This post started out as a piece on optimal cord clamping, but has become a whole new beast. (Optimal, or delayed cord clamping is the process whereby the umbilical cord is left to cease pulsating before cutting). I read and I researched, after which time, this article changed tracks. I don’t need to tell you the pros and cons of delayed cord clamping. You can read all about it on the websites listed below. After which time you can make your own mind up.
Could this be my shortest ever blog post? No, what all this lead me towards is the fact that in so many cases, women are not given factual evidence-based information to make a choice. Often it is the experience of others that leads us toward making our decisions, when it should be the combination of experience and information.
It is in our nature to want others to have the benefit of our own experiences. Informed choice happens when we consider the experience of others and combine it with scientifically proven, evidence-based information. Sharing experience is a vital way to keep ideas flowing. Experience, or the stories that we tell, should serve as a motivation to gather more information on a particular topic; people usually make choices based on what is best for them. Being that individuals are unique, this will vary from person to person. I have made different choices in all four of my births. Many of them ill informed, but all of them mine. I hope to share my experience, tell you a story, then give you some information so that you can make your choice. First, a non-birth related example:
My husband is the sort of person who falls in love with a new product, and immediately wants others to experience the same revolution that he has. If something makes his life easier, cheaper or gives him pleasure, he shares his experience with all around him. When we were first married, we bought an “upside down” fridge. He would show all his friends the said upside down fridge, spout the benefits on not having to bend down to get vegetables, and marvel at the convenience of the mighty upside down design. Despite his enthusiastic sales attempts, I don't think any of the afore mentioned friends jumped aboard the upside down fridge revolution. I am sure that they looked at them, but made their choice based on what suited them and their family and not solely on the eloquent ramblings on my husband. Simply put, they listened to his experience, did their own research and make the choice that was right for them.
So often advice is based on the experience of others, and not the evidence and information available. Many women that I speak to don’t know that they have a choice in regards to management of the umbilical cord after birth. The World Health Organization (WHO) recommends an actively managed third stage of labor, (another choice here, as you can request natural or physiological third stage) but recommends that after the birth of most infants, regardless of gestational age or weight, the cord should be left for 1 to 3 minutes before clamping.
When I discussed my preference for a natural third stage with my fourth child, my caregiver refused. She told me that there are too many risks of postnatal hemorrhage, and that she would “not allow it.” We went back and forward over the issue of delayed cord clamping and a natural third stage. Eventually she “allowed” me to have optimal cord clamping if I would agree to an actively managed third stage. Interestingly, I have learnt while researching optimal cord clamping, that what I fought my caregiver for is exactly what the WHO recommends should be standard practice. It was her experience that women having their fourth + baby were are greater risk for hemorrhage. I accepted her expertise and experience as my sole source of information.
I don’t want to underplay the importance of closely monitoring the third stage of labor. I understand in many cases, administration of an oxytocin based drugs has saved lives. In my circumstance, had I done my own research, and searched for evidence-based information, I would have refused active management. I was very low risk, regardless of the fact it was my fourth birth. I am left wondering how many birth related choices are influenced by experience instead of evidence. I was educated, informed and proactive, but still managed to be persuaded to do things differently based on the words that were spoken to me, and the manner in which they were delivered.
You always have choices. Don't let anyone take them away. You wouldn't go out and buy an upside down fridge simply because my husband, or even a well versed fridge expert told you they are the bomb. You might use his experience to motivate you go out and learn more about them; hey, you might even go out and buy one. Choice is always there, beware of advice and experience that disguises itself as information, and it truly becomes yours.
Over to you now- make your choice. Here is some evidence-based information on optimal cord clamping and different options for the management of the third stage of labour.
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