Christian Argument for Reproductive Justice (Boston, Massachusetts: Beacon Press, 2018).
  5. Judith S. Mercer and Debra A. Erickson-Owens, “Rethinking Placental Transfusion and Cord Clamping Issues:,” The Journal of Perinatal & Neonatal Nursing 26, no. 3 (2012): 202–17, https://doi.org/10.1097/JPN.0b013e31825d2d9a.

Image credits 

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