I'm a big believer in evidence-based medicine. I don't want a treatment just for the sake of doing something, nor do I want something that hasn't been proven to be beneficial and effective, with those benefits outweighing any potential risks/side effects. I'm thankful that there are doctors who look at the evidence and change practises if need be. This is what Dr Nicholas Fogelson is doing in now advocating for delayed cord clamping, since he hasn't seen evidence justifying routine immediate cord clamping. This is also why routine episiotomies are becoming less common, thankfully. And why kangaroo care is, thankfully, becoming more commonplace with preemies.
These things lead me to wonder, though, why these practises were adopted at all, given that the evidence doesn't seem to be there. The commonality I see is that these were all things that said that our bodies were wrong and not to be trusted, or perhaps not "scientific" enough. Maybe that's cynical, but it's how I see it. In the process, women have been told (by implication) that they always need help birthing and caring for their babies. Note: I'm not speaking of those times when medical intervention truly is needed, I am speaking about routinely treating birth as a medical procedure that will always need medical intervention.
Of course, one could also argue that all the things I mentioned above came about due to the medicalisation of birth and women being supine when giving birth in a medical setting, and sometimes too drugged or badly positioned to push effectively. This could, of course, lead to an episiotomy instead of repositioning the woman, and immediately cutting the cord to check the baby instead of placing the baby on the mother's chest. I'd like to say that these things no longer happen, or at least not with midwives, but both happened to me when I had K. There was an OB there, too, so I'm not sure who made the decision for the episiotomy and immediate cord clamping; I only know that it was done, and that I had no say in it. It's one thing if it's a true emergency (though one should always get informed consent if at all possible), but these things likely could have been averted had they just helped me change position first.
Going back to the cord clamping, though, I would again ask: where's the evidence for immediate cord clamping, even when the baby was thought to be in distress? We know about the importance of immediate skin-to-skin contact to regulate the baby's temperature, calm the baby, and facilitate breastfeeding and bonding. We also know that delayed cord clamping can be done even with active management of the third stage of labour. While it might not be routine, the initial checks can be done with the baby on the mother's chest, allowing for both skin-to-skin contact and delayed cord clamping. This could also mean that the baby will avoid being put in a warmer due to his temperature dropping (thankfully that didn't happen with K, as they did hand him over once he'd been checked over).
So before something is done my child or me, show me the evidence.
It was a practice developed by doctors in the 1940's because it was thought to prevent jaundice, which has turned out to be dead wrong. Look how long it's taken to just get where we are now?
ReplyDeletePart of the problem is that premature cord clamping is still being taught as standard of care. Thanks to the way medical education is nearly militaristic in its instruction and hierarchy, it's really difficult to train oneself out of a paradigm that was deeply ingrained during one's training.
I think it's important to realize that, in the hospital setting, as long as mother and baby are attached to each other, the obstetrical care provider is responsible for BOTH of them. The baby cannot be passed off to a different member of the care team, thus becoming their responsibility.
I'm sorry to know that your wishes, and you and your babies were so disrespected. In my practice as a homebirth midwife, it is my protocol to never cut the cord prematurely unless it is truly impeding the birth of the baby once the head is out - a situation I have yet to see. But then, I am just a midwife; a servant and paid consultant to my employers, the families that have hired me. And I am considered "uneducated" by medical professionals, even though I practice evidence-based care with excellent outcomes.
Thank you for what you do. Having had a home birth with my second, I never want to birth outside the home again if I don't have to do so. My home birth midwives were fine with leaving well enough alone. They hadn't had a chance to read my birth plan because my labour was rather fast and they only arrived just before transition, but they were sure to ask before doing anything once my daughter was born. (my regular midwife wasn't on call that night)
ReplyDelete