Monday
Oct182010
Note re: Umbilical Cord
Monday, October 18, 2010 at 04:54AM If the placenta is already born, the cord has stopped pulsating.
I'm watching Unassisted (child)Birth after UC where women are checking to see if the cord's still pulsating... after the placenta is already born.
How can this basic information not be common knowledge. Let's just pass the info on now, eh?
Reader Comments (33)
You mean the placenta doesn't take on an independent life of its own, complete with beating heart and circulatory system?? Who'd-a thunk it?
Sorry to be snarky. But SHEESH. Common sense, people.
I have read the experiences of several knowledgable women who have witnessed the cord pulsating after delivery of the placenta. My birth teacher/midwife friend has also witnessed this and explained that it was likely caused by the change in high pressure to low pressure.
*blink*
There just is nothing to say. Not a thing.
I attended a homebirth and the baby arrived in not a great shape. As usual we felt the cord to reassure ourselves that he was oxygenated while he sorted himself out. It was pulsing. Mama then asked 'what's that?' and I noticed she was sitting on the placenta. The placenta had separated as the head crowned (that's what the blood was about!). Baby was fine after a little stimulation and encouragement. But - the cord was pulsing away for minutes after the placenta was out. Unfortunately it was not circulating any oxygen!
I, for one, will not be passing on any such information. I've been attending homebirths for over 22 years, and I've frequently experienced cords pulsing with the placentas in the bowls. So personally, I can't help but think, "How can it NOT be common knowledge to any experienced homebirth midwife that this phenomenon exists?"
What's pulsating? Does it have its own circulatory system going on?
And why is there a divide between those that have never seen it (including midwives and nurses who've been doing this far longer than either one of us) and those, like you, that have?
Logically... no, let's go to *scientifically*, which makes sense?
I've also attended a birth where the cord continued to pulse after the placenta was born....again, not delivering any oxygen (duh)....but pulsing nonetheless.
Honestly, there was no jab intended from me (I'm happy to admit when there is), so I'm not sure what you're seeing, but rather I retorted with both surprise and a tone equal to the original post. Maybe it might have read differently had the original post said something like, "They're checking the cord for pulsation after the placenta's out. I've never experienced that it can do that; has anyone else?"
I don't know what you mean by a "divide" which I've never experienced; simply when it's come up in conversation, those midwives who have never seen it have said, "Really? That can happen!? Cool!" as opposed to "That could never happen, so teach everyone else that from now on."
Most of the time I've encountered those conversations, they are either midwives who haven't been to a lot of homebirths (in which case it just hasn't occurred yet, or they haven't felt it) or hospital-based midwives who would rarely be in the position of catching something like that due to earlier cord clamping. So it surprises me that you would think it can't happen, because most homebirth midwives I know have experienced the phenomenon of the cord still pulsing after the placenta's out.
I do (really) apologize for being snarky. That wasn't fair.
I woke up in the night and thought, "Well, girl... you're just going to have to look for it! Maybe you've never seen it because it never dawned on you to."
So, thank you for not jabbing -or jabbing back... your patience is always appreciated.
Btw, just referred someone to you that I thought would be a better fit for you than me. :)
Thanks again and sorry again.
Okay, so *if* the cord *is* pulsating after the placenta's born, does it have a purpose in the same way it does before it's born? *Is* there a reason to still wait for the cord to stop pulsating? Besides the kindness part, which I totally honor.
Just wondering; could it still be pulsing because the baby still has fetal circulation and is pushing some blood back out into it? The change away from fetal circulation isn't always immediate. I am not sure whether this would be any help to the baby though. Would the baby's heart be able to push blood up the umbilical cord to the placenta and therefore push leftover oxygenated blood back? I would think the oxygen would be used up pretty fast. It is the baby's heart, though, that drives the circulation through the umbilical cord and the placenta, not the mothers. So there still could be a pulse.
I've seen it happen. It makes sense to me that it can happen even though it's not the usual; since it's the changes in wharton's jelly that collapse the vessels and stop the pulsation, if the placenta is out but the vessels haven't collapsed it makes sense that the baby's pulse could push the blood however far the vessels are still open. However, once the placenta is detached, the baby won't benefit from oxygenation any longer. The couple times I've seen it, the moms have chosen to clamp and cut even with the cord still pulsating because of this, but I wonder whether it helps the baby get all her blood to wait til it stops pulsing even after the placenta is out, though, since the point at which the pulsing stops is closer to the placenta at first and gradually makes its way toward the baby until the whole cord is still (don't know if that's textbook, it's just what I've noticed when I've been able to pay attention to such things).
Well, Megan, your explanation of why makes sense to me. Not sure if it's the truth or not. ;) But, sounds great to me.
Susan: If the baby's blood went back towards the placenta, I think that would not be a good thing *at all*.
Thoughts, others? Vickii? Where would one find info on this?
I'd always read, though not witnessed, that the delayed cord cutting or lotus birthing was nutrtionally, hormonally and immunologically beneficial.
Well, if there is a pulse in the cord, and the pulse comes from the beating of the baby's heart, and fetal circulation is still in place, then that means blood is being pushed out into the cord. If it is pushed out, it might also force placental blood back in, I suppose, since this is how it works before the baby is born.
If fetal circulation is not still in place, would there even be any pulse in the cord? I am not saying I know the answer to this.
Here are some very clear diagrams -activated-of fetal circulation and circulation after birth. But they assume that the umbilical cord is cut at birth.
http://www.embryology.ch/anglais/pcardio/umstellung01.html
http://www.embryology.ch/anglais/rrespiratory/geburt01.html
They might help us think through this issue though.
Susan
from what i understand about neonatal transitional physiology, the umbilical arteries (leading blood away from baby) close first; and the vein stays open, allowing blood that had been shunted into placenta during birth to make its way back to baby. a phsyiologic transition allows the blood to equilibrate so baby is not hypovolemic.
*learning*
http://web.archive.org/web/20040924124133/http://www.cordclamping.com/
The Judith Mercer articles explain transitional physiology quite well.
Just as labor progress not just cm dilation, umbilical cord blood is way more than just a means to oxygenation.
Yet again, instead of asking without being judgmental, you jump on UC-ers and their perceived ignorance. Seriously. I guess you can learn something from us. Who would have thunk? I hate it that you hide your arrogance under 'I am learning' label. True learning does not judge first.
Oh, so YOU have the definition of learning. I always wondered who had it.
I did not give a definition of learning. I only mentioned one thing that it does not.
Anne Frey writes:
Even after the placenta is born, equilibration continues by slight adjustments that occur via reflex action of the intra-abdominal portions of the vessels, eliminating the development of excessive central nervous pressure and thus allowing the baby’s system to gradually integrate the additional blood volume…Allowing physiologic equilibration to take place as it naturally occurs is the most gentle option as far as normal neonatal transition is concerned.(p.496)
I've always taught and believed that humility is one of the most important midwifery skills.
As far as WHY it's still pulsing when the placenta is born...we don't fully have that answer yet, and neither do I. But I do believe that whyever it occurs, there's a darn good reason for it. I assume that it's how they regulate their blood volume: if they get too much, they shunt some back, and until they have enough, they keep it going. So as long as the baby's controlling it, it likely will go in the direction it should. I imagine it sounds odd that it might be shunting BACK, but I think how perfect a system: it is possible to have too MUCH of a blood volume, so he regulates it until the right amount for his needs is in his body. Of course, I don't really know why it's happening for sure.
To me, even though it's a mystery, we need to honor it...So I do believe it's a travesty to cut that cord before it's done doing its job--even if the placenta is out of the mother. The mother may be done with the placenta, but for some babies, it's obvious they are not. I just wonder what else besides oxygenation and nutrition they get from the cells that pass in via the cord in the moments/hour after birth. Look at how much we know that we never even suspected before...and how much we will likely find out in the next 20 years.
Frankly, until this post, I thought the same thing as NGM did.
I think saying "learning" is an acknowledgement that she didn't know as much about this particular subject as she thought she did. Either did I. It is difficult to say "I was mistaken." I think she said it. I don't think she deserves your anger here, Maria. Once someone says, "I was mistaken" in any form, that should be enough.
Susan Peterson
Susan, my anger comes from the tone in the post:
'How can this basic information not be common knowledge. Let's just pass the info on now, eh?'
As a UC-er I take offense with how she talks to 'us' derogatively. 'I was mistaken' refers to the fact that Barbara was mistaken about the cord not pulsating after the placenta was born, it was not about her tone. From her tone I deduct, and perhaps mistakenly so, that she would have loved to be right and point the finger at UC-ers for their perceived ignorance.
Some midwives in my state (Colorado) do something I don't often hear of in midwifery circles. We leave the cord intact for hours after the birth. Many of us cut between 1 and 3 hours after the birth. I try not to cut until the cord has stopped pulsing--at the umbilicus. If you have never actually left a cord intact for a long period of time, you have probably never had the chance to notice it, but there is usually a pulse in the cord close to the baby (within a few inches) for at least an hour, sometimes longer. When that pulse is gone, at the umbilicus, that is when I will cut. It's a bit of a culture shock when I see homebirth midwives in other areas cutting cords any earlier.
Susan~
Barb's response/apology was to Vickii, as I read it. I could be mistaken!
I saw no direct apology to me or to the UC mamas she referred to in the original post. I am still angry--not SO much at Barb--I expect her to be snarky--it's her blog after all! I appreciate Barb's original post for provoking us to share more and hopefully increase the general level of knowledge about birth physiology. I am delighted with the new info! ♥
I AM angry that UC mamas and mamas-to be are still getting disrespected by so-called experts--Barb is just one of many midwives who do this--she is just more honest about it and visible here on her blog.
If midwives truly want to be "with woman" then they would be well-advised to keep an open heart and an open mind when faced with new information from mamas--especially UC mamas. Who else is going to have the chance to experience an unhindered, physiological birth than a UC mama who isn't being witnessed by a professional caregiver? (not saying this happens most of the time, but it CAN happen more in a UC...)
I am still learning from my UC mama friends and from my EFT clients--and I am willing to be surprised by something new every day.
And I feel blessed to have learned so much from Maria--who doesn't always get it right, but isn't afraid to admit it! ♥
I'm watching/listening, ping pong discussion at its finest... thinking, "You guys? I'm right here in the room." (a la Phil in "Hangover.")
I *do* owe (the/some) UCers an apology. Hmmm... some apologies? But a comment area isn't the place to do it.
Writing. Sorry it's taking so long.
*Waiting*... ; )
Karen....I rarely even consider cutting the cord until about 2 hours postpartum--it has a job it's still doing, and there's more for me to do, so I have no reason to even think about it in most cases. My general rule of thumb is not to address it until the mother says, "Can we do something about this?" because it's in the way of her nursing or moving or passing baby to partner. Sometimes, it's been "in the way," like when it's a short cord and mom can't move freely or nurse freely, and *I* have been the one to ask, "Are you done with the cord yet?" and interestingly, she sometimes doesn't even hear me, completely ignores me. That's when I know she really isn't ready.
Still writing. It's taking time. But, I am writing.
also, and I know this doesn't fit in with the 'scientific' discussion, but in the folk history of placenta it is believed that the cord is where the baby's soul rests and many religious traditions believe that we are just souls living in bodies. maybe that pulsing is a slow moving soul making its transition. I think it is best to leave it alone for as long as possible, and I feel sad that so many of us were immediately cord clamped and cut in this generation and nation. BTW I have been reading your blog for a while Barb, and I want you to know that I really appreciate what you write and how vulnerable you make yourself at times.