# delayed cord clamping with C section?



## newmum35 (Aug 16, 2007)

can you do delayed cord clamping with a c section?

I did this with DS (vaginal delivery) and have a ton of great bookmarks about the benefits.

I want to mention it to someone who is pregnant but she is planning a c section and don't want to make her feel bad if its not even a possibility.


----------



## mamabadger (Apr 21, 2006)

In theory, yes. I know of one OB (now retired) who delayed CC and lowered the newborn below delivery table level following a Cesarean to allow easier blood flow, provided the baby was well.
In practice, it might be very difficult. Since a C section is major surgery, things tend to be done according to a specific routine, including quickly cutting the cord and getting the baby to the warming table. Even if the doctor agrees to delayed clamping, he might very well forget and fall into his accustomed practice. The mother could request it, but probably should not count on it happening.


----------



## mrsfru (Jul 12, 2005)

It would have been my preference, but we must remember that your belly is open, and the surgeon is working quickly to get that all closed up properly to keep the risk of infection and blood loss as low as possible w/a surgery. That means that the placenta will likely be quickly removed as well. They aren't going to leave the patient wide open while they wait for the cord to stop pulsing--she's losing blood and being exposed to infection during that time.

It would be quite unlikely.

hths

mrsfru


----------



## momofmine (Jan 8, 2007)

Quote:


Originally Posted by *newmum35* 
can you do delayed cord clamping with a c section?

I did this with DS (vaginal delivery) and have a ton of great bookmarks about the benefits.

I want to mention it to someone who is pregnant but she is planning a c section and don't want to make her feel bad if its not even a possibility.

Can you share your bookmarks? I am collecting research on this now.


----------



## newmum35 (Aug 16, 2007)

Quote:


Originally Posted by *mrsfru* 
It would have been my preference, but we must remember that your belly is open, and the surgeon is working quickly to get that all closed up properly to keep the risk of infection and blood loss as low as possible w/a surgery. That means that the placenta will likely be quickly removed as well. They aren't going to leave the patient wide open while they wait for the cord to stop pulsing--she's losing blood and being exposed to infection during that time.

It would be quite unlikely.

hths

mrsfru

But can't they remove the baby AND placenta as quick as they want to without cutting cord? I certainly didn't mean to wait until cord stops pulsating before finishing surgery, leaving the mother open the entire time, but thought during the time they are finishing surgery (after baby is out) the baby could still be attached to its cord & placenta, etc.. that's what happened to me with vaginal birth. My dr was busy stitching me up, because I guess I tore at the end, had the epi so I didnt feel much... the baby was on my chest still attached to cord, placenta was still inside me of course but in the case of a C section I figured they could just remove it also, but leave everything attached a few minutes longer. I have the link saved somewhere but I think around 80% of cord blood goes back into baby in just 2 minutes. I waited until mine was completely white and stop pulsating and I think that was around 10 but I forget really - we waited extra just in case, and it may have been 15 total.

I decided not to mention it to her for other reasons but I would still be curious to know the answer myself.


----------



## newmum35 (Aug 16, 2007)

Quote:


Originally Posted by *momofmine* 
Can you share your bookmarks? I am collecting research on this now.










I had my baby in 2007 so most of my bookmarks are probably from that year. I checked them all and a few don't work but I'll go ahead and post them all here anyway, so you can see what I've saved. The first one didn't work for me and the WHO (world health organization) one also didn't. But the others still work.

http://www.labouroflove.org/birth/de...the-umbilical/

http://www.thestar.com/news/article/194281

The one I had for WHO has changed, and I'm not sure where it went but a search for "delayed cord clamping" brings up quite a few so I'll just post the new search I did:

http://search.who.int/search?ie=utf8...ch&sitesearch=

http://www.bellybelly.com.au/article...-cord-clamping

http://academicobgyn.com/2009/12/03/...in-obstetrics/

http://articles.mercola.com/sites/ar.../20/clamp.aspx

Hope this helps!


----------



## mrsfru (Jul 12, 2005)

Quote:

But can't they remove the baby AND placenta as quick as they want to without cutting cord? I certainly didn't mean to wait until cord stops pulsating before finishing surgery, leaving the mother open the entire time, but thought during the time they are finishing surgery (after baby is out) the baby could still be attached to its cord & placenta, etc.. that's what happened to me with vaginal birth. My dr was busy stitching me up, because I guess I tore at the end, had the epi so I didnt feel much... the baby was on my chest still attached to cord, placenta was still inside me of course but in the case of a C section I figured they could just remove it also, but leave everything attached a few minutes longer. I have the link saved somewhere but I think around 80% of cord blood goes back into baby in just 2 minutes. I waited until mine was completely white and stop pulsating and I think that was around 10 but I forget really - we waited extra just in case, and it may have been 15 total.
I guess that they *could*, and maybe baby would get some of his blood that way...it would make sense. I would hope the doc could try this for me if I asked. However, would they get that much blood from it once it is removed from the uterus? I don't know.

I look forward to reading the links one of the other posters gave--sounds very interesting.

GL!

mrsfru


----------



## mwherbs (Oct 24, 2004)

I would say discuss this with your doc and see, many docs pride themselves on the speed they can do a c-section in- and blood loss for moms tends to be 2x as much as average for a vaginal birth. You may be able to get delayed clamping like they do for vaginal births like for 1-3 minutes but the doc would need to be holding the baby low very near your body not high above your body.


----------



## thefreckledmama (Jun 1, 2007)

Wouldn't removing the placenta from the uterine wall before it detaches by itself introduce a whole new set of risks?

Honestly, most docs don't even like to delay cord clamping in a normal vaginal birth, I think finding an OB who would do so during a c-section would be quite rare.


----------



## Storm Bride (Mar 2, 2005)

I asked my OB about this when I had dd2.

She basically said that it would leave me open too long (I was open a long time, as it was - lots of scar tissue from earlier sections to deal with, plus I had a tubal). I thought about pushing it, and discussing removing the placenta with the baby. I finally decided that, even though I'd have preferred it, my preference was for a surgeon who was totally comfortable with what she was doing. Having her try to delay clamping kind of fell into the scope of turning myself into an experimental surgical subject, and that was outside my comfort zone.


----------



## newmum35 (Aug 16, 2007)

Quote:


Originally Posted by *thefreckledmama* 
Wouldn't removing the placenta from the uterine wall before it detaches by itself introduce a whole new set of risks?

Honestly, most docs don't even like to delay cord clamping in a normal vaginal birth, I think finding an OB who would do so during a c-section would be quite rare.

I haven't researched c sections, but I was under the impression that the normal sequence of events is: remove baby; cut cord; remove placenta. (waiting for detachment of placenta isn't something thats already done) ..... the variable I was asking about is the "cutting of the cord" - not removing the placenta any sooner/later than is normally done. Who knows, perhaps removing it before its ready to detach _does_ introduce risks (thus, the risk of c section being higher than vaginal birth) but, thats not what this thread is about.

If I'm wrong, and they don't remove placenta before stitching you all back up again (thus leaving it to come out naturally), please someone correct me.


----------



## womenswisdom (Jan 5, 2008)

It's the pulsating of the cord that moves the blood from the placenta to the baby. I don't see that the baby would get much benefit from remaining attached to the placenta which has already been removed from the uterus. I believe Sarah Buckley's Gentle Birth, Gentle Mothering has a graph that shows a significant portion of the blood being transfused to the baby in (IIRC) about 20 seconds, so you might be able to check that out and talk with the OB about that.


----------



## thefreckledmama (Jun 1, 2007)

Quote:


Originally Posted by *newmum35* 
I haven't researched c sections, but I was under the impression that the normal sequence of events is: remove baby; cut cord; remove placenta. (waiting for detachment of placenta isn't something thats already done) ..... the variable I was asking about is the "cutting of the cord" - not removing the placenta any sooner/later than is normally done. Who knows, perhaps removing it before its ready to detach _does_ introduce risks (thus, the risk of c section being higher than vaginal birth) but, thats not what this thread is about.

If I'm wrong, and they don't remove placenta before stitching you all back up again (thus leaving it to come out naturally), please someone correct me.

I've never had a c-section, but I would assume they remove the placenta before closing the incision, because I've never heard a mama who has had a c-section mention having to push out the placenta.

I just know in a vaginal birth when you manually tear the placenta from the uterine wall before it detaches on it's own, it can cause massive hemorrhaging in the mom, so I don't know how they handle the placenta during a c-section.

ETA: The reason I mentioned the placenta being removed or not removed immediately is because if the OB wants to get mom closed up as quickly as possible, and they need to wait for the placenta to detach, delaying cord clamping could possibly delay how long the placenta takes to detach.


----------



## newmum35 (Aug 16, 2007)

Quote:


Originally Posted by *womenswisdom* 
It's the pulsating of the cord that moves the blood from the placenta to the baby. I don't see that the baby would get much benefit from remaining attached to the placenta which has already been removed from the uterus. I believe Sarah Buckley's Gentle Birth, Gentle Mothering has a graph that shows a significant portion of the blood being transfused to the baby in (IIRC) about 20 seconds, so you might be able to check that out and talk with the OB about that.

This makes sense, perhaps removing placenta prematurely will cause the cord to stop pulsating (assuming it pulsates only if connected to the mother) ... not sure if its true, but it does make some sense. Thought perhaps it continued to pulsate for a while on its own... not sure how to find out


----------



## CherryBomb (Feb 13, 2005)

Yes, they remove the placenta before stitching you back up.


----------



## womenswisdom (Jan 5, 2008)

Quote:


Originally Posted by *newmum35* 
This makes sense, perhaps removing placenta prematurely will cause the cord to stop pulsating (assuming it pulsates only if connected to the mother) ... not sure if its true, but it does make some sense. Thought perhaps it continued to pulsate for a while on its own... not sure how to find out

Yes, the cord/placenta will only continue to actively move blood when attached to the uterus.


----------



## mrsfru (Jul 12, 2005)

On the question of is the placenta left in to be pushed out later: No, never. Many c-section mommas aren't in labor, so there aren't any contractions going on to push the placenta out. Not to mention, they are either under general anesthesia OR have had a spinal/epidural which would certainly hinder some of the process of expelling the placenta (not completely, obviously, since it's the *feeling* that is gone). But a spinal/epidural given for a c-section is likely far more than what is given for a vaginal delivery. Also, the uterus has been operation--I could imagine that to expect it to work harder after surgery to expel the placenta would be painful and it would be less likely to come out all in one piece and such due to the incisions and the inflammation.

Interesting thread.

mrsfru


----------



## mrsfru (Jul 12, 2005)

Quote:

I just know in a vaginal birth when you manually tear the placenta from the uterine wall before it detaches on it's own, it can cause massive hemorrhaging in the mom, so I don't know how they handle the placenta during a c-section.
I was told that they carefully pull it off by hand and thoroughly check the uterus inside to make sure it is all removed. The patient is given a shot of pitocin to stimulate contractions to help the bleeding stop more quickly, and in my case w/my last c-section, my doctor manually massaged my uterus to help it contract and shrink b/c I was bleeding so much (on aspirin and fish oil in pregnancy). Having my doc hold my uterus in his hands and squeeze it felt like having someone sit on my chest--I couldn't breathe--didn't feel pain, just freaked out about not being able to breathe (my biggest fear).

mrsfru


----------



## claddaghmom (May 30, 2008)

Ok but is 30 seconds to a minute too much to ask?


----------



## mamatoElias (Aug 2, 2006)

I think it would be highly unlikely for an OB to wait several minutes to cut the cord. 20 seconds might be possible if baby comes out vigorous and the doctor is willing to accommodate the parents request.

In my experience, the surgeon is not the person responsible for baby once baby is born. Baby is generally suctioned on mom's abdomen and then passed off to either a nurse or doctor (depending on risk factors). That person is present specifically to care for baby. This person puts on sterile gloves and uses a sterile towel or blanket to take baby from the surgeon, but this person isn't actually in a sterile gown and needs to take baby away from the sterile field in order to warm, dry, and stimulate baby (and provide suction or resuscitation if needed). The cord is cut immediately after birth to allow baby to go to the warmer.

If it were really important to someone, maybe it could be made to happen? I personally don't think I'd bring it up to a friend who was scheduling a c-section.


----------



## mrsfru (Jul 12, 2005)

Quote:


Originally Posted by *claddaghmom* 
Ok but is 30 seconds to a minute too much to ask?

In my experience of 2 c-sections (albeit w/compromised preemies), yes, it would have been. Even if I had full term babes, all of the docs I saw would have said they couldn't do it--that it would deviate too much from their standard practice, amongst other concerns. Not that I'm saying I validate all of their "concerns", anymore than I validate their belief that a VBAC after 2 c-sections isn't safe!







But in so many cases, we already have to fight so hard for docs to treat our c-section births as the births that they should be, as opposed to just surgeries.

mrsfru


----------



## honeybee (Mar 12, 2004)

I've seen a presentation by Dr. Morley (one of the great cord-clamping researchers) about his daughter's c-section, where they allowed baby to get all the cord blood (which only takes about 2 minutes). He monitored the birth and took pictures, showed how the blood levels in baby changed dramatically. The docs performing the c/s had never seen such a pink, vigorous baby.







He went through a lot of hoopla to get them to "allow" this, and it pretty much only happened because he is an OB himself. Docs still refuse to look at the evidence of the benefits of delayed cord clamping in any situation. Thankfully, there are people like Dr. Morley who continue to try to educate people.

I think the benefits to baby for a slightly delayed clamping (even 1 minute) would probably outweigh the possible increased infection risk (which I wonder is how much for 1 minute??), but nobody is doing them to see the great potential health benefits for baby.

Babies in trouble in normal vaginal births would do better to continue receiving chord blood, and be worked on my neonatal resuscitation while still attached to mom.... but getting anyone to change the cut and whisk away policy is the difficulty.

Established procedures are VERY slow to change.


----------



## momofmine (Jan 8, 2007)

That is awesome to hear! Thank you for sharing that!


----------



## mamatoElias (Aug 2, 2006)

Honeybee, interesting information. I'm going to go look-up Dr. Morley. I agree that established procedures are slow to be changed. Unfortunately that means hospitals policies are often not evidence-based. Maybe when my babies are having babies delayed cord clamping will be standard of care. As things stand now, I couldn't get the doctor to delay cord clamping at my son's vaginal birth.







(He agreed to it, but accidentally clamped the cord out of habit.)

If I were having a cesarean birth, timing of cord clamping would be way down the list of battles I would be willing to fight, but that's just me.


----------

