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Peripartum practices

Joanna Parga-Belinkie, MD and Solomon Behar, MD
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Sol and CHOP NICU doc Joanna Parga-Belinkie review the evidence behind some of the peripartum practices that happen in the delivery room and in the immediate aftermath.

  • Delayed cord clamping is recommended by the Neonatal Resuscitation Program (NRP) and by American College of Obstetricians and Gynecologists (ACOG) and entails waiting for anywhere from 30 seconds - 3 minutes after birth to cut the umbilical cord.

    • The position of the baby is not thought to be that important.

    • For term infants, the benefits of delayed cord clamping include increased hemoglobin and improved iron stores (for months). 

    • For premature infants, delayed cord clamping has many benefits:

      • Decreased rates of intraventricular hemorrhage, necrotizing enterocolitis, chronic lung disease and need for blood transfusion.

  • Risks include: polycythemia and hyperbilirubinemia.

  • Contraindications for delayed cord clamping involve need for immediate neonatal resuscitation, congenital malformations that make the procedure difficult and maternal hemodynamic instability.

    • In these situations, the OB may decide to “milk” the cord for 10-15 seconds to try to get some blood to the baby.  This practice has not been well studied.  

  • Cord banking has to be initiated by parents, so pediatricians should be discussing with their families prenatally.  The AAP recommends cord blood be publically banked for all babies.  

    • The umbilical cord contains mostly hematopoietic STEM cells (precursors to blood cell lines), but there is also evidence of pluripotent STEM cells in cord blood, too.   

    • The process of collecting cord blood is as follows: after the cord is cut, a needle is placed into the cord and blood is extracted.

      • Because this requires labor and resources, not all hospitals offer cord blood banking.  After the appropriate information is filled out, the public bank will decide whether to accept the cord blood and will cover all the expenses to get the blood there.

      • Private cord blood banking is a big business.  Families should be educated to the following: only about 0.06 percent of the population will ever require the use of these STEM cells, private banks have individualized quality oversight and cost money.  

    • There are currently about 80 diseases for which STEM cell transplants are standard treatment and that one could use cord blood banks for these STEM cells.

    • Delayed bathing (meaning the first bath for baby happens at  24 hours of life) is practiced in many hospitals. The suggested benefits include: improved bonding time, improved breast feeding rates and decreased cold stress hypoglycemia. 

    • Practices that are not endorsed by any professional organization, but are seen in certain communities include:

      • Lotus Birthing  or umbilical nonseverance: in this birthing practice, the cord is not cut but stays attached to the placenta; the intact cord and placenta stay with the baby (even when the baby goes home) until the cord falls off.  Generally, the placenta is placed in some sort of bag.

        • There is no scientific reason this would be beneficial and may, in fact, cause harm as the placenta is now dead tissue. 

      • Vaginal Seeding: this practice involves placing gauze inside the vagina and after the baby is birthed by c-section the babies face is swabbed with this gauze.  The practice likely stemmed out of the proposed idea that the mode of delivery affects the neonate microbiome; recent research has challenged this idea.

        • There is no consensus to support this practice and it may, in fact, be harmful as this is also a way to spread infection to the baby (HSV, GBS).

      • Placentophagia (ingestion of the placenta): the notion is that this will somehow increase postpartum energy, improve milk supply and improve iron stores.   This process is not regulated. 

        • The CDC traced a case of invasive GBS infection in a neonate to placental pills.

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Hippo Peds RAP - November 2019 Written Summary 328 KB - PDF

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