Cord-clamping news: Somebody call ACOG!

Finally… the current issue of Obstetrics & Gynecology includes an article that supports delayed cord clamping (DCC) for healthy term newborns. (Obstetrics & Gynecology is the official journal of  the American Congress of Obstetricians & Gynecologists, better known as ACOG.)

Tying_Umbilical_Cord

Just a matter of when…

Written by pediatrician Ryan McAdams of the University of Washington, the article reviews the evidence that delayed cord clamping (DCC) is beneficial for healthy term newborns compared with early cord clamping (ECC), mainly because DCC provides increased iron to the newborn.* (For a brief tutorial on the timing of cord clamping and why iron is so important to infant brain development, click here for a couple of posts I wrote for Science & Sensibility, Lamaze International’s blog.)

Despite the proven benefits of DCC, and the ease of switching from ECC to DCC (there’s no training or equipment needed–the obstetrician simply has to wait two or three minutes after delivery to clamp the cord), the American Congress of Obstetricians and Gynecologists (ACOG) has been lukewarm in recommending the practice. In a 2012 policy statement, ACOG stated that:

“…insufficient evidence exists to support or to refute the benefits from delayed umbilical cord clamping for term infants that are born in settings with rich resources.”

That phrasing was a bit of a puzzler. Given that a) it’s been known for several years that DCC increases iron stores in infancy, and b) that as many as 1 in 6 American toddlers are iron deficient, it’s not exactly clear what “insufficient evidence” and “settings with rich resources” ACOG was referring to.

McAdams dismantles that logic:

“Delayed cord clamping in term neonates promotes improved iron stores, prevents anemia beyond the neonatal period, and is more physiological than early cord clamping. Although the effect of delayed cord clamping may be more apparent in settings with a high prevalence of anemia in neonates and children, it is likely to have an important effect on all newborns, independent of birth setting.”

It’s hard to know if this will be enough to get ACOG to amend its 2012 statement on the timing of cord clamping for term babies. Regardless, now comes the hard part–convincing reluctant maternity care providers to change old practice habits and adopt DCC, with or without ACOG’s official blessing. This article should help.

* * *

*There are even greater benefits for premature babies, but that’s the topic of a different post.

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Time to wake up…

Well, it’s been almost exactly one year since my last post. Unlike my friend in the photo here, though, I haven’t exactly been sleeping. I smacked head-first into grad school last summer (getting my Masters in Public Health from the University of Minnesota), and between homework, term papers, and managing school deadlines for the first time in a few decades, my writing energy got all used up. But I’m proud to say I survived biostatistics, which was a bit hair-raising. (I swore when I finished college that I would never take another math course, but what are you gonna do? Stuff happens.)

Image

Your Blogger, hard at study…

There’s quite a bit of interesting research on pregnancy, labor, and the newborn these days, and that’s what’s got me interested in blogging again. So, here I go…

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How mama ‘roos do it…

Busy mother, wildlife park outside Perth

Busy mother, wildlife park outside Perth

Here’s a lactation trick humans can only marvel at:

A kangaroo mama often nurses two babies (“joeys”) of different ages, meeting the individual nutritional needs of both simultaneously. She does this by producing milk of very different composition from each of her two breasts–one milk designed for the newborn and the other for the “toddler.” Protein and fat content differ considerably between the breasts.

Kangaroo lactation consultants certainly have their work cut out for them…

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Here’s to Peg and Barney…

What hath polio wrought? Ma and Pa, April 19, 1947

Peg (Dalton) and Barney Sloan–April 19, 1947

Today is my parents’ 66th wedding anniversary…

  • 7 children
  • 16 grandchildren
  • 5 great-grand-kids…and counting!

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Australia

Neighbors, north of Sydney

Neighbors, north of Sydney

Just back from three weeks Down Under, where I was invited to address the Rural Health West Annual Conference in Perth. The theme this year was “Children of All Ages: Health Across the Continuum in Rural Communities.” It was a wonderful experience, and I’m grateful to Belinda Bailey and the organizing committee for their warmth and hospitality.

I gave the keynote address (“Unintended consequences: How mode of delivery impacts long-term child health”) on the mounting evidence that cesarean birth increases the risk of a number of chronic illnesses later in childhood. (For previous posts on the subject, see here and here.) Lots of discussion followed–the cesarean saga in Australia has paralleled that in the U.S., and in sparsely populated Western Australia, where hours-long air transport to a tertiary care hospital is common, decisions about when to intervene in a woman’s labor are particularly challenging. As here in the U.S., a popular movement is pushing back at unnecessary cesareans, or “caesars” as they’re known in Australia.

Later that day I spoke on the history of neonatal resuscitation, a talk loaded with odd historical tidbits, as is my habit… (Did you know that newborn babies in ancient Greece were salted and coated in honey (scroll link to page 82) to protect them from infection? Or that midwives were performing

Perth, From King's Park

Perth, from King’s Park

mouth-to-mouth resuscitation on sick newborns as early as 3,000 years ago? Or that in Germany, the accepted means of reviving a sick newborn until well into the 20th century was to simply swing them up and down?) That talk always gives an audience an appreciation for modern resuscitation equipment.

Perth is a beautiful city, more or less the San Diego of Australia. The weather was gorgeous, and my wife Elisabeth and I did quite a bit of touring around. Became fairly familiar with a number of marsupials, including a few we’d never even heard of. (Numbats, anyone? Quokkas?) We spent a week in and around Sydney, too (over on the east coast, for those of you not up-to-date on your geography)–another fascinating city. We finished up with four days in a cottage in a national park, which is where my kangaroos-in-the-field photo at the top was taken.

Talking cesareans with new friends

Talking “caesars” with new friends.

Oh, and I actually drove over 400 miles on the “wrong” side of the road without so much as a scratch on our rental car, let alone the fiery chain-reaction pile-up (my fault, of course) that I’d been expecting…

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The Brazilian preference?

4753658072_3816f74c0d_nWhat happens when a woman emigrates to a foreign country and then gives birth? Is her birth experience more likely to conform to the country she comes from, or the one she moves to?

For example, is an immigrant woman more likely to have a cesarean birth than a native-born woman, or less? How big a role do the cultural norms and expectations she brings with her from her home country play in determining mode of delivery?

Studies of immigrant birth experiences have been mixed to date. Immigrants do tend to have higher cesarean rates than natives, but interpretations of such findings are often complicated by things like language barriers and the difficulties new arrivals may have in accessing timely maternity care. Teasing out the effects of culture can be tricky.

A Portuguese article just published in the journal PLOS ONE helps to clarify this issue. The study compares cesarean rates between native-born and immigrant Brazilian women in northern Portugal. Two major potential confounders are quickly dealt with: the two groups of women both spoke Portuguese, which eliminates language barrier as a source of cesarean-inducing miscommunication, and all the women were drawn from five public hospitals, so that the care they received was more or less uniform.

The authors found that Brazilian immigrant women had a 50% higher cesarean rate than did native-born Portuguese women (48.4% vs. 32.1%), a difference that persisted even after controlling for such things as demographic, medical and obstetric risk factors. In fact, the cesarean rate for Brazilian immigrants was nearly identical to the overall cesarean rate in Brazil itself.

What explains the native-immigrant difference? The authors speculate it has much to do with attitudes about childbirth that the women brought with them from Brazil:

“This extremely high prevalence [of cesarean birth] seems to be a cultural consequence of attitudes towards labor and the perception of obstetric care among Brazilian women. The majority of Brazilian women perceive cesarean as the most adequate mode of delivery and as a symbol of high social status.”

In other words, culture strongly influences mode of delivery, even far from home. A woman raised to see cesarean birth as a desirable norm is much more likely to end up having one.

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Things Kids Say: Australian art critic edition

"What the...?"

“What the…?”

“Why would anyone think to draw that?”

Small child in Sydney’s Museum of Contemporary Art, viewing painting that looks a lot like, well…guts.

 

 

 

(Photo credit: jenny818)

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