Waiting to Cut the Cord

Why there is even a debate over this topic is a testimony to how slow evidence-based practices are to take root in hospitals across the nation. There really is no debate over this matter. Multiple research studies make it very clear: waiting several minutes after birth to cut the umbilical cord of newborns is beneficial to a newborn's health. Unfortunately, medical dogma remains and old habits die hard. And so the debate remains and what should clearly be a standard of practice is still not consistently being observed by midwives and obstetricians across the United States. And so, yet again, it is up the parents to educate themselves on the matter and make sure that their wishes are followed regarding cord clamping following delivery.

So what exactly is cord clamping, and why does it matter when it occurs? More often than not, clamping of the umbilical cord is simply something that new parents see as a ceremonial task that often gets handed over to the father. The cord is clamped, then cut, and a small plastic clamp placed near the newborns belly that will remain for 24 hours or so. Eventually, the stump of the umbilical cord falls off. Simple, right? It's not quite that simple, unfortunately. The umbilical cord is the life-line from baby to mother. In-utero, baby receives oxygen and nutrients from it's mother through the umbilical cord. Deoxygenated and nutrient-depleted blood is then removed from the baby via that same cord. Immediately following birth, blood is still being pumped from the placenta inside the mother into her newborn child. The umbilical cord pulsates with each beat of mom's heart and can easily be felt by simply grasping the cord. Typically, an umbilical cord will pulsate 2-3 minutes after a baby is born. In water births that occur in warm water, pulsation may continue 5 minutes or longer (World Health Organization - WHO). Studies have shown that after 1 minutes of pulsating, 80 ml of blood have been pushed into the newborn. By 3 minutes, this number rises to 100 ml. A baby is typically born with 75 mg/kg of body iron. Waiting just 3 minutes to clamp the cord increase that number to about 115-125 mg/kg. The effects of this are long term. At 6 months of age, babies that received cord clamping after pulsation had stopped had higher levels of iron than babies that had early cord clamping (WHO).

The Cochrane Review summed up their most recent findings regarding cord clamping at follows: “The suggested neonatal benefits associated with this increased placental transfusion include higher haemoglobin levels (Prendiville 1989), additional iron stores and less anaemia later in infancy (Chaparro 2006; WHO 1998b), higher red blood cell flow to vital organs, better cardiopulmonary adaptation, and increased duration of early breastfeeding (Mercer 2001; Mercer 2006). There is growing evidence that delaying cord clamping confers improved iron status in infants up to six months post birth (Chaparro 2006; Mercer 2006; van Rheenen 2004).”

Also being pushed into baby during these few extra precious minutes are those ever-so-precious stem-cells. Stem cells are cells that can develop into other cells. Researcher Paul Sanberg from the University of Florida recently published an article in the Journal of Cellular and Molecular Medicine that concluded that waiting to clamp the umbilical cord could reduce the infant's risk of many illnesses, including "respiratory distress, chronic lung disease, brain hemorrhages, anemia, sepsis and eye disease." Fascinating. Especially since giving vitamin K injections to babies immediately after birth are routinely given to help prevent brain hemorrhages. Vitamin K started being given for this reason during the 1960s. Early clamping of the cord was first suggested in the 1930s (in order to minimize the amount of anesthesia baby would receive from mom's blood) and became routine by the 1960s. While I have not been able to find any studies that could confirm it, I cannot help but wonder if this new technique of early clamping of the umbilical cord lead to a greater risk of brain hemorrhages in infants, which in turn lead to giving vitamin K shots. Is this, yet again, another example when (overall) less medical intervention during birth is actually better?

Humans are the only mammals that severe the umbilical cord of their young so early after birth. Most animals will - after a while - gnaw through the cord to separate the placenta from the newborn. Chimpanzees ignore the cord altogether and allow it to remain attached. After several days, the cord will dry and fall off (as does the stump of the cut cord with all newborns). Several cultures around the world practice this method (commonly referred to as a Lotus Birth). Diaries from pioneers reveal that this method was practiced at times in order to avoid causing an infection when clean instruments and supplies were not available. While leaving the umbilical cord attached for several days does not seem exactly practical, leaving it attached for 3-5 minutes after birth is. The cord will cease pulsating as the last of the blood is pushed into the newborn and a gelatinous substance called Wharton's jelly inside the cord helps it to occlude naturally within 5-10 minutes.

I could find no studies, unfortunately, that addressed premature clamping of the cord when resuscitation was required.

And the downfalls of waiting to clamp and cut the cord? Several studies have suggested that delaying cord clamping may result in a higher incidence of hyperbilirubinemia (jaundice). Other studies do not find this link. Either way, almost all breastfed babies will experience some sort of jaundice during their first 5-10 days of life. It is a very normal part of a baby adapting to the outside world and, when properly managed, is nothing to worry about. Frequent breastfeeding (every 2 hours) and exposure to a little sunlight will help clear almost all babies of this very normal condition. Little Bear had jaundice the first week of her life and was treated with a little light and lots of breast milk! (**Note: Rarely, jaundice can become a life-threatening condition. If yellowing worsens, baby becomes lethargic, or feeding/elimination habits change, contact your physician or midwife immediately.) Yet others suggest that an increase in jaundice may indeed be related to delaying cord clamping only if labor is augmented with the drug pitocin (a drug very commonly used in labor). One of the side-effects of pitocin is jaundice and it makes sense that the more blood that is pushed in from the cord would also mean more pitocin from the the mother is also reaching baby. No studies that I have found have been done to look at pitocin and jaundice rates with cord clamping.

And so there we have it. A myriad of reasons why delaying cord clamping and cutting by 1-3 minutes is beneficial to the health of your baby. The debate, in my opinion, is not a debate at all. Modern science is, yet again, proving what humans have known and practiced for thousands of years. Waiting to cut the cord is best. Premature cutting of the cord is a 50-year old practice that should be left to historical textbooks, just like lobotomies and bloodletting. Unfortunately, this practice still continues. It is up to us as expectant and new parents to insist that this practice is stopped so that our children receive the most health benefits possible from the moment they take their first breath.

Breastfeeding: Benefits for Mom

It's easy for moms to look at their little one and decide that breast really is best. All the health benefits for baby are amazing and incredible. Click here to read about many benefits to baby of exclusive breastfeeding for 6 months. But here is some more great news: breastfeeding isn't just good for baby ... it's good for mom, too!

1. Weight Loss. Okay, it might not be the most important reason to keep breastfeeding, but it definitely is a motivating one! I gained 48 pounds while pregnant with Little Bear. I went from a size 4/6 jeans to a size 14. It seemed that no matter how healthy I ate, the pounds just kept packing on! The female body knows what it needs to do to carry a baby - and gaining weight is part of the process. Two weeks after Little Bear was delivered, though, I couldn't help but wonder if I'd ever fit into my pre-pregnancy pants again. Suddenly, around month three, the weight just started falling off. And falling off. And falling off. Weight loss typically peaks during months 3-6. As Little Bear grew and required me to make more milk for her - my body started burning calories like crazy. Breastfeeding can burn between 200-500 calories/day. That's like going out and running several miles - every day!

Some things to remember: Your body needs lots of calories the first two months after delivery! Don't restrict calories to try and lose weight at this time. Doing so could interfere with your milk supply. Eat a healthy diet and drink plenty of fluids. Click here for more information.

2. Uterine Contractions. The sooner a baby is put to her mother's breast after delivery, the better. There are several reasons for this, but one of them is to start uterine contractions. Stimulation of the nipples causes a release of oxytocin in the mother. Oxytocin works naturally on the body to begin uterine contractions. And why is this a good thing? In the first few hours, these contractions will help seal off blood vessels in the uterine walls, lessening the amount of bleeding you experience overall. Over the next 4-6 weeks, these contractions will help the uterus shrink back to it's pre-pregnancy size. Each time your little one suckles at the breast the first few weeks, you may be aware of cramping in your abdomen. This is not only normal - it's good! The drug pitocin was introduced as a man-made alternative to oxytocin. Pitocin also works to contract the uterus after delivery. It is often times given to women after delivery. But why even bother with a man-made alternative when we have the real thing built into our own bodies! Pitocin can have the following side-effects: anaphylactic reaction, postpartum hemorrhage, nausea, vomiting, pelvic hematoma, hypertensive episodes, heart arrhythmias. Oxytocin made in a woman's body has no side effects! So start nursing and get the oxytocin flowing!

3. Reduced Cancer Risk. Here is perhaps my favorite reason for women to breastfeed - other than for the health of the baby, of course. Research done over the past 10-15 years is showing that breastfeeding can significantly reduce a woman's risk of getting breast, ovarian, uterine, and edometrial cancers. And even better news: the longer you breastfeed, the lower the risks. Breastfeeding for a total of 6 years throughout your lifetime (if you have 3 children, that's 2 years for each child ... which is the World Health Organization's recommendation) decreases your risk of breast cancer 63%. That's huge. So here's to less cancer and more breastfeeding!

4. Increased Bone Density. This one is a bit counter-intuitive. One might think that all that nursing and providing nutrients to your little one would actually decrease bone density. And actually, it does, for a while. But studies show that upon weaning, a woman's bone density actually increases again.  In a culture where osteoporosis is rampant, this is a good thing (one might also consider giving up those diet sodas that can also cause a loss in bone mineral density - but that is another topic altogether). Dr. Sears states that "non-breastfeeding women have a four times greater chance of developing osteoporosis than breastfeeding women and are more likely to suffer from hip fractures in post-menopausal years."

5. Oxytocin (the "love hormone"). Every time your baby suckles at your breast, oxytocin rushes through your body. It not only helps in the uterine contractions ... it is also considered the "love" or "bonding" hormone. Oxytocin helps reduce post-partum anxiety and depression. It also can help a mother to relax and adjust to all the changes a new baby brings into her life. Oxytocin is a tremendous hormone and anything that helps us get more of it on a regular basis is a good thing!

6. Natural Birth Control. Exclusively breastfeeding can actually work as a natural birth control for the first 6 months, and in some cases, much longer! One must be following what is called the lactation amenorrhea method (LAM) of family planning, however, for it to be effective. If followed, this method has been shown to be over 99% effective in preventing pregnancy. Here is information on LAM. Be aware of all the specifications that must be met ... women in our culture rarely meet all of them and therefore should not rely solely on LAM for birth control (for example: using a breastpump on a regular basis does not meet the specifications).

7. Saving Money/Convenience. Formula for a baby costs anywhere from $60-$250/month, depending on the brand and type of formula you choose. Wow. Breastfeeding literally costs you $0/month. Even if you factor in the cost of buying a breastpump, you are still saving big time by breastfeeding. The convenience of breastfeeding, in my opinion, cannot be overstated. Whether we decide to go for a drive, take Little Bear on a long hike, or are out to dinner with friends, I never have to think about packing a bottle for Little Bear. Having an instant supply of food for our little ones is another wonderful advantage!

8. Time Together. They grow so darned fast. I can't believe Little Bear turned 7 months yesterday. She has started eating solids and skips 2 breastfeeding sessions each day. Soon, I know, she'll need me even less. I cherish, more than ever, our nursing time together. I love watching her when she finally gets to latch on ... her eyes close and her breathing becomes calm and content. Her little fingers stroke my skin and I can feel her heart beating against mine. I know that all too soon these intimate moments will be nothing more than fond memories. She won't remember these times together, but I will remember them even when I'm old and grey. It's easy to get caught up in the crazy business of our culture. Our forced quiet times together helps me to slow down, enjoy the present, and remember what an incredible gift and blessing it is to be a mom.

Exclusive Breastfeeding: The First 6 Months

During the first 6 months of a baby's life, breast really is best. While this seems obvious to many mothers (yes, intuition and instinct is still alive and well for many moms), it really is news to many. Even nurses and doctors have recommended feeding infants rice cereal and other foods starting at 3-4 months of age. Yet as the research emerges, it is hard to argue that this recommendation should be continued.

The journal Pediatrics published a study done in the Netherlands in 2010 that looked at exclusive breastfeeding for various lengths of time. The results are clear: 6 months of exclusive breastfeeding led to a "significant reduction of respiratory and gastrointestinal diseases in infants," as well as reduced the number of infections for the next 6 months of life. The entire study can be read by visiting this link.

According to the Center for Disease Control's 2009 data, only one-third of mothers are exclusively breastfeeding at 3 months in the United States. By 6 months, only 14% of mothers are exclusively breastfeeding. To see data state-by-state, visit the CDC's website.

Exclusive breastfeeding is defined as giving only breastmilk (no formula, food, juice, or water) to an infant. Exclusive breastfeeding does include giving breastmilk that has been pumped using a breast-pump. Breastmilk contains ALL of the nutrients an infant needs during his or her first 6 months of life. It also contains precious antibodies passed on from the mother. That means that if a mother has built up antibodies in her system to that nasty cold everyone around town is getting ... her baby is most likely going to be protected. It also means protection from serious infections that cause diarrhea and pneumonia, the two leading causes of infant mortality worldwide. The World Health Organization (WHO) estimates that nearly 1 million child deaths could be prevented each year by following the recommended 6 months of exclusive breastfeeding. Visit WHO's website for more information.

Science aside, I can attest that as a mother, exclusively breastfeeding for 6 months offers many other benefits to mother and child. Each time an infant suckles at her mother's breasts, oxytocin (the love and bonding hormone) is released into the mother's bloodstream. Oxytocin is not only responsible for feelings of intimacy and love, but also help a mother feel more calm and relaxed. And what new mother couldn't use more of THAT? It also allows for hours of quiet time spent together - offering a place of refuge and quiet for both mom and baby.

While it has become somewhat "un-PC" or "controversial" to talk about the benefits of breastfeeding out of fear of hurting a mother's feelings that either cannot or choose not to breastfeed - I strongly believe that we must continue talking about and encouraging breastfeeding whenever possible. I recognize and understand that not every mother will physiologically be able to breastfeed her child. For those women, formula is a wonderful alternative. Yet many mothers that can are choosing not to breastfeed - often times due to lack of knowledge or convenience. I have known several mothers that stated they had to give formula because they did not produce enough milk, stating they were having to breastfeed every 3 hours or less. Unfortunately for these women, they did not understand that breastfeeding every 2-3 hours is normal ... and that their bodies were producing enough milk. But lack of knowledge caused them to stop breastfeeding. This is unacceptable. Women MUST be informed.

Additionally, the United States has become an overly-sexed culture that often views the woman's breast as merely a sexual object. While this is certainly one function of a woman's breast, it is most certainly not the only function (and I would argue, most definitely not the most important one, either!). We live in a culture where it is okay to have women parade around in underwear (or less) on prime-time television, yet it has not been okay to expose a breast to feed a child. In recent years, most states have passed laws that allow women to breastfeed in public (and sometimes private) locations. While I am grateful that women are finally being protected so that they can feed their children, the fact that we even had to pass these laws speaks volumes about our nation's attitude toward breastfeeding.

I encourage everyone to become a supporter of breastfeeding mothers! Encourage friends and family by sending them information from the above websites. Start conversations. Express support whenever possible. Let's change the attitude toward breastfeeding in our nation, so that when Little Bear is old enough to have her own children, exclusive breastfeeding for 6 months is considered the norm - and not the exception.

Baby Food Making!

We have decided to make our own baby food for Little Bear for several obvious reasons:

1) Saving money! The cost of baby food at the store is outrageous! I saw a very (and I mean VERY) small jar of mashed sweet potato for $1.00. I could buy 2 whole, organic sweet potatoes for about the same price!

2) Waste reduction. Buying all those tiny glass bottles with metal lids just seems like one more thing to have to recycle. And while they might be recyclable, the process of recycling still takes a toll on the environment. Better to reduce!

3) Nutrition. By making our own foods we know exactly what is (and more importantly, what is not) going into Little Bear's body. So many foods require heavy processing and preservatives to maintain a long shelf life. By making our own foods, we know that the ingredients are fresh - with no additives!

4) It's easy! While this is not the driving factor behind making our own baby food, it's a nice bonus that it is SO easy! More on that below ...

We mash Little Bear's foods in a BabySteps Hand Crank Food Mill. It cost us about $10 online. You can also find them at Whole Foods and other natural grocery stores for about the same price. There are all kinds of fancy baby food mills you can buy. One is call the Beaba Babycook Baby Food Maker. It cooks, grinds and warms. Seems a bit excessive to me, but if you have an extra $150 lying around, it might be worth it? Any sort of food mill/grinder will obviously work. I chose to buy the hand crank one because it is easy to wash and easy to pack up and take out of the house.

As of now we have introduced Little Bear to: avocado, sweet potato, banana, and pear. Her favorite so far is banana. The sweet potato is the only one I cook, and I do that by simply placing several sweet potatoes (in their skins) in the oven for about 45 minutes. When they are nice and squishy and soft, I take them out, skin them, mash them in the grinder, then separate them into an ice-cube tray to freeze. After they are frozen, I take out the sweet potato cubes and store them in a plastic bag in the freezer until ready to use. I set out one or two cubes in the fridge the night before and they are ready to go by the morning.

On most days, I feed Little Bear solids twice a day: mid-morning and in the evening. I usually mix 2 foods together at this point. Since she likes bananas so much, we are using that to mix with the less sweet avocado and sweet potato. She LOVES it.

When Little Bear was first starting foods, she would gag on the thick consistency of the mashed foods. Because of this, I added quite a bit of my own breast milk to the mash to make it very thin. This made it easier for Little Bear to swallow without gagging. Two weeks later, we no longer have to thin out the foods and she can take the thick mashed sweet potato and banana without any difficulty.

Here is a good link of foods to avoid with babies: Baby Foods to Avoid. I don't know how scientific it is, but most of what it says makes sense and reaffirms what I have heard in the past about avoiding wheat products, dairy, honey, etc.

The most important thing to remember (in my opinion) is that babies still need to continue to be breast-fed until 2 years of age if possible! The World Health Organization and La Leche League both recommend 6 months exclusive breastfeeding with continued breastfeeding with appropriate complimentary foods up to 2 years. If unable to breastfeed, still continue to give formula as it contains many important nutrients/fats in the right proportions that foods alone cannot provide at such a young ago.

Going Organic

About a week ago Little Bear started to show more interest in food. She would stare intently at our forks during dinner, watching them move from plate to mouth, and back again. She also started grabbing at food in our hands. My goal with Little Bear was to exclusively breastfeed for 6 months since that is what La Leche League, the World Health Organization (WHO), and my midwife suggested. Apparently, exclusively breastfeeding babies for 6 months lowers the risk of food allergies later on in life, as well as continues to offer them a really great immune system! Since we were 5 ½ months along, I thought it was time to start adding a few bites of food here and there.

Everything I have read, as well as talking with many mothers that I respect, suggests beginning a baby on mashed sweet potato and/or avocado – NOT canned, mashed rice cereal, like they used to. And personally, that makes a lot of sense to me. If we are going to introduce something to Little Bear, it might as well be packed full of great vitamins and nutrients! I also decided many years ago that my children would eat ORGANIC whenever possible. It was this resolution I had made that caused me to stop and ponder … If it is so important for me to feed Little Bear organic foods … and if I’m willing to spend extra money to make sure those foods I give her are organic … why am I not willing to spend extra money to feed Kyle and myself organic foods!?! This question has been nagging me for several weeks now, and the only honest answer I’ve come up with is this one: I’m too cheap! And while that may be an honest answer, it isn’t a good one!

Not that I haven’t tried to buy organic things over the years. I buy organic half-and-half for our morning coffee. I try to buy “natural, hormone-free” chicken and meat. And if I see organic produce at a good price, I will pick it up. But when I see an organic avocado for $1.99 – I usually go for the non-organic that is only $1.00. This behavior, I finally realized, has to change. We are on a pretty tight budget right now while Kyle is job searching and going to school. That means that I’m still not able to buy 100% organic right now for us (Little Bear, however, is getting 100% organic as she eats so very little!). But I am doing better. Today I bought organic apples, salt, butter, zucchini and spinach. The oranges are not organic, but I’ve heard that fruit with a think peel will often carry most of the chemicals in the peel. I hope this is true. Did it cost more? Yep. Is it worth it? I think so.

I’m also focusing on using more and wasting less. That means saving bacon grease and chicken fat for cooking. It means boiling bones and saving ends of vegetables for broths and stocks. We’ve cut down on sugar and white flours – which really helps curb one’s appetite … so we actually end up eating less throughout the day.

We also are trying to eat out less. We make coffee at home every morning so we don’t have to spend $2.00 on a cup at the store. Kyle especially enjoys grabbing food outside of the house (goes back to his bachelor-day habits, I believe) … so I’m trying to send him out the door with plenty of snacks, a sandwich, etc. It’s not going to be easy, though. We just relocated to the Portland area that offers an amazing variety of really good restaurants! But for now, I think we are going to try and limit our eating-out to once a month. Wish us luck!