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I think these articles are interesting, but
although I am an advocate for physiological third stage and delayed if any
clamping at all, for a normal birth, I don't think I agree with or understand
the neonatal physiology arguments in some of these articles.
Firstly re neonatal anemia in Zanzibar,
while early cord clamping may not improve
the situation I don't think it causes it, it would be due, I think, to malaria
or other parasitic maternal infections, which do affect the fetal haemoglobin
levels. Thus the fetus is anemic and hence hypoxic inutero, this I think, is
where the brain damage would occur. I haven't worked in Africa, but my eldest
daughter has, in Ghana, and has assured me that the effects of maternal malaria
are profound and not limited to neonatal anemia.
Second, and the last at this moment
of time, fetuses have high levels of hemoglobin because, life in utero is a
low oxygen environment, therefore you need more red blood cells to get the
oxygen needed to the tissues, fetal hemoglobin has a lower partial pressure of
oxygen and so is unsuitable as an oxygen carrier after birth. Also, as the
placenta is shearing off after birth, its function as a waste transfer organ is
over, and the pulse is coming from the baby, so unless the baby is kept lower
than the uterus, the baby is loosing blood, not gaining it. These extra fetal
hemaglobin carrying red blood cells are being recycled just before and
after birth as the oxygen environment changes. It is the different partial
pressures of oxygen in the baby's blood after he/she starts to breathe that
contribute to the change from fetal circulation that the baby needs to make to
continue to be adequately oxygenated. All of this means to me that if a baby
needs to be resuscitated and the cord needs to be cut to facillitate this, then
it is ok. But this is not in a normal birth.
Marilyn
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Title: Message
- FW: cord clamping Vicki Chan
- cord clamping Marilyn Kleidon
- cord clamping elizabeth mcalpine
