Making the Case for Delayed Umbilical Cord Clamping: A Grand Rounds Lecture by Dr. Nicholas Fogelson

Believe me, the time is well-worth it.  Before you open the following video link, set aside 50 minutes of uninterrupted time to watch Dr. Nicholas Fogelson’s Grand Rounds lecture, in which he makes the case before his colleagues regarding the research supporting delayed umbilical cord clamping & cutting.

Thank you, Dr. Fogelson, for granting Science & Sensibility the opportunity to re-post this video:

Dr. Nicholas Fogelson on Delayed Cord Clamping & Cutting-Part I

Delayed Cord Clamping, Evidence Based Medicine, Guest Posts, Practice Guidelines, Uncategorized , , , , ,

  1. avatar
    | #1

    So happy my OB already practices delayed cord clamping, against the grain of the colleagues in his own practice and hospital.
    My last baby stayed attached for a good while, I don’t even recall how long. I just know that he was already nursing before it was clamped and cut.
    The baby nurse wanted him to cry at one point and my doc said to her, “Leave him be, he doesn’t need to cry. He is pink and his cord is still pulsing. He’s fine.”

    Thank you Dr. Fogelson for getting the word out. I just hope your colleagues listen!!

  2. | #2

    I had to really fight for delayed cord clamping when my daughter was born, and the nurses acted as if I was some kind of crazy conspiracy theorist. It’s really refreshing to see this!

  3. avatar
    | #3

    At the start of the 3rd clip, he said something that struck me. That Darwin probably saw a big difference because his patients were malnourished, but modern OG/GYNs don’t see it because their mothers have better iron status to begin with.

    I would have to say that he missed one glaring fact – the OBs today NEVER SEE THE BABIES after mom leaves the delivery room. How can they notice the effect of their practices if their job doesn’t allow them even a cursory look?

    I do love hearing him say though that the burden needs to be on the intervention – the deviation from evolution – to prove its safety. It’s so refreshing to hear that from a doctor.

  4. avatar
    | #4

    Thank you for posting this, I’m going to try to find time to watch it. But what is a “grand rounds” lecture?

  5. | #5

    At hospitals–especially big, research-based (but usually all) hospitals– once a month there is a Grand Rounds meeting where a lecture is presented about some clinical issue–it’s a form of in-house continuing medical education (CME). Docs/nurses/NPs/PAs can get CME hours which go toward their license maintenance.

  6. avatar
    | #6

    Oh, thank you. 😉

  7. avatar
    | #7

    Thank you – certainly changed my future practice. May I ask though, what about with the use of Syntocinon/Syntometrine? Is there then an issue re the resultant uterine contraction causing increased volume of blood transfusion to the baby?

  8. | #8

    Many if not the majority of the patients in the modern studies would have been on oxytocin/pitocin (the USA name of the drug you mention), so I think the data is applicable. The use of a uterine tonic agent is likely to increase the rate of placental transfusion, but we don’t have specific data on pit vs no pit.

  9. avatar
    | #9

    @Nicholas Fogelson, MD
    Thank you for clarifying that.

  10. | #10

    Hello Ms. Hull,
    Full respect for your work and your site. I often refer patients here when they are debating pregnancy issues and childbirth choices. As a urogynecologist and reconstructive pelvic surgeon, I often play “shadow counsel” to the women I care for vis a vis their obstetrician’s recommendations. Your site is invaluable! Many Thanks.

    Lauri Romanzi, MD, FACOG

  11. | #11

    Dr. Romanzi,

    Thank you for your compliment. We work extremely hard at Science & Sensibility to make this blog community a “go-to” source for a wide audience: both the dearth of professionals who work in the perinatal care space, as well as the women to whom they (we) provide service.

    My personal mission, contained herein, is to be a “bridge builder” between the different factions of maternity care providers–offering information and discussion that is deemed valuable and, indeed, necessary, for the folks who care for pregnant, laboring and postpartum women–no matter what side of the philosophical fence they reside on.

  12. avatar
    | #12

    Great, Thank you for posting this!

  13. avatar
    Sarah Branson
    | #13

    @Nicholas Fogelson, MD

    I am a CNM who has attended births in both a hospital setting and home settings. I am currently overseas and I have just found these videos. I generally delay clamping of the cord and so I am looking forward to learning the evidence based information that these contain. However, I could not make it past the first 50 sec without stopping to comment.

    I am a Duck, as is my husband (undergrad and masters) and my daughter (undergrad and masters) and my son-in-law and my youngest son. The credentials of Oregon just delight me! Go Ducks!

  14. avatar
    Steve P.
    | #14

    Delayed cord clamping and its benefits was a topic in a child birth class my wife and I recently took part in. I had never heard about this topic until then. After doing more research this is something my wife and I are interested in doing with out first child (due 3/4/12). One question I have is the effects this has if you want to do private cord blood banking. We had signed up with a private bank before we covered this topic in our class and are now conflicted. Can you do both? I talked to the bank and they said we can but we have to understand that we will not bank as much blood. There is a target weight they look to collect and if they do not meet at least that weight there isn’t enough for them to bank. From watching the video I see there are benefits from leaving the baby on the cord for just a minute. Does that make sense or really should we weight until it stops pulsing? I see that the last comment here is a good 8 or so months old but was hoping someone with experience in this area can answer this question. I would love to ask Dr. Fogelson directly but can’t find an email address for him anywhere. I am wondering if he has had any patients that were able to do both successfully. I’m having a hard time wrapping my head around the idea of taking away from my baby for something I hope I never have to use in the future.

  15. | #15

    Steve ~ This is a very common question from parents – “Can I both delay the cord clamping and donate or bank the cord blood?” The short answer is in most cases, no. There is a limited amount of blood in the umbilical cord at the time of birth. In talking to one of the cord blood banks here in Pittsburgh, PA, they need at least 40-60 ml to do research and 75+ ml to store it for use in stem cell transplant. The longer you let the cord drain into the baby, the less blood there is for donation or banking.

    Some nurses are adept at manipulating the placenta to encourage the blood to drain further for collection purposes. Other nurses are not. So, there is no way to know if you will have enough blood to do both, until you try.

    I can’t give you specific advice for your situation, since this something that only you and your partner can decide. What I can say is that the best evidence we have points to delaying clamping the cord for at least 2 min to start reaping the benefits. So, what you have to decide for yourself is – does the potential benefit of privately banking the cord blood outweigh the immediate benefit of delayed cord clamping?

    Some additional info: “The American College of Obstetricians and Gynecologists (ACOG) takes no official position for or against cord blood banking, but says the chances are slim that a child – or even a family member – will ever use that saved cord blood. The organization points to a 1 in 2,700 (or lower) chance that a child will use his own saved cord blood. ACOG also points out that no one knows how long cord blood can successfully be stored.” http://www.babycenter.com/0_private-cord-blood-banking-is-it-for-you_1369773.bc?page=1

    Penny Simkin has a video illustrating the cord blood transfer from the placenta to the baby. http://www.youtube.com/watch?v=W3RywNup2CM&list=FL07bJXHIPaNIeDOvb_5QAKQ&index=12&feature=plpp_video

  16. avatar
    Steve P.
    | #16

    Thank you for the response. The more I read about private banking the less I feel comfortable with it. The evidence right now isn’t the best but the potential for the future is what makes me think. But again why deny your baby of what is theirs for something you hope you never have to use or may not even be able to use if needed. Ultimately I think we are going to delay clamping (haven’t yet decided on how long) and then try to get what we can for private banking. If it’s not enough to store we’re not liable for it. I just wish I can find documentation on people who were able to do both.

  17. | #17

    Steve ~ I wish I did have data to give you on people who were able to both delay and store the cord blood. At this point, there is no one collecting the data. More research does need to be done in this area.

  18. avatar
    | #18

    I also see that babies who have been subjected to early cord clamping, are absolutely starving in the weeks post birth. THey feed frequently from their mothers, then consequently the mothers believe they don’t have enough milk to breastfeed… it is a terrible vicious cycle. Please don’t cut the umbilical cord before the placenta has birthed.

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