Midwifery Today Community

 hi! i work in a hospital as a midwife and there we must give pitocin after birth. I have noticed that if i administer Pitocin IM ( 10- 20 units) right after baby is born the mother bleeds a lot less (100 CC blood) then when i wait and give the Pitocin (IM or IV) after the placenta comes out (300-500 CC). So, in knowing that, i would always administer the pitocin right after baby was born. but here is the dilema,  I would also love to clamp the cord after it stops pulsing but i am worried that the pitocin that i gave the mother might harm the baby b/c it is a big amount and the baby is still attached. i know the baby has a lot of oxytocin right after birth, but if he gets it unnaturally, and its so much, maybe it could harm him, like high/low blood pressure which we know the pitocin sometimes does to the mother. 

 what do you think?

another question,  one of the causes of neonatal jaundice is polycetemia, and if the baby is attached longer to the cord to the placenta he will get more blood so it can cause neonatal jaundice and sometimes he will need phototherapy and that is more seperation from the mother and anxiety etc etc. first- do no harm, so, maybe i should clamp the cord fast? now i know clamping the cord later will also raise the hemoglobin of the baby in his first few months which is great, but i am in an area of the world where there is great nutrition so i am not so worried about the hemoglobin. what do you think?

thank you!!

I am hoping that more than one midwife will reply so that you can get a good amount of opinions, but have you seen George Morley's information?

http://www.whale.to/a/morley1.html

and here is the very conservative US opinion: http://jama.ama-assn.org/content/297/11/1241.short which actually addresses polycythemia and refers to it as "benign" (normal, full term infant).

and then: http://www.hutchon.net/cordclamping/index.htm

More links:  http://erinmidwife.com/2011/05/30/omg-you-did-not-just-clamp-out-a-third-of-my-babys-blood-supply/

Penny Simkin:  http://www.youtube.com/watch?v=W3RywNup2CM

I don't know where you work.  What about informed consent and refusal? Does mother have the right to refuse routine pitocin after birth?

Thank you for the links. yes, mothers can refuse routine pitocin after birth- but they rarely refuse.

ok, so i am convined that late cord clamping is the way to go but still, active management of the third stage of labor has been proven to save mothers from PPH (more than expectant management).

In one of the links you sent, it was written they are now combining both active management and late cord clamping but they don't know the effects of the pitocin on the baby. I'm nervous to do this if i don't know what the effect on the baby will be. (its like giving the baby a huge amount of hormon)

thanks for your time 

Newbe,

when you have delayed cord clamping/cutting you'll have mama/babe skin to skin, nursing, bonding in, hopefuily, a dim, quiet atmosphere and mama will have a burst of natural oxytocin.  Why interfere, unless there is a need?  Give mama and babe the opportunity and gift to do what nature has intended them to do.

I have found that most well nourished women who don't get induced, don't have excessive blood loss at birth. Remember the blood volume doubles during pregnancy, so mom can afford to  loose a fair amt. of blood afterwards. Why do you think nature has to be improved with artificial hormones? The way I practice "active mgmt" is far different from how you do it. I stress dark green leafy veges during pregnancy. The best defense is a good offense after all. I rarely cut the cord before the placenta is out, and rarely see more than a touch of jaundice. Putting baby right to breast, skin to skin, helps the uterus clamp & the placenta comes naturally. I don't carry pit, just OTC herbal remedies. If I see 2 cups of blood before placenta is out, I don't wait to see the actual pph,  because I know there's usually about double that behind the placenta as well. So I start giving herbs right away, and it stops promptly. But  never give the herbs unless I see an indication. Anyway, that is my version of active mgmt, I do not passively  stand by & watch a pph happen before taking  measures. Nor do I rely on artificial substances but on the green herb God gave us to use for our health. In the rare instance the herbs don't work, I give a little slice of bucchal placenta.  So far in all these years it has never failed except for one case of accretion, which needed & D&C.

Thanks for weighin in, Marlene!  So glad you did!!!!