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Cord Clamping

The “Third Stage” of labor is one that is often forgotten. This is the span of time between the birth of the baby and the expulsion of the placenta. The typical medical birth looks like this for the third stage: baby emerges, cord is clamped immediately, baby is taken by a nurse to a warmer, mother is injected with pitocin, cord is tugged and the placenta is pushed out through force such as a nurse or the doctor pushing on the abdomen.

While I find a lot wrong with that whole picture I want to focus on the part that really effects your baby the most (in my opinion) – immediate cord clamping.

First, and fundamentally – when the cord is cut within seconds this allows that baby to be taken from the mother. It is proven that skin-to-skin directly after birth, and for the first hours, is best for mother and baby barring medical emergency. If the baby is still connected to you, they can’t take baby and you get skin-to-skin.

But the most important aspect of cord clamping to me is the loss of blood to your newborn. “Blood Loss?” you might say – after all the cord is clamped off at both ends, this is not a messy process. The blood loss I am talking about is all the blood that has been left in the cord and placenta and that belongs to your baby – up to HALF of your newborn’s blood is still waiting to go into the body when the cord is clamped immediately.

Let us get a quick education in how the cord reacts if left alone. The cord will normally pulse (deliver blood to the baby) for about 3 minutes after the birth – sometimes longer. The cord then clamps itself. Yep, that’s right – it does the job for you.

This amazing cord contains Wharton’s Jelly. During pregnancy and the birth this jelly protects the arteries and veins in the cord – this is why knots and tangled babies are fine the majority of the time – the Wharton’s Jelly keeps the cord firm and unable to collapse. After the birth the Jelly slowly “clamps” down on the arteries first, then the umbilical vein. The cord will slowly turn from heavy and firm (and colored) to limp and white. At this point it can be cut with little to no mess at all – no medical clamps needed!

Now back to the immediate clamping of the cord – which is common medical practice.

The immediate effects of this are pretty common sense – after all, what would you do with half your blood missing? Your body could not move oxygen as well, could not clean out impurities as fast, and your iron levels would be horrible. Oh, and you would most likely need major medical care. Luckily newborns are pretty tough – but why do we take the risk?

To get the “visual” of this issue, here is a great and quick video that shows visually the blood volumes we are talking about here. I also have found an amazing resource in this group of videos by an OB/GYN who lectured on this subject during Grand Rounds. It is in four parts and long, but very worth the time to watch. (And perhaps to pass along to your OB/GYN?)

Jaundice is one of the big questions that comes up with delayed clamping. After all, doesn’t more blood mean more blood to “clean” to get rid of bilirubin? In fact, when women talk with me about what their doctors have to say about delayed cord clamping, they normally say this is brought up as the #1 reason to not delay.

However, studies show that while jaundice is slightly increased, it is a benign increase. In other words – more “tan” babies but no increase in SICK babies. After all, not all jaundice is harmful, in fact it is pretty normal. There was no increase in the amount of babies needing phototherapy or other clinical issues relating to jaundice.

Blood iron levels are something that pediatricians watch in little ones. Many parents are told that infants need extra iron during the first six months, be that from formula (which has added iron) or from drops given to the breastfed infant.

However, one has to wonder if this issue has cropped up due to the practice of immediate cord clamping, since studies show better iron levels in infants who have delayed cord clamping. Even better – this effect lasts until about six months of age – the age many babies are ready to start solids and therefore get more iron in a natural way.

When studies looked at infants within 24 hours after birth, at 2-3 months of age, and at six months, all the studies showed higher iron and ferritin levels for those with late-clamping. This seems to say that our babies were made by design to store enough iron to keep themselves healthy until they start solid foods. Of course, this only happens if we let nature take its course as intended.

Another effect of early cord clamping is less oxygen. This makes sense – after all, your blood carries your oxygen. If you don’t have enough blood, you don’t have enough oxygen. This is why many midwives will call the cord/placental unit a “resuscitation kit” – if baby is having trouble starting up right away that extra blood and oxygen from the placenta and cord can help the lungs get to work – and provide the baby with oxygen in the meantime (like the placenta has been doing for the past 40 or so weeks).

These studies even show that preterm infants are better off getting delayed clamping if at all possible. Cesarean section births were included and the benefit is pronounced for these infants as well – no doubt due to the higher instance of resuscitation needed after cesarean sections.

Loss of oxygen and proper blood flow at birth could also be a risk factor for Autism later, though no major studies have been done relating to cord clamping and Autism.

With all the evidence pointing to leaving the cord alone for at least 3 minutes (or heck, why not until the placenta emerges – or longer!) – even for a cesarean section or preterm infants – why are we still cutting cords willy nilly? Your guess is as good as mine. But the good news – we can change this – talk to your care provider, show them the information. Change some minds – and maybe some births.

this is why i plan on delaying cord clamping until it stops pulsing…along with refusing pitocin and forced removal of the placenta.

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Graduate

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Japanese Barista Makes 3D Latte Art

neuromorphogenesis:

USF researchers find far-reaching, microvascular damage in uninjured side of brain after stroke

Findings suggest that blood-brain barrier integrity suffers days after ischemic stroke, leading to serious complications; repair of this protective barrier might prevent them

While the effects of acute stroke have been widely studied, brain damage during the subacute phase of stroke has been a neglected area of research. Now, a new study by the University of South Florida reports that within a week of a stroke caused by a blood clot in one side of the brain, the opposite side of the brain shows signs of microvascular injury.

Stroke is a leading cause of death and disability in the United States, and increases the risk for dementia.

“Approximately 80 percent of strokes are ischemic strokes, in which the blood supply to the brain is restricted, causing a shortage of oxygen,” said study lead author Svitlana Garbuzova-Davis, PhD, associate professor in the USF Department of Neurosurgery and Brain Repair. “Minutes after ischemic stroke, there are serious effects within the brain at both the molecular and cellular levels. One understudied aspect has been the effect of ischemic stroke on the competence of the blood-brain barrier and subsequent related events in remote brain areas.”

Using a rat model, researchers at USF Health investigated the subacute phase of ischemic stroke and found deficits in the microvascular integrity in the brain hemisphere opposite to where the initial stroke injury occured.

The study was published in the May 10, 2013 issue of PLOS One.

The USF team found that “diachisis,” a term used to describe certain brain deficits remote from primary insult, can occur during the subacute phase of ischemic stroke. The research discovered diachisis is closely related to a breakdown of the blood-brain barrier, which separates circulating blood from brain tissue.

In the subacute phase of an ischemic stroke, when the stroke-induced disturbances in the brain occur in remote brain microvessels, several areas of the brain are affected by a variety of injuries, including neuronal swelling and diminished myelin in brain structures. The researchers suggest that recognizing the significance of microvascular damage could make the blood-brain barrier (BBB) a therapeutic “target” for future neuroprotective strategies for stroke patients.

The mechanisms of BBB permeability at different phases of stroke are poorly understood. While there have been investigations of BBB integrity and processes in ischemic stroke, the researchers said, most examinations have been limited to the phase immediately after stroke, known as acute stroke. Their interest was in determining microvascular integrity in the brain hemisphere opposite to an initial stroke injury at the subacute phase.

Accordingly, this study using rats with surgically-simulated strokes was designed to investigate the effect of ischemic stroke on the BBB in the subacute phase, and the effects of a compromised BBB upon various brain regions, some distant from the stroke site.

“The aim of this study was to characterize subacute diachisis in rats modeled with ischemic stroke,” said co-author Cesar Borlongan, PhD, professor and vice chairman for research in the Department of Neurosurgery and Brain Repair and director of the USF Center for Aging and Brain Repair. “Our specific focus was on analyzing the condition of the BBB and the processes in the areas of the brain not directly affected by ischemia. BBB competence in subacute diachisis is uncertain and needed to be studied.”

Their findings suggest that damage to the BBB, and subsequent vascular leakage as the BBB becomes more permeable, plays a major role in subacute diachisis.

The increasing BBB permeability hours after the simulated stroke, and finding that the BBB “remained open” seven days post-stroke, were significant findings, said Dr. Garbuzova-Davis, who is also a researcher in USF Center for Aging and Brain Repair. “Since increased BBB permeability is often associated with brain swelling, BBB leakage may be a serious and life-threatening complication of ischemic stroke.”

Another significant aspect was the finding that autophagy — a mechanism involving cell degradation of unnecessary or dysfunctional cellular components —plays a role in the subacute phase of ischemia. Study results showed that accumulation of numerous autophagosomes within endothelial cells in microvessels of both initially damaged and non-injured brain areas might be closely associated with BBB damage.

Autophagy is a complex but normal process usually aimed at “self-removing” damaged cell components to promote cell survival. It was unclear, however, whether the role of autophagy in subacute post-ischemia was promoting cell survival or cell death.

More than 30 percent of patients who survive strokes develop dementia within two years, the researchers noted.

“Although dementia is complex, vascular damage in post-stroke patients is a significant risk factor, depending on the severity, volume and site of the stroke,” said study co-author Dr. Paul Sanberg, USF senior vice president for research and innovation. “Ischemic stroke might initiate neurodegenerative dementia, particularly in the aging population.”

The researchers conclude that repair of the BBB following ischemic stroke could potentially prevent further degradation of surviving neurons.

“Recognizing that the BBB is a therapeutic target is important for developing neuroprotective strategies,” they said.

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The Cronut, NYC Pastry Chef Creates a Donut-Croissant Hybrid

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Human stem cells successfully cloned for the first time

A working process for cloning stem cells from existing human cells has finally been discovered by a team at Oregon Health & Science University.

These stem cells were created by reprogramming healthy skin cells, a goal that has eluded researchers around the world for years. It’s the first key step in developing medical procedures for replacing dying or injured cells with new ones to stave off disease and age. That could mean growing a new liver, or kidney or heart, in the lab for an organ transplant, or even repairing the brains of those suffering with diseases like Parkinson’s.

The team was led by Shoukhrat Mitalipov from the reproductive and developmental sciences department of the Oregon National Primate Research Centre. He said: “A thorough examination of the stem cells derived through this technique demonstrated their ability to convert just like normal embryonic stem cells into several different cell types, including nerve cells, liver cells and heart cells. Furthermore, because these reprogrammed cells can be generated with nuclear genetic material from a patient, there is no concern of transplant rejection.”

“While there is much work to be done in developing safe and effective stem cell treatments, we believe this is a significant step forward in developing the cells that could be used in regenerative medicine.”

The technique Mitalipov and his team used is called “somatic cell nuclear transfer” — as you can see in the video, it essentially involves sucking out the DNA from an adult cell and inserting it into the empty nucleus of a donor egg. This creates a clone of the original cell, and is in fact the first step in the cloning method used to create animal clones like Dolly the sheep.

However, in its therapeutic mode, the new cells can be grown as replacements for the original type of cell. That objective hasn’t been reached until now as human eggs are extremely fragile compared to many of the animals which we have cloned. That Mitalipov and team have succeeded is down to research on primates, and adapting primate stem cell research to humans.

As a cell divides after fertilisation, it undergoes several transformations as it prepares to split and multiply. The metaphase is the moment just before a cell splits, as the chromosomes align alongside each other in the very centre of the cell so that, when it splits, one goes one way as another goes the other, each taking the full copy of the genetic code. The researchers managed to stall the metaphase while the cell underwent nuclear transfer, effectively giving the new chromosomes time to get settled before the metaphase finished and cell division proceeded.

An added bonus is that the eggs used have not been fertilised, so there won’t be any debates over the ethics of embryonic stem cells as we have seen in the US in the past. While the researchers placed skin cell nuclei into the receptor egg cells, the method is conceivably similar for any other kind of cell.

And, while it may sounds like the first step towards a practical method for cloning humans, the Mitalipov has made it clear that’s not the aim. “Our research is directed toward generating stem cells for use in future treatments to combat disease. While nuclear transfer breakthroughs often lead to a public discussion about the ethics of human cloning, this is not our focus, nor do we believe our findings might be used by others to advance the possibility of human reproductive cloning.”

The research has been published in the journal Cell.

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