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How the Cord Clamp Injures Your Baby's Brain
By George M. Morley, M.B., Ch. B., FACOG
This paper describes a major error in modern obstetrical practice,
namely, routine premature clamping of the umbilical cord. Some
sections require medical knowledge for full comprehension and the
language is very technical, but overall, medical jargon is avoided or
explained in terms that most expectant parents can understand. The
error was defined very clearly over 200 years ago:
"Another thing very injurious to the child, is the tying and cutting
of the navel string too soon; which should always be left till the
child has not only repeatedly breathed but till all pulsation in the
cord ceases. As otherwise the child is much weaker than it ought to
be, a portion of the blood being left in the placenta, which ought to
have been in the child."---Erasmus Darwin, (Charles Darwins
grandfather) Zoonomia, 1801
Despite repeated publications illustrating the effects of the error,
and official notification, medical academia and its peer review press
have yet to acknowledge the possibility of any error. Public exposure
and knowledge of the issue is intended to accelerate correction of the
error. The nature of the injury caused by this practice unhappily
precludes a cure; for the unfortunate parents of an impaired child,
the knowledge may assuage any guilt they may have and give them
reassurance regarding future births.
Modern obstetrics ignores the normal functions of the cord and
placenta from the moment that the child is born, and in most hospitals
the umbilical cord is clamped and cut at the earliest convenient time
after birth. (1)(2) At premature births and when the newborn
is depressed or "at risk," immediate cord clamping is routinely
performed in order to rush the child to a resuscitation table and to
obtain cord blood samples for medico-legal purposes. (3)(4)
Placental blood, which ought to have been in the child, is either
thrown away or used to provide stem cells or other commercial
products.
Doctors are taught (and believe) that delayed cord clamping /
placental transfusion gives the baby too much blood, (hypervolemia)
while neonatal intensive care units (NICU) are filled with weak, fast
- clamped newborns exhibiting signs of severe blood loss (5),
pallor, hypovolemia (low blood volume) anemia, (low blood count)
hypotension (low blood pressure), hypothermia (cold), oliguria (poor
urine output), metabolic acidosis, hypoxia (low oxygen supply), and
respiratory distress (shock lung) to the point that some need blood
transfusions and many more receive blood volume expanders. (2) (5)
At this point, an explanation of the terms anemia, polycythemia,
hypovolemia and hypervolemia is required. Blood is a mixture of red
cells and plasma, a fluid. Blood is usually about half cells and half
plasma. When blood contains too few cells, the term anemia is used;
the blood is "dilute." Polycythemia means there are too many red cells
"concentrated" blood. The "-volemia" terms refer to the total volume
of blood in the childs heart and blood vessels; blood vessels are
elastic and are constantly filled by the heart pumping blood through
them, like a long, circular balloon.
Too much blood volume (hypervolemia) overworks the heart and overfills
the "balloon." Too little blood volume (hypovolemia) lets the balloon
and the heart collapse; it makes no difference if the blood is diluted
or concentrated. Anemia and polycythemia are about the quality of
blood; hypo- and hyper-volemia are about quantity of blood. An anemic
baby may be hypervolemic -too much fluid, and a polycythemic child may
be hypovolemic - dehydrated. A normal child that suffers acute blood
loss will have a normal blood count and low blood volume
(hypovolemia.) During recovery from the hemorrhage, blood volume is
restored with fluid (plasma), and the child becomes anemic (diluted
blood) as it takes much longer to restore the lost red cells. Early
infant anemia is a strong indication that the child has suffered
significant previous blood loss.
Before birth, the cord and placenta "breathe" for the baby. Humans and
all other mammals have evolved, over millions of years, a very safe
mechanism for closing umbilical cords at birth without interrupting
"breathing," and ensuring optimal survival of their offspring. An
occasional natural accident such as a ruptured cord may rarely occur,
but it is biologically impossible for that mechanism to routinely give
a child too much, or too little, blood; mammals that routinely give
their offspring the wrong amount of blood for survival become extinct
in one generation.
Erasmus Darwins late clamping method is safe because the tie is placed
on vessels that the child has already closed physiologically (by
natural constriction) after it has received the right amount of blood;
the tie does no harm because it virtually does nothing. Safe cord
closure at birth involves closing the placental life support system
and starting the childs life support systems without significant
interruption of life support during the changeover process. Oxygen
supply and blood to carry the oxygen are crucial to life support; blue
blood contains little oxygen, red (pink) blood is saturated with
oxygen. Brain cells die quickly from lack of oxygen; they do not
regenerate, and asphyxiation (choking / lack of oxygen) for about six
minutes will cause permanent brain damage. (6)
Normal Cord and Placental Function after Birth (No Cord Clamp Used)
Before birth, the lungs are filled with fluid and very little blood
flows through them; the child receives oxygen from the mother through
the placenta and cord. This placental oxygen supply continues after
the child is born until the lungs are working and supplying oxygen
-that is, when they are filled with air and all the blood from the
right side of the heart is flowing through them. When the child is
crying and pink, the cord vessels clamp themselves. During this
interval between birth and natural clamping, blood is transfused from
the placenta to establish blood flow through the lungs. Thus the
natural process protects the brain by providing a continuous oxygen
supply from two sources until the second source is functioning well.
Placental blood transfusion occurs by gravity or by contraction of the
mothers uterus which forces blood into the child. (7) Transfer of
blood into the child through the cord vein can occur after the
arteries are closed (no cord pulsation). The transfusion is controlled
by the childs reflexes (cord vessel narrowing) and is terminated by
them when the child has received enough blood (cord vessel closure).
The switch from placental to pulmonary oxygenation also involves
changing the fetal circulation to the adult circulation - the
one-sided heart (body blood flow only) changes to a two-sided heart
(blood flows through the lungs, then through the body.) Ventilation of
the lungs and placental transfusion effect this change. This is a very
basic account of a very complex process. (8) It all happens
usually within a few minutes of birth, and when the cord pulsations
have ceased and the child is crying and pink, the process is complete.
Clamping the cord during the changeover process disrupts these life
support systems and may cause serious injury.
The Effects and the Injuries of Immediate Cord Clamping (ICC)
The American College of Obstetricians and Gynecologists (ACOG) and the
Society of Obstetricians and Gynecologists of Canada (SOGC) advocate
immediate cord clamping at birth (3) (4) before the child has
breathed. This instantly cuts off the placental oxygen supply and the
child remains asphyxiated until the lungs function. Blood, which
normally would have been transfused to establish the childs lung
circulation, (9) remains clamped in the placenta, and the child
diverts blood from all other organs to fill the lung blood vessels.
(1)
After immediate clamping, the normal term baby usually has enough
blood to establish lung function and prevent obvious brain damage, but
it is often pale, weak, and slow to respond. Occasionally, a child
will cry as soon as the head is delivered, and the uterine contraction
that delivers the child may also squeeze in some placental transfusion
before the fast clamp can be applied; however, cord clamping before
the first breath (9) always causes some degree of asphyxia and
loss of blood volume:
It totally cuts off the infant brains oxygen supply from the placenta
before lungs begin to function.
It stops placental transfusion -the transfer of a large volume of
blood (up to 50% increase in total blood volume) that is used mainly
to establish circulation through the childs lungs to start them
functioning.
Cerebral Palsy
While ICC is a danger to all newborns, if a child is born asphyxiated
and depressed following fetal distress from cord compression (e.g. a
tight cord around the neck) (10) immediate cord clamping may very
well be fatal. (9)(1) A child deprived of oxygenated placental
blood before birth is in dire need of oxygenated blood after birth.
Immediate clamping in such circumstances (11) often produces a
hypovolemic and asphyxiated child who cannot begin to breathe
adequately to relieve the asphyxia; oxygen in the lungs will never
reach the brain if the newborn does not have enough blood to flow from
lungs to brain. (12)
The medical term for the condition that causes cerebral palsy (CP) is
hypoxic, ischemic encephalopathy. (HIE) Hypoxic means lack of oxygen -
the child has no placental oxygen supply; ischemic means lack of blood
flow - half of the childs blood is in the placenta; encephalopathy
means brain damage. HIE is often treated with blood transfusion or
blood volume expanders after a large part of the childs own oxygenated
blood has been discarded with the placenta. In addition, babies with
HIE usually develop anemia.
The obvious correct way to resuscitate the depressed child is to keep
the cord and placenta functioning while ventilating the lungs.
(1)(9)(12) If a child is born depressed with a knot in the
cord, should the knot be loosened or tightened? (11) A newborn
depressed from lack of blood and lack of oxygen (10) is quickly
restored to normal with a large transfusion of oxygenated placental
blood and is unlikely to develop HIE. (12) Rapid restoration of
oxygenation is crucial in preventing brain damage in the depressed
child, and that child must have enough blood to transport oxygen to
the brain. If hypoxic brain damage has occurred before birth,
placental oxygenation and transfusion will not cure it after birth -
nothing will - but progression of the damage will be prevented. Blood
transfusion given after the child has developed HIE will not restore
the dead brain cells. Blood transfusions given in the NICU are usually
examples of "too little and much too late."
Fetal distress (intra-partum asphyxia (13)) from cord compression,
such as occurs with a cord prolapsed during labor (a cord squeezed
between the head and the cervix,) may be rapidly reversed by relieving
the compression - elevating the presenting part (head) or changing the
mothers position. The fetal heart rate and monitor tracing soon return
to normal, and at delivery by emergency c-section, the child may show
no sign of asphyxiation. The same result can be obtained at birth in a
child asphyxiated with a tight cord around the neck by reducing
(unwinding) the cord and allowing the placental circulation to
resuscitate the child. (1) The current standard obstetrical
practice is to clamp the cord immediately to obtain a cord pH
(3)(4) - this maximizes the asphyxiation and hypovolemia, and
accelerates HIE; the life-saving blood in the placenta is thrown away
while parts of the childs brain die.
Learning Disorders and Mental Deficiency
The varying degrees of cerebral palsy and spastic paralysis are
usually evident soon after birth in the movement and reflexes of the
child, but lesser degrees of hypoxic, ischemic brain damage may remain
hidden for years. (6) Iron deficiency anemia in infants is
associated with learning disorders and behavioral problems to the
point of mental retardation when these children reach grade school;
(14) the degree of mental retardation increases with more severe
degrees of infant anemia. (15)
At birth, no newborn is anemic; adequate iron is supplied from the
mother regardless of her iron status. Any newborn that receives a full
placental transfusion at birth has enough iron to prevent anemia
during the first year of life. (13) It is, therefore, reasonable
to conclude that full placental transfusion will prevent the mental
retardation, behavioral disorders and learning disabilities that occur
following infant anemia.
The immediately clamped newborn may be missing one third to one half
of its normal blood volume and is very prone to develop infant anemia,
(13) and as shown previously, it is also at risk for hypoxic,
ischemic brain damage at birth. While some studies on treatment of the
anemia in infancy have shown some behavioral improvement, most studies
show no improvement or prevention of the brain dysfunction following
correction of anemia, (16) making it difficult to establish a
cause and effect relationship between anemia and brain dysfunction.
In HIE and CP (severe brain dysfunction) anemia develops AFTER the
brain is damaged. Moderate hypovolemia and hypoxia at birth will
produce infant anemia; it may also cause undiagnosed minor brain
damage (6) that will later produce behavioral defects. Evidence
strongly points to infant anemia and behavioral brain dysfunction
having a common cause - immediate cord clamping; in other words, both
anemia and brain dysfunction are effects, not a cause and an effect.
In a comprehensive review of cord clamping in 1982, Linderkamp
concluded: "immediate clamping can result in hypovolemia and anemia. -
A medium placental transfusion appears to be more appropriate in order
to avoid the risk of hyperviscosity, whereas iron deficiency in later
infancy is probably less dangerous." And in a similar review in 1981,
Peltonen stated: "Closing of the umbilical circulation before aeration
of the lungs has taken place is a highly unphysiological measure,
which should thus be avoided. Although the normal infant survives
without harm, under certain unfavorable conditions, the consequences
may be fatal." Within a few years, reports of these unharmed,
"normal," anemic infants being mentally retarded in grade school began
to appear in the literature.
While Linderkamp never proved that "hyperviscosity," (a hematocrit of
>65%) was any risk at all to a newborn, Peltonens remarks were based
on his observations of newborns chests viewed under a fluoroscope, and
he described incomplete filling of the cardiac ventricles (decrease in
heart size) following immediate clamping; his use of the word "fatal"
indicates that, after immediate clamping, he witnessed a cardiac
arrest that was not reversed. His blunt advice to avoid the procedure
(he mentions no exceptions) emphasizes that the "normal" child may not
be free from risk. He did not advise repeating his experiment; ACOG
and SOGC (3) (4) do. Cardiac arrest, or inadequate cardiac
output for a few minutes, will produce permanent brain damage.
Immediate cord clamping is clearly identified as a cause of newborn
neurological (brain) injury ranging from neonatal death through
cerebral palsy to mental retardation and behavioral disorders.
Immediate cord clamping has become increasingly common in obstetrical
practice over the past 20 years; today, rates of behavioral disorders
(e.g., ADD/ADHD) and developmental disorders (e.g., autism, Aspergers,
etc) continue to climb and are not uncommon in grade school.
Respiratory Distress Syndrome
The premature baby is much more vulnerable to injury from immediate
cord clamping than the robust term child. The brain is at an earlier
stage of development and actively growing tissues are more easily
damaged by lack of oxygen and lack of blood. The preemies most common
problem and a leading cause of neonatal death is respiratory distress
syndrome (RDS); it is caused by lack of blood volume (hypovolemia)
(13)(9) resulting from immediate cord clamping and poor blood
flow through the lungs. Hyaline membrane disease (HMD) is diagnostic
for RDS; under the microscope, the HMD of "shock lung" - RDS - in
adults and geriatric patients appears the same as HMD in newborns.
Immediate cord clamping in newborn foals can cause RDS and HMD, and
similar lung lesions in newborn puppies and rabbits were produced by
removal of blood volume after birth. (17)
Landau completely prevented RDS/HMD in sectioned newborns by
suspending the placenta and cord like an I.V. to give a full placental
transfusion. (18)
Kinmond virtually prevented RDS in preemies by giving a partial
placental transfusion; none of these babies needed blood transfusion
in the NICU. (2)
Retraction respiration, which is seen in the initial stages of RDS, is
a reflexive effort to draw blood into the thorax; in adults with
terminal hypovolemic shock, it is seen as gasps of "air hunger."
Newborns with optimal blood volumes from placental transfusion do not
exhibit retraction respiration. For years, there has been abundant and
overwhelming evidence that neonatal RDS is caused by interruption of
the placental transfusion by a cord clamp; however, to the medical
profession, the cause of neonatal RDS remains a mystery. By allowing
every newborn to have a normal placental transfusion, iatrogenic RDS,
and the hypoxia and brain damage that accompany it, should be
completely preventable.
Lung Maturity, Surfactant and RDS
A 34 week preemie has no surfactant in its lungs which are, as defined
by current perinatal concepts, immature, yet it readily cries and
turns a ruddy pink color when it has an optimal blood volume - no cord
clamp used; the lungs behave in a most mature way that conflicts with
the current idea of lung "maturity." Surfactant lowers the surface
tension of water and lessens the tendency of alveoli (air sacs) to
collapse. The newborn lung is erectile tissue, (19) which expands
and "erects" the alveoli with the onset of pulmonary blood flow.
(20)(21) Ventilation relaxes pulmonary arterioles and massive
pulmonary blood flow distends the left atrium and closes the foramen
ovale (changes the heart from one-sided to two-sided) - the child
turns pink. Placental transfusion maintains blood flow and erection
(aeration) of the alveoli.
Low plasma colloid osmotic pressure (with high capillary hydrostatic
pressure) may lead to initial pulmonary edema, but rapid
hemo-concentration (fluid loss into systemic tissues) following
placental transfusion (22) quickly corrects this situation, and
the lungs "dry out" physiologically. Surfactant may help to prevent
atelectasis and may, by lowering surface tension, lessen the force
needed to inflate the lungs at birth (21).
However, surfactant is of little value if the child has insufficient
blood volume to erect the alveoli. Surfactant does not cure RDS, and
its absence does not cause RDS. Normal function of premature lungs
(lung "maturity") depends much more on placental transfusion and
plasma colloid osmotic pressure than on the presence of surfactant.
Normal lung function supplies adequate oxygenation to the preemies
growing brain.
Steroid Treatment and RDS
The administration of steroids to the mother before premature birth
greatly reduces the incidence and severity of pulmonary complications
(RDS) in the newborn preemie, regardless of when its cord is clamped;
however, long term use of steroids results in growth retardation.
(23)(24) A rational explanation of these phenomena is that
steroids constrict the placental blood vessels, not to the point of
impairing respiration, but enough to impair nutrition and cause growth
retardation over the long term. Over the short term, placental
vaso-constriction will squeeze blood into the child, giving it a
placental transfusion before it is born. The extra blood volume, and
possibly some hemo-concentration will account for the improvement in
respiratory status.
Of course, not using a cord clamp would be much more effective and
much less expensive. In addition, it would avoid long-term growth
retardation.
Persistent Fetal Circulation
Before birth, the fetal circulation bypasses the lungs with oxygenated
blood from the placenta. RDS impairs newborn lung oxygenation, putting
brain cells at risk. Persistent fetal circulation (PFC) is often a
component of RDS poor blood flow through the lungs results in low
pressure in the left atrium which allows the foramen ovale flap valve
to remain open; PFC has a high mortality rate. The placental
transfusion is an essential factor in effecting the shift from the
fetal circulation to the adult circulation at birth, (8) and PFC
is also commonly associated with cesarean section newborns (25)
who typically have immediate cord clamping and who receive little or
no placental transfusion. (1) After birth with the placenta
removed, PFC bypasses the lungs and circulates de-oxygenated blood to
the brain.
Hyaline Membrane Disease (HMD)
Hyaline membrane formation is diagnostic for RDS and indicates gradual
death of lung tissue. If the newborn survives, lung scarring indicates
permanent damage. HMD is, in essence, slow pulmonary infarction (death
from lack of blood flow) due to poor perfusion and lack of blood borne
nutrients. Lung tissue does not die from lack of oxygen - there is
oxygen in the alveoli that rapidly exhausts the deficient nutrients
(aerobic respiration) and lung cells die from starvation. Protein
exudation into alveoli through dying cells forms the hyaline material.
Bleeding into alveoli also occurs in severe RDS - as it does in the
adult in acute pulmonary infarction - the patient coughs up pink
blood. HMD indicates severe lung dysfunction and consequent poor
oxygenation of the childs brain.
Intra - Ventricular Hemorrhage (IVH) (Brain Hemorrhage)
IVH is often associated with RDS in preemies. (26) It has all the
characteristics of a hemorrhagic infarct of the germinal matrix. (GM)
The GM is a very active metabolic area of the preemies brain and is
very prone to hypoxic, ischemic necrosis (death) such as that produced
by the intense vasospasm of hypovolemic shock. Following restoration
of blood volume, hemorrhage into the dead tissue and into the
ventricle occurs. Later, absorption of dead tissue enlarges the
ventricle. These preemies have permanent neurological defects. No
studies allowing preemies to close their own umbilical cords and to
achieve normal blood volumes have ever been done.
Necrotizing Entero-Colitis (NEC)
This is a common bowel lesion in preemies (and some term newborns)
with an ischemic component and has all the characteristics of a bowel
infarct - blood in the stool and bowel perforation. Intense vasospasm
of hypovolemic shock due to immediate clamping is a plausible
explanation for the lesion. The placental transfusion normally
supplies the newborn gut with extra blood flow in preparation for
feeding and digestion.
Discussion
The purpose of all medical care should be the maintenance or
restoration of normal (healthy) form and function. Therefore,
definition and recognition of normal form and function are essential
before any treatment can begin. Normal healthy (physiological)
childbirth does not require medical treatment; it does require
observation (care) to detect any developing abnormalities. Natural
childbirth includes the normal and the abnormal. A true knot in the
umbilical cord occurs quite naturally, but it is not the routine,
normal form of the cord; if it is a loose knot, it does not affect
cord function, and it does not require medical treatment. If the knot
is tight, it impedes the childs oxygen supply and that requires
treatment (restoration of the normal). The midwife or physician who
does not understand the normal form and function of the umbilical cord
is not qualified to treat or take care of the umbilical cord.
All primates (monkeys, apes and humans) have large brains that cannot
live and function without a constant oxygen supply. Other tissues can
live for a while without oxygen using "anaerobic respiration" - a
person may be "brain dead" following drowning, but have normal
muscles, kidneys and other organs. The primate brain is at most risk
during birth when its primary oxygen supply (placenta) is at the end
of an exposed and vulnerable supply line (umbilical cord.) For species
survival, primates must have a virtually perfect, innate mechanism
that rapidly establishes the oxygen supply from the lungs while the
placenta is still functioning. That mechanism must then close the cord
vessels to prevent the newborn from bleeding to death after the cord
is severed. Complicated anatomical and physiological changes occur
during transfer of oxygenation from the placenta to the lungs.
Most obstetricians, pediatricians and especially their academic peers
have never seen a child close its own cord; they are totally ignorant
of the physiology of the process. Institutional dogma and
misinformation have obliterated scientific thought and method, and
have changed a healthy, normal process into an imaginary disease. They
then advise curing the imaginary disease with an injurious cord clamp.
Amputating a functioning placenta destroys the organ that is keeping
the child alive and is preparing the child for life outside the womb.
There is no excuse or justification for ACOGs / SOGCs immediate
clamping to obtain medico-legal blood samples; (3)(4) if
indicated, a fine needle inserted into a pulsating cord artery will
supply the same information without destroying the childs life support
system.
Doctors believe that placental transfusion causes hypervolemia,
plethora, polycythemia, and hyperviscosity. They ignore the fact that
polycythemia (hematocrit > 65% - "too many red cells") occurs in many
normal, healthy babies. (22)(27) Doctors have made a normal
laboratory reading into a disease because red cells increase blood
viscosity (stickiness). They have never defined what normal viscosity
is, but they have defined the hyperviscosity syndrome (HVS) as
extremely poor blood flow through tissues. HVS is supposedly caused by
"sticky" blood such as occurs after the child has received "too much"
blood.
However, HVS has never been described in a late clamped child; it
usually occurs in immediately clamped newborns. HVS is a
vaso-constriction syndrome due primarily to low blood volume and has
very little to do with blood viscosity. (1) If, on very rare
occasions, a child ever receives too much blood after natural cord
closure, the condition should be properly diagnosed and the excess
blood removed, just as if a cord ruptures spontaneously at birth, it
should be clamped immediately to prevent blood loss.
The cord clamp is very useful for stopping bleeding from a ruptured
cord; so doctors use it at every delivery to prevent bleeding. This
usually stops placental transfusion, and hundreds of studies have been
done to determine whether clamping before the transfusion is more
beneficial than clamping after the transfusion, and hundreds more on
clamping during the transfusion to get the "right amount" of blood
into the baby. Linderkamps review (13) alone has over 200
references. Gunthers study demonstrates that during placental
transfusion, blood may flow into and out of the child until the right
amount of blood is attained after the child is breathing. (7)
If the cord clamp were applied at the height of a uterine contraction
that is forcing blood into the child at high pressure, (7) it
could well trap too much blood in the child, blood that would have run
back into the placenta if the clamp had not been used. Clamping
between uterine contractions may leave too little blood in the child,
making it impossible to decide when to clamp the cord.
It is generally understood (misunderstood) that too much blood causes
jaundice and damages the brain. Hundreds more studies have been done
on immediate clamping to resuscitate preemies and to measure cord pH
values at birth for the benefit of risk managers. All of these studies
on cord clamping are scientifically flawed; they have no physiological
norm - not one of these studies included a physiological control set
of babies delivered without the use of a cord clamp - normal babies
that do not have too much or too little blood clamped in them.
Without an established norm, the cord clamp and its injuries are
accepted as part of "normal" childbirth. Nearly all premature babies
develop anemia that is "normal," and later, in school, are found to be
mentally retarded. (15) (28) All received standard care as
prescribed by medical academia; the anemia and mental retardation are
the result of normal cord clamp birth injury.
The absurdity of the cord clamping / "too much blood" controversy is
best illustrated by satirical analogy:
Endo-tracheal intubation (a tube in the windpipe) is very useful for
ventilating a newborn that is too depressed to breathe. Therefore, at
every birth, a tube is placed in every childs trachea to help it
breathe. This prevents most newborns from crying, though some cry
before the tube can be inserted and it then prevents further crying.
Many studies are then done to find out if intubation before crying is
more beneficial than intubation after crying. It is generally
understood that too much crying may give the child too much oxygen and
damage the eyes. Many more studies are done on immediate intubation
(to document the carbon-dioxide content of the first breath for risk
managers) and are compared to thousands of babies intubated after
three minutes and after five minutes to find out what is normal.
All premature babies are intubated immediately as this gives them a
normal respiration Apgar score of 2 at one minute even when they do
not have a heartbeat. All ventilation is monitored so that no baby
gets "too much oxygen." Torn vocal cords and pneumo-thoraces are an
accepted part of this "normal" childbirth. Doctors are surprised when
told that babies born at home never have torn vocal cords, but they
are all terrified of not using intubation on even a few newborns, or
even asking the mothers consent about it, because immediate intubation
is the Standard of Care set by the gods of Academia for use by trial
lawyers.
The cord clamp, like the endotracheal tube, is not a part of human
anatomy. It is a dangerous surgical instrument with very limited
indications for use. A clamp placed on the pulsating cord of a newborn
that cannot breathe has the same effect as a clamp placed on the
throat of a child that is crying - complete asphyxiation.
Natural cord closure and placental transfusion are just as normal and
as healthy as is crying at birth. (1) The normal Apgar score at
five minutes is 10 - a pink, active, crying baby - and many
immediately clamped newborns do not achieve that score; low five
minute Apgar scores correlate with neurological injury. (29)
Windle states: "A child with a slight brain defect often appears no
different from a normal child. His intelligence quotient may lie in
the range considered normal, but one never knows how much higher it
would have been if his brain had escaped damage in the uterus or
during birth. (6)
The neurological disorders, memory and behavioral defects, and the
corresponding brain lesions that Windle demonstrated in monkeys, were
produced by interrupting placental oxygenation and circulation at
birth and by delaying the onset of pulmonary oxygenation. They did not
occur in newborn monkeys that delivered without interference with the
cord and placenta. Strikingly similar neurological disorders and
behavioral defects occur in human infants following a period of
asphyxiation occurring between the cessation of placental oxygenation
and the establishment of pulmonary oxygenation. The primary cause of
these defects in human babies is premature clamping of the umbilical
cord that stops placental oxygenation and placental transfusion.
Windle's experiment on monkeys is repeated every day on human newborns.
"Learning disabilities are increasing dramatically. One child in six
is afflicted by autism, aggression, dyslexia, or attention deficit
disorder. In New York, cases of learning disability rose 55 percent
between 1983 and 1996, from 132,000 to 204,000. In California there
were 11,995 reported cases of autism in 1998, up 210 percent from
1987." (30) The injuries alluded to by Erasmus Darwin over 200
years ago have been convincingly demonstrated in number, variety, and
severity by the practice of immediate cord clamping.(3)(4)
This practice has increased greatly over the past twenty years.
Discontinuing the use of the cord clamp until after physiological
closure of the umbilical vessels will eliminate most of these
injuries. However, the purpose of this paper is not only to avoid
newborn injury, but also to ensure optimal survival. The child has the
biological equipment and wherewithal to become the brightest and the
best; non-use of the cord clamp helps to ensure that potential.
)Copyright George M. Morley February 21, 2002
Footnote:
In the February 2000, I formally requested that ACOGs ethics and
practice committees revoke ACOG Educational Bulletin 216 which was
published in 1995. In the February 2002 edition of OBSTETRICS &
GYNECOLOGY, ACOG quietly announced, in very small print on a back page
(361), that Bulletin 216 has been withdrawn from circulation. I have
yet to receive a formal reply from ACOG.
For the past seven years, thousands of obstetricians have been taught
that immediate cord clamping is an acceptable, standard obstetrical
procedure, and millions of newborns have been subjected to it. Without
any attempt at warning the profession, ACOG has quietly relieved its
officials from further responsibility for an injurious procedure that
is widely and naively performed by many practicing obstetricians. It
would be ethically and morally appropriate for ACOG TO ANNOUNCE TO
EVERY OBSTETRICIAN IN VERY LARGE PRINT:
That immediate cord clamping is no longer officially sanctioned as
standard care.
That the person who clamps the cord before the lungs are oxygenating
the child should have sound, documented, clinical justification for
doing so and
That the person who clamps the cord immediately or prematurely is
individually responsible and liable for the resulting injuries.
George Malcolm Morley, M.B., Ch.B., FACOG
C.V.
Dr. Morley graduated from Edinburgh University Medical School in 1957,
completed a residency in OBGYN in 1962, and practiced obstetrics and
gynecology until his retirement in 1999. He is board certified in
OBGYN, and a Fellow of the American College of Obstetrics and
Gynecology.
Criticism, comment and refutation on this article is encouraged and
may be sent to mor...@cordclamping.com they will receive responses
from the author.
______________________________________________________________
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