The Umbilical cord is magical and fascinating! It is the method that provides the growing baby with all its physical nutrients until the baby is born.
Here I will share with you some fascinating facts and the physiology versus modern practice which will inform our work on healing our birth story.
Biology
The Umbilical Cord has formed by the fifth week of development. The cord is physiologically and genetically part of the foetus not the mother. It contains two arteries and one vein which are covered in a substance called Wharton's Jelly. The cord does not go straight to the mother - it goes to the placenta which is an organ formed as an interface between the baby and mother and allows nutrients and waste to transfer between baby and mother without direct mixing between the two different people.
Back to the cord - oxygenated and nutrient rich blood from the placenta is supplied to the baby via the umbilical vein and then the foetal heart pumps the low oxygen , nutrient-depleted blood through the umbilical arteries back to the placenta.
The cord grows to about 50 cm long and 2 cm in diameter. This is an average, some cords grow longer, but the length is approximately the length needed for the baby to reach the breast whilst still being attached to the placenta whilst waiting or the placenta to be born.
What happens at birth:
Physiological - The baby is born first, and the cord is still attached to the placenta inside the mother. At this stage the cord is still pumping and active. Around 30% (or up to 50% for premature babies) of the baby's blood is still circulating in the placenta and cord. During the time it takes for the placenta to be born - approximately 10-35 minutes on average but can be longer, this blood is transferred to the baby and the cord gradually empties, turns white and shuts down.
Medical Practice Versus Physiology
Current and recent medical practice in many Westernised countries is to clamp, then cut the cord immediately at birth. This practice of early clamping officially started around 60 years ago. It was introduced in the 1960s following concerns of placental transfusion to the newborn and beliefs that it would reduce heavy bleeding. There was no good evidence to support this theory and there is since much evidence to refute it. There is also evidence that the practice was happening before then, starting at the turn of the century in an effort to prevent the drugs being used such as ether and chloroform from crossing the placenta and reaching the baby.
Immediate cord clamping still lingers today despite evidence against it. Even delayed cord clamping as introduced in many hospitals has varying timing between 1 and 3 minutes and this is not the full length of time that the cord needs to transfer all the blood and stop pulsing.
This practice leads to the baby starting life missing 30% of its blood. For context, an adult is allowed to donate a maximum of 12.5% of its blood and children are not allowed to donate. In addition, losing 30-40% of the blood is a Class 3 haemorrhage for an adult which requires blood transfusion. More than 40% loss necessitates immediate resuscitation to prevent the heart and other organs from shutting down.
There are many studies done that are document the harm that immediate cutting of the cord can cause and benefits to delayed clamping and there are many groups campaigning for change. For example 'Wait for White' (where the above figures are quoted) Despite this overwhelming evidence and basic common sense, the hospitals are slow to change. Many of us alive today, who were born in a hospital, likely had our cords cut earlier than we should. It is astonishing to me that the benefits of this are still under debate and that practice has not changed.
Some facts around this blood:
By clamping the cord immediately the baby may weigh as much as 214 grams less.
The baby will have a lower ratio of red blood cells
There is a greater risk of iron deficiency anaemia due to the iron in the missing blood. WHO estimates that 43% of children worldwide under 5 are iron deficient anaemic and the biggest cause is cord clamping.
This blood helps the baby during the transition form receiving oxygen via the blood receiving it via breathing. Missing blood also means there is less blood in the lungs as well as the rest of the body.
The foetal blood has a higher concentration of stem cells than later in life and allowing the blood to return to the baby also means a higher concentration of stem cells. Stem cells are special as they are unspecialised but can divide and become other cells, They play an essential part in the body's repair system. They belong in the baby at birth. ( Note there is big business in harvesting and storing cord blood because of these cells in the name of being able to help you as an adult - that's a whole other subject,)
Jargon demystified!
You will hear terms like Delayed Cord Clamping , Optimal Cord clamping, and Lotus birth. Let's demystify that:
Nuchal Cord - The technical term for when the cord is looped around the babies neck at birth.
Cord Clamping. - In Hospitals in the UK and most of Western world there is a plastic clamp that is applied to the cord to prevent bleeding and to prevent infections from entering.
Delayed Cord Clamping - waiting for a specified amount of time before cutting and clamping the cord. Usually between one and 5 minutes. Any time is better than no time but this is not the full amount of time needed for all the blood to return to baby. It is commonly written in hospital protocols.
Optimal Cord Clamping - is usually what is meant when people say wait for white. In this practice you wait for the cord to stop pulsing when you know no more blood transfer is taking place.
Lotus Birth
The practice of keeping the cord attached to the placenta until the cord falls off by itself. This takes between 3 to 10 days and so during that time the placenta is treated with preserving herbs and salts.
Cord Ties - Many people make their own cord ties to complete their own ritual.
Cord Burning - This is another way to ritually cut the cord rather than scissors and is used in some cultures. The cord is burnt through with a candle.
Fascinating Facts
Let's finish with some interesting facts about umbilical cords and the practices surrounding this transition of the baby.
1. We are mammals still! and all mammals grow their young inside and nourish them with a cord and placenta system. What do they do at birth. Here are some examples.
Great Apes - bite through cord and eat placenta.
Chimpanzees - leave it attached - lotus birth
Horses- Allow it to snap. Horses are taller and the foal gets to its feet and can walk independently almost straight away.
Cats - They bite through the cord.
Dogs -bite the cord and eat the placenta
Whales - it breaks naturally with birth of calf and movement of the water
Note - mammals that bite the cord wait for it to stop pulsing to do so.
2. Traditional cultures have many rituals around birth. Here is one teaching and ritual from the Navajo people
"The umbilical cord is the physical representation of the three central relationships that orient a Navajo child in this world—to the mother, to the homeland, to the Holy Spirits. The navel is a lifelong reminder of the roots established before birth." ( Quoted in https://hms.harvard.edu/news/navajo-farewell)
3. A Cord Knot and Wharton's Jelly.
Wharton's Jelly is a gelatinous substance that protects and cushions the umbilical cord to prevent it from being compressed and ensuring the blood can flow at all times. It is thanks to Wharton's Jelly that the cord being wrapped around the neck is not usually a problem for the baby. It also means that if the baby does do somersaults and create a knot in the cord, the cord will usually not tighten around this knot and cause problems, This actually happened with the cord of my second child! He was born with a knot in his cord. This had not caused problems . Knots that cause problems are very rare. They call them true knots. Although a knot that is not causing a problem is the same kind of knot. You can also get 'false knots' which are bulges in the cord that look like knots.