Thank you all for your responses to my question. I too like to leave the maternal end of the cord unclamped, although as a student I had some midwives ask me to reclamp it as they wanted to know where the blood being lost was coming from. On thinking about the responses I would like to venture that the concern about the baby getting extra blood has been also raised in discussions of physiologic third stage and I think Lois's response is right on the money: it depends on the position of the baby in relation to the mum how much extra blood the baby is getting. Regarding the stronger contractions causing more blood being pumped to the baby, I don't think it works this way for these reasons: 1. The baby's heart is pumping the blood, not the uterus. 2. When you augment or induce a woman in labour and if her uterus experiences hyperstimulation, then the baby may receive less blood not more resulting in fetal distress. 3. The intent of the oxytocic in third stage is to schear the placenta off the uterine wall with the increased contractions constricting the uterine capillaries, if anything perhaps the stronger uterine contractions would restrict the amount of residual placental blood available to the baby. 4. My original concern about the oxytocic crossing the placenta to the baby also seems to be mute if what I just wrote is in someway correct. Bottom line is I still feel like I am guessing about this.
The question came up when as a student the mum I was caring for had agreed to having third stage actively managed (she had had a "long labour": tired uterus), but she didn't realise that this meant the cord would be cut immediately after the oxytocic was given (this was our fault as we hadn't covered this with her in the discussion, which brings to mind the flaws of giving informed consent in labour). So, when I was about to clamp the cord she said "Oh, but it hasn't finished pulsing", I said "your right then, we'll just wait for a minute or 2" and the midwife who was supervising me said "Oh! but we've given the pitocin, so we have to cut the cord now". And we did, the mum seemed to be ok with it, she had had a lovely and triumphant birth (I think and hope) apart from that. It was just after reading AndreaQ's lovely story, I felt a pang of guilt and also a lack of knowledge re the consequences of delayed cord clamping after an oxytocic has been administered. Again, thank you to all who responded, I am still pondering. marilyn -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
