1 – Who cares or takes an interest in the outcome?
Cutting off placental circulation within seconds after birth may be dangerous.  
Apgar et al. stated in 1958 that all infants with a score of 8, 9,or 10 were
vigorous and breathed within seconds of delivery.  Infants who are not
breathing within seconds nevertheless, per protocol, have their umbilical
cords clamped and are given over to a neonatologist for resuscitation.  In
1953 Apgar commented that breathing (a satisfactory cry) is sometimes not
established even when the infant leaves the delivery room [2].  At this point
the infant is at risk for brain damage and other adverse outcomes.
Is  my baby all right?
Apgar wrote a book for mothers, Is My Baby All Right (1972).  In this book she
discusses the dangers of placenta praevia, prolapse of the umbilical cord
during labor, and umbilical cord around the neck, along with problems like
prenatal rubella infection and genetic metabolic disorders, but  clamping the
cord at birth is not even mentioned - only that circulation from the cord stops
after the baby is pushed from his mother's body:
"Asphyxia can also occur after birth, if the baby does not begin to make
successful attempts to breathe on his own.  Usually breathing is
triggered by a complex combination of chemical and mechanical
changes within the just-born baby as he is pushed from his mother's
body and circulation from the cord stops..." (Apgar & Beck 1972, p123).
No attempt was made to explain the "complex combination of chemical and
mechanical changes within the just-born baby."  What about the most urgent
continuing and essential need of the just-born baby for oxygen?
Your baby didn't breathe at the moment of birth?  That's your problem.
We need to be able to do better than consult people of authority with
questions like, "Is my baby all right?"  What if the baby didn't breathe within
seconds of birth, and was assigned a low Apgar score at 1 minute, or worse
at 5 minutes?  Whose responsibility is the cost of life-long disability?  Why did
you cutoff my baby's oxygen supply, and leave him exsanguinated, pale, and
limp?  Then in the newborn nursery you wrote in his record he had no "Moro
reflex" and his muscle-tone was poor, but you sent him home with me as a
"well baby."  That was the extent of any outcome study.
Then it becomes a family problem.  Most tax-payers don't want money wasted
on special education programs for children who are not educable.  Waiting
lists for adult services are all families with a "special child" have to look
forward to.  Permanent disability is an intolerable burden for society as a
whole, and for communities who fight opening of group homes in their local
area.  No group is more discriminated against than the mentally disabled, and
the stigma on other family members is severe.
We should be able to expect more from professional experts than the
hypotheses they spin off well-funded research studies that seek gene loci on
"candidate chromosomes" and to try to show that parents and siblings of
handicapped children also have learning problems, or look for outcome
measures that go no further than behavior in the newborn nursery.
Neglect of historical data
Perhaps worst of all is failure to look back further than 20 or 40 years in the
medical literature, thus having to perpetually try to re-invent the wheel.  At a
conference I recently attended, one young investigator began her
presentation with the remark, "Very little is known about the effects of hypoxia
on the brain."  How wrong!  Excellent data is available in the medical literature
from over 150 years ago.  A great deal of it is written in French or German,
which is why, in the past, reading proficiency in these languages was a strict
academic requirement for scientists in training.  The data and its interpretation
remain valid.  Certainly the Cochrane Reviews ought to look back beyond the
year 1966.
http://placentalrespiration.net/
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