Besides being no mail, I had some e-mail difficulties last week so didn't
spend much time at the computer.  On reading last week's threads I had to
comment on the one about cord clamping.  I can't believe no one
Wiessingerized the subject line!

At present there is no consensus among birth attendants about the
appropriate time to divide or clamp the umbilical cord after a term birth.
We know that for premature babies, it is a good idea to give them the entire
placental transfusion, as they run into serious problems trying to perfuse
the pulmonary capillary bed if they are deprived of this extra volume due to
too early clamping of the cord.  But for term babies, there are those who
warn against babies getting an overdose of their own blood if you wait to
cut the cord, and those who warn against traumatizing the baby by dividing
the cord too soon.  Some pseudoscientists in Sweden who have made their
fortune marketing a new kind of fetal heart monitor claim that all babies
will suffer from not having their cords clamped BEFORE they have taken their
first breath, because they will be likely to develop jaundice and even heart
failure from the increased volume.  They present absolutely no documentation
for this very radical claim.

In reviewing some of the literature on timing of cord clamping a couple of
years ago I was amused to find that what was referred to as delayed cord
clamping was three to five minutes after birth.  To my mind, that is not
much of a delay, and I often don't get around to doing anything at all with
the cord until it has stopped pulsating.  I was taught to keep the baby at
about the same height as the uterus, to avoid a strong gradient one way or
the other that would either cause more blood to end up in the baby, or less.
Placing the baby skin to skin on mother's abdomen accomplishes this easily.
If mother gives birth in an upright position she will usually lift the baby
to her arms where it ends up very nearly at the same height as her uterus.
Must say I have not observed reactions in newborns to having the cord cut,
but I haven't been looking for them either. It seems very plausible that the
baby perceives the sudden loss of connection, and maybe notices the
difference when blood stops flowing in and out through the cord and whether
or not the pain is physical is a moot point.  I don't think there is any
evidence for sensory nerves in the cord itself that could transmit pain from
cutting or clamping.  But also, most babies I see immediately after birth
don't cry much at all unless we separate them from their mothers - and then
they scream in distress.

In the last couple of years, nutritionists have started measuring iron
status in one year olds, and have found that early clamping, which is before
three minutes, is consistently associated with significantly lower
hemoglobin and ferritin levels in children.  They have recommended delaying
clamping until at least five minutes have passed as a public health measure,
to reduce anemia in children.  

The fact that human milk has low levels of iron, just as it has low levels
of Vitamin D, should tell us that we are meant to get our iron and our
Vitamin D somewhere else during that time in our lives.  We do know that the
iron in human milk is utilized very efficiently by the child.  It is also in
a protein bound form which makes it unavailable for E.coli and potential
pathogenic bacteria who need free iron to proliferate in our guts.  In other
words, it is packaged brilliantly to ensure that it reaches its intended
destination, in contrast to other dietary iron or supplements, which we must
ingest in large amounts in order to absorb the small amounts we need,
leaving large amounts in our guts and thus making us more vulnerable to
diarrhea.

Rachel Myr
Kristiansand, Norway

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