March 4, 2015
Volume 17, Issue 5
Midwifery Today E-News
“Delayed Cord Clamping”
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Read about the third stage of labor
MT e-book

The Third Stage of Labor e-book is packed with information about the umbilical cord, the placenta and natural approaches to this phase of birth. This collection of 15 articles from past issues of Midwifery Today magazine includes “Placenta Accreta” by Marion Toepke McLean, “Cord Burning” by Kelly Dunn, “On Meconium at Home and Delayed Cord-cutting” by Naolí Vinaver, “Placenta Rituals and Folklore from Around the World” by Sarah J. Buckley and “The Problem Is Induction, Not Meconium” by Gail Hart. Buy your copy and have it with you at the next birth you attend!

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In This Week’s Issue

Eugene conferenceLearn about Essential Oils

Attend this full-day class with LaRee Westover to increase your knowledge of essential oils, herbs and homeopathy, and to learn how they can aid a midwife’s work during pregnancy, labor, delivery and postpartum. Part of our conference in Eugene, Oregon, March 18–22, 2015. Deadline to receive your registration in office is March 9, 2015. After that, please register at the conference.

Learn more about the Eugene, Oregon, conference.

Learn about breech birth at our Germany conference

Attend this full-day class with Cornelia Enning, Angelina Martinez Miranda, Michel Odent and Gail Tully. You will learn about the most current breech research, see demonstrations of basic breech skills and increase your knowledge of breech complications. Sessions include Breech Birth Research, Turning Breech Babies, Alternative Methods for Breech and Breech Birth in Water. Part of our conference in October 2015.

Learn more about the Bad Wildbad, Germany, conference.

Quote of the Week

Start by doing what’s necessary; then do what’s possible; and suddenly you are doing the impossible.

Francis of Assisi

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The Art of Midwifery

Human babies usually express the rooting reflex (searching for the nipple) during the hour following birth, at a time when the mother is still in a special hormonal state and therefore has the capacity to behave in an instinctive mammalian way. The result of the complementary behavior between mother and newborn is the early initiation of breastfeeding.

Michel Odent
Excerpted from “Cord Cutting in the Framework of Neonatal Beliefs and Rituals,” Midwifery Today, Issue 108
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Editor’s Corner

A Natural Event

An old Chinese proverb from the Song Dynasty (960–1279) talks about pulling up a crop to help it grow. A rice farmer was growing rice, but it was growing too slow for him, so he pulled up each plant a few inches hoping that would give it a jump-start to grow. Instead, the plants began to wither and die. This proverb reminds us to let things take their natural course. If we are too anxious and try to help an event go faster, it often results in damage or sometimes death.

Similarly, when I was young and raised pigeons, I tried to help a little bird out of its shell. It died. I learned a harsh lesson. Birth is just like this; it is a natural event. It most often does not need our help. When we think we are helping, sometimes we are doing untold damage! Let’s really learn to discern when we are needed and when it is better not to disturb the motherbaby, which is most often the case!

— Jan Tritten, mother of Midwifery Today

Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.

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Conference Chatter

Eugene Conference

If you have not signed up for our conference in Eugene, Oregon, March 18–22, 2015, there is still time to pre-register through March 9. In addition, we take walk-in registrations all five days. You can choose from the rich array of classes that we have going on and come right in and be greeted by our lovely and welcoming staff. We will also know by the time of the conference which classes are approved for CEUs (continuing education credits).

With the theme of “Birthing in Love Changes the World,” this conference promises to be an amazing event. Our teachers are excellent and there is a nice combination of clinical, cultural and practical classes. There is also built into the conference framework places for you to share your ideas, hopes, dreams and practices. Midwifery Today conferences are very special with an amazing group of teachers and registrants. Our sister midwives from Fiji are working on their visas to join us, so you can make friends from other parts of the world as a bonus! Bring your address book!

— Jan Tritten

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Featured Article

Optimal Cord Clamping

There are many things that help our children to be as healthy as possible during their first minutes, hours, days, months and years. If the findings of new research are correct, then ensuring that our babies get their full volume of blood as they are born might be one of the more important steps we can take for the well-being of our children.

Here is the problem: while studies are showing us that there appears to be no good justification for the routine clamping and cutting of a baby’s umbilical cord seconds after the baby is born, survey after survey shows that most obstetricians and many midwives are still clamping and cutting cords very soon after delivery as a matter of course, with some rates as high as 95% (Downey and Bewley 2012; van Rheenen 2011). Dr. Jose Tolosa and colleagues write, “Although without clear benefit and no rationale to support it, early cord clamping remains the most common practice among obstetricians and midwives in the western hemisphere” (Tolosa et al. 2010).

What can we do about the disparity between evidence that strongly supports delayed cord clamping and widespread habits of practice that we know are not benefiting our children? We can educate ourselves. We can share research with our doctors and midwives. We can advocate for a change in business as usual.

Another thing very injurious to the child, is the tying and cutting [of] the navel-string too soon; which should always be left till the child has not only repeatedly breathed, but till all pulsation in the cord ceases. As otherwise the child is much weaker than it ought to be; a part of the blood being left in the placenta, which ought to have been in the child.
— Erasmus Darwin, 1796, a respected physician, philosopher, botanist and the grandfather of Charles Darwin (Chaparro 2011)

As Grandfather Darwin’s comments illustrate, we have a record of debate over the timing of when to clamp and cut the “navel string” that dates back centuries. For the most part, however, the cross-cultural norm appears to have been to wait until the placenta is delivered and frequently hours after the placenta emerges, to “tie off” the cord (Downey and Bewley 2012). In the early-to-mid-1900s, however, a new norm began to appear. Physicians argued for and widely disseminated the practice of cutting the cord soon after a baby was born. Over the 20th century, immediate cord clamping joined the triumvirate of practices making up what we now refer to as the active management of third stage labor: early cord clamping, a uterotonic drug such as Pitocin and controlled cord traction (for a research-based critique of the active management of third stage labor, see Goer and Romano 2011, pages 377–410). Decades later and following a near-universal adoption of immediate cord clamping, we are left with an absence of solid evidence that this intervention confers a benefit to our babies and more and more evidence of harm (van Rheenen 2011). It is time to move beyond this practice.


  • Chaparro, CM. 2011. “Timing of Umbilical Cord Clamping: Effect on Iron Endowment of the Newborn and Later Iron Status.” Nutr Rev 69 (Suppl 1): S30–6.
  • Downey, C, and S Bewley., 2012. “Historical Perspectives on Umbilical Cord Clamping and Neonatal Transition.” J R Soc Med 105 (8): 325–29.
  • Goer, Henci, and Amy Romano. 2012. Optimal Care in Childbirth: The Case for a Physiologic Approach. Classic Day Publishing: Seattle.
  • Tolosa, J, et al. 2010. “Mankind’s First Natural Stem Cell Transplant.” J Cell Mol Med 14 (3): 488–95.
  • van Rheenen, P. 2011. “Delayed Cord Clamping and Improved Infant Outcomes.” BMJ 343 (1): d7127.

Mary Esther Malloy
Excerpted from “Optimal Cord Clamping,” Midwifery Today, Issue 108
View table of contents / Order the back issue

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You can now purchase a portable USB drive with MP3s of selected classes from the 2012 Germany conference. You will receive most classes from the two-day Midwifery Skills sessions, as well as several others. Teachers include Elizabeth Davis, Gail Hart, Carol Gautschi, Lisa Goldstein and Gail Tully. To order

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Website Update

Read this editorial by Jan Tritten from the Spring issue of Midwifery Today:

  • Fiji, the Land of Smiles

    Excerpt: We learned a lot about Fiji and its birth situation. About five years ago, the government decided that all women needed to come to the main island of Viti Levu to birth in one of the large hospitals. Mothers come to the island around 28 weeks, depending on their risks, to have prenatal care in the city; they often wait all day for a short visit.

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Birth Q&A

Q: Are hospitals in your area starting to change their policies on cord clamping? Are they recognizing the benefit of delayed clamping?

— Midwifery Today

A: One hospital has changed their policy and implements delayed cord clamping (although it’s generally only around three minutes). Otherwise, it varies by provider. Most of the providers my moms are working with do delayed cord clamping as a matter of course and one of our local OB groups (with two CNMs and two OBs) is doing resuscitation at the perineum and leaving cords intact until they stop pulsating with immediate skin-to-skin. I haven’t seen an OB rush cord clamping in a while though, but all of my clients are demanding delayed cord clamping regardless.

— Chelsie Towns

A: They’re too impatient.

— Mary Bernabe

A: Oh how I wish we could change our language to preserve normal physiology, and start expecting “them” to defend “premature cord clamping”!

— Andrea Reynolds

A: In my town, hospitals have come to recognize the benefits of delayed cord clamping. There are even posters on the wall with messages of patience and reminders to not rush things. This is encouraging!

— Nancy Halseide

A: Yes, they tout delayed clamping, but that amounts to three minutes versus immediately!

— Rebecca Lynn Frye

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