1801
“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 portion of the blood being left in
the placenta, which ought to have been in the child.”

 Erasmus Darwin, (Charles Darwin’s grandfather) Zoonomia, 1801; Vol. III
page 321


1842
Meigs:  Regarding clamping a cord around the neck:

“The head is born: perhaps the cord is turned once, or even more than once
around the child’s neck, which it encircles so closely as to strangulate it.  Let
the loop be loosened to enable it to be cast off over the head. … [or] by
slipping it down over the shoulders. … If this seems impossible, it should be
left alone; and in the great majority of cases, it will not prevent the birth from
taking place, after which the cord may be cast off. … Should the child be
detained by the tightness of the cord, as does rarely happen, … the funis
may be cut … Under such a necessity as this, a due respect for one’s own
reputation should induce him to explain, to the bystanders, the reasons which
rendered so considerable a departure from the ordinary practice so
indispensable.  I have known an accoucheur’s capability called harshly into
question upon this very point of practice.  I have never felt it necessary to do
it but once. …  The cord should not be cut until the pulsations have ceased.”

Meigs C. Professor of Obstetrics and Diseases of Women and Children,
Jefferson Medical College.  A Philadelphia Practice of Midwifery, 1842

1850
Churchill F (1850) On the Theory and Practice of Midwifery. London: Henry
Renshaw.
p 91 (#181 The umbilical cord, funis, or navel string) “After birth of the child,
the pulsation ceases in about fifteen or twenty minutes, and that portion of
the cord which remains attached to the umbilicus dies, and gradually withers,
until it falls off, in the majority of cases, on the fifth or sixth day.”

p 131 “…in ordinary cases, if we find that the cord is twisted around the neck,
all we need do is to draw down more of the cord, and either slip the lop over
the head or shoulders.  If we cannot do this, we must loosen the cord as
much as we can, so as to prevent the strangulation of its vessels, and wait for
the uterus to expel the child.”

p 132 “If the child be healthy, and not have suffered from pressure, &c. it will
cry as soon as it is born, and when respiration is established, it may be
separated from its mother…”

1871
Cazeaux P (1871) A Theoretical and Practical Treatise on Midwifery.  Fifth
American from the Seventh French Edition by Wm R Bullock, MD.  
Philadelphia: Lindsay and Blakiston.
p. 406 “…the circulation existing between it [the child] and the placenta is
observed to continue for some time… pulsations in the arteries gradually
cease, commencing at their placental extremity; and some authors have
advised this event to be waited for before cutting the cord…”

1882 Lusk WT (1882) The Science and Art of Midwifery.  New York: D
Appleton and Company, pp214-215
"Infants which have had the benefit of late ligation of the cord are red,
vigorous, and active, whereas those in which the cord is tied early are apt to
be pale and apathetic."

"1. The cord should not be tied until the child has breathed vigorously a few
times.  When there is no occasion for haste, it is safer to wait until the
pulsations of the cord have ceased altogether.

2. Late ligation is not dangerous to the child.  The child receives into its
system only the amount of blood required to supply the needs created by the
opening up of the pulmonary circulation."

1910 Jellett, Henry (1910) 25.a.1910.1
A Manual of Midwifery for Students and Practitioners.  New York: William
Wood & Company MDCCCCX
p. 350
"As soon as the child is born, its eyes are wiped, any mucus in the air
passages is removed, and it is placed in a convenient position between the
patient's legs.  The cord is tied as soon as it has stopped pulsating, and the
infant is then removed."

                                             ---------------------------

1917
Williams JW (1917) Obstetrics: A Text-Book for the Use of Students and
Practitioners, Fourth Edition, pp342-343
"Immediately after its birth the child usually makes an inspiratory movement
and then begins to cry.  In such circumstances it should be placed between
the patient's legs in such a manner to have the cord lax, and thus avoid
traction upon it. "

"Normally the cord should not be ligated until it has ceased to pulsate.."

"I have always practiced late ligation of the cord and have seen no injurious
effects following it, and therefore recommend its employment, unless some
emergency arises which calls for earlier interference."

                                         – – – – – –

1921
von Reuss, August Ritter (1921)  WS 420 R446d 1921
The Diseases of the Newborn.  New YorkL William Wood & Co, MCMXXI
(Vienna, January 1914)

p. 419 – "… A compromise is usually adopted, in that the cord is not tied
immediately after birth, nor does one wait till the expression of the placenta,
but only until the cessation of pulsation in the cord, an average of five to ten
minutes."

1927
Willaims, J. Whitridge (1927)  25.A.1927.2
Obstetrics: A Textbook for the use of Students and Practitioners, Fifth
enlarged and revised edition. D. Appleton and Company, New York/London,
1927

"I have always practiced late ligation of the cord and have seen no injurious
effects following it, and therefore recommend its employment, unless some
emergency arises which calls for earlier interference…"

1930
DeLee JB (1930) The Principles and Practice of Obstetrics.  Philadelphia and
London: WB Saunders Company.

“p. 330 “Tying the cord. – After waiting until the pulsation in the exposed
umbilical cord has perceptibly weakened or disappeared, the child is severed
from its mother.  Until the cord is severed the child is still part of its mother
and has no legal existence…  During the four or eight minutes while waiting to
tie the cord the child obtains from 40 to 60 gm. Of the reserve blood of the
placenta – a fact that was first shown by Budin.  The blood is pressed into the
child by the uttering contractions, and part is aspirated by the expanding
chest.  This extra blood the child needs in its first days of life, and observation
has shown that such children lose less in weight and are less subject to
disease…”

1933
Curtis AH, ed (1933)
Obstetrics and Gynecology (3 vols).  Philadelphia & London: WB Saunders
Company.
Baer JL Chapt XXIV – The conduct of normal labor pp 702-844.

P 828 – "In most clinics the cord is not tied until pulsation has ceased.  This is
based on the accepted fact that the delay provides the infant with an
additional average of 60 to 90 cc of blood.  With premature infants or twins,
most of which are usually below the weights of average single infants, this
additional blood is a distinct advantage.  In full-term infants of normal size the
advantage is more theoretical than real."

1936
DeLee, Joseph B (1936)  25.A.1936.6
The Principles and Practice of Obstetrics, Sixth Edition.  Philadelphia and
London: W.B. Saunders Company, 1956.
[earlier editions: 1913, 15, 18, 24, 28, 33 (6th) à reprinted in 34 & 36]

p. 334 – "After waiting until the pulsation in the exposed umbilical cord has
perceptibly weakened or disappeared, the child is severed from its mother."

"During the four or eight minutes while waiting to tie the cord the child obtains
from 40 to 60 gm of the reserve blood of the placenta – a fact that was first
shown by Budin.  The blood is pressed into the child by the uterine
contractions, and part is aspirated by the expanding chest.  This extra blood
the child needs in its first days of life, and observation has shown that such
children lose less in weight and are less subject to disease.  It is an error, on
the other hand, to force the blood of the placenta into the child by stripping
the cord toward the child.  This overloads its blood vessels, causes icterus,
melena, even apoplexy …"

1937
Fitzgibbon, Gibbon (1937)  25.A.1937.2
Obstetrics. Browne and Nolan Limited, Dublin/Belfast/Cork/Waterford, 1937.

p. 128 "…If the infant has cried and has respired well for about five minutes,
there is no advantage in leaving at attached any longer to the placenta.  Its
pulmonary circulation has been opened up and the pulmonary vessels filled
with blood …"

1944 Read, Grantly Dick (1944) 25.B.1944.2
Childbirth Without Fear: The principles and practice of natural childbirth.  
Harper & Brothers Publishers, New York and London, 1944.

P 95 – "It is my custom to lift up the crying child, even before the cord is cut
…"
"Its first cry remains an indelible memory on the mind of a mother; it is the
song which carried her upon its wings to an ecstasy mere man seems quite
unable to comprehend."

1950
Eastman HJ (1950) Williams Obstetrics, Tenth Edition, pp 397-398

"Whenever possible, clamping or ligating the umbilical cord should be
deferred until its pulsations wane or, at least, for one or two minutes."

"There has been a tendency of late, for a number of reasons, to ignore this
precept.  In the first place the widespread use of analgesic drugs in labor has
resulted in a number of infants whose respiratory efforts are sluggish at birth
and whom the obstetrician wishes to turn over immediately to an assistant for
aspiration of mucus, and if necessary, resuscitation.  This readily leads to the
habit of clamping all cords promptly."

1951 Greenhill JP (1951)  25.A.1951.2)
Principles and Practice of Obstetrics; originally by Joseph B. DeLee, M.D.,
Tenth Edition.  W.B. Saunders Company, Philadelphia and London, 1951.

p.251 "After waiting until the pulsation in the exposed umbilical cord has
ceased, the child is severed from its mother."

"DeMarsh, Alt, Windle and Hillis showed that those infants whose cords were
not clamped until the placenta had separated from the uterus had on average
0.556 million more erythrocytes per cubic millimeter and 2.6 gm more
hemoglobin per 100cc during the first week than those whose cords were
clamped immediately.  These authors maintained that early clamping of the
umbilical cord is equivalent to submitting the child to a hemorrhage at birth.  
Wilson, Windle and Alt found that infants whose umbilical cords were clamped
immediately after birth had a lower mean corpuscular hemoglobin at eight and
ten months of age than those whose cords were clamped after the placenta
began to descend into the vagina.  It was suggested then that early clamping
of the cord may lead to an iron deficiency during the first year of life."

"McCausland, Holmes and Schumann advise stripping the cord and placental
blood into the infant because it is harmless if done gently and because term
babies receive about 100cc of extra blood in this way.  These authors claim
that babies receiving this blood had higher erythrocyte counts, higher
hemoglobin values, higher initial weights and less initial weight losses."

1952
Greenhill, JP (1955) WQ 100 G812p 1955
Obstetrics Eleventh Edition WB Saunders Company, Philadelphia and
London.
[1913, 15, 18, 24, 28, 33, 38, 43, 47, 51]
 1       2    3    4    5    6    7     8   9   10

280-282 -  "Immediately after the baby is delivered it should be held well
below the level of the vulva for a few minutes or placed in a warm container
the level of which is considerably below the mothers' buttocks (Fig 279).  The
purpose of keeping the baby at this level is to permit the blood in the placenta
to get to the baby.  Dieckmann and associates maintain that this procedure
will add from 50 to 75 percent of the blood in the placenta and cord to the
newborn child.  If the placenta separates while waiting, expressing it from the
uterus and holding it elevated for two or three minutes will accomplish the
same purpose.  The cord is cut after about three minutes or after it
collapses.  If the baby is in a special container, it is left in until after the cord is
cut.  As soon as possible after delivery any mucus in the air passages must
be removed with a soft rubber bulb or a tracheal catheter.

Tying the Cord.  After waiting until the pulsation in the exposed cord has
ceased, using dull scissors, the child is severed from its mother.  With a piece
of linen bobbin, coarse silk, rubber band or any sterile strong string, the cord
is ligated close to the cutaneous margin of the umbilicus , making sure that
there is no umbilical hernia which might allow a loop of intestine to be caught
in the grasp of the ligature.  It is important to leave as little as possible of the
cord to be cast off except when a baby has erythroblastosis…"

"DeMarsh, Alt, Windle, and Hillis showed that infants whose cords were not
clamped until the placenta had separated from the uterus had an average of
0.56 million more erythrocytes per cubic millimeter and 2.6 gm. More
hemoglobin per 100 ml. during the first week than those whose cords were
clamped immediately.  These authors maintained that early clamping of the
cord is equivalent to submitting the child to a hemorrhage at birth.  Wilson,
Windle and Alt found that infants whose umbilical cords were clamped
immediately after birth had a lower mean corpuscular hemoglobin at 8 and 10
months of age than those whose cords were clamped after the placenta
began to descend into the vagina.  Thus early clamping of the cord may lead
to an iron deficiency during the first year of life.

McCausland, Holmes and Schumann advise stripping the cord and placental
blood into the infant because it is harmless if done gently and because term
babies receive about 100 ml of extr blood in this way.  Babies receiving this
blood have higher erythrocyte counts, higher hemoglobin valuies, higher
initial weights and less initial weight losses."

Dieckmann, WJ, Forman JB, and Philips GW:  Effects of Intravenous
Injections of Ergonovine and Solution of Posterior Pituitary Extract on the
Postpartum Patient.  Am. J. Obst. & Gynec 60:655 (Sept) 1950.

p 281 – "After waiting until the pulsation in the exposed cord has ceased,
using dull scissors, the child is severed from its mother."

P 832 – "In attempting to account for the death of babies delivered by
cesarean section, Landau and associates concluded that blood loss to the
child incurred by immediate clamping of the cord amounted to 90 ml, a
quantity of definite significance, especially in preterm infants.  Improvement
was noted in the condition of babies when drainage of blood from the
placenta, after its removal, was facilitated by suspending it in a towel above
the child for six to ten minutes or until the cord vessels collapsed."
Landau DB et al. (1950) J. Pediat 36:421, April 1950.

1958
Willson JR, Beecham CF, Forman I, Carrington ER (1958)   WP 100 x02 1958
Obstetrics and Gynecology.  The CV Mosby Company, St. Louis, 1958

P 337 –
"The baby is held with its head downward for a few seconds while the cord is
stripped from the introitus toward the infant several times.  This adds 75 or
more ml of blood, which would otherwise be discarded with the placenta, to
the infant's vascular system."

P 373 –
"The blood in the fetal circulation is distributed between the vessels in the
infant's body and those in the placenta …"

"…At the end of the second trimester about half the total blood is in the
placenta, but as the baby grows larger relatively more is contained in the
infant itself.  The blood volume of the newly born baby is only about 250 ml.  
Consequently as much as possible must be preserved.
 If clamping and ligation of the cord are delayed for several minutes after the
baby is born, as much as 100 ml of blood will be transferred from the placenta
to the baby.  The same result can be obtained by stripping the cord from the
vulva toward the infant repeatedly until no more blood enters the vessels from
the placental end."

1965
Greenhill JP (1965) WQ 100 G 812p 1965
Obstetrics: Froim the original text of Joseph B. DeLee, MD. Thirteenth Edition.
W.B. Saunders Company, Philadelphia & London.
[1913, 15, 18, 24, 28, 33, 38, 43, 47, 51, 55, 60]

   1     2    3    4    5    6    7    8    9  10   11  12

p 376 – "After pulsation in the exposed cord has ceased, using dull scissors,
the child is separated from its mother."

1966
Taylor, E. Stewart (1966) WQ 100 B40 1966
Beck's Obstetrical Practice, Eight Edition.  The Williams & Wilkins company,
Baltimore, 1966

p. 202 – "After delivering the child, the obstetrician suspends it by its feet …
During this time the fluid within the tracheobronchial tree may be expelled by
gravity.  Most infants take their first extrautering gasp at this time, and it is
well to have the trachea clear."

"If the obstetrician waits until the cord stops pulsating, the child receives a
considerable amount of blood (up to 100 ml).  This procedure is harmless to
the normal infant and may be beneficial.  However, the extra blood volume
from the placenta may be detrimental in some pathological conditions of the
infant.  The most notable of these are maternal-fetal blood group
incompatibilities, anomalies of the infant cardiovascular system, or severe
fetal asphyxia."

"In normal full-term deliveries, the cord is clamped with two hematostats as
soon as the cord stops pulsating."

1966
Fitzpatrick E, Eastman NJ, Reeder SR (1966)
Maternity Nursing, Eleventh Edition, JB Lippincott Company, Philadelphia,
Toronto, 1966.
[1929, 33, 34, 37, 40, Zabriskie's Handbook of Obstetrics, 1st to 6th editions
by Louise Zabriskie]
[1943, 48, 52, 7th to 9th editions, Zabriskie's Obstetrics for Nurses, Tenth
Edition, 1960, by Elise Fitzpatrick  & Nicholson J. Eastman]

p 268 –
"…The infant usually cries immediately, and the lungs become expanded;
about this time the pulsations in the umbilical cord begin to diminish.  The
physician usually will defer clamping the cord until this occurs, or for a minute
or so if practicable, because of the marked benefit of the additional blood to
the infant."

P 288 (emergency delivery) –
"There is no hurry to cut the cord, so this should be delayed until proper
equipment is available.  It is a good plan to clamp the cord after pulsations
cease (but not imperative at the moment) and to wait for the physician to cut
the cord after he arrives."

1969
James LS (1969) Resuscitation of the newborn, in DE Reid and TC Barton,
eds, Controversy in Obstetrics and Gynecology.  Philadelphia, London,
Toronto: WB Saunders Company, pp 220-221.

"In infants delivered by cesarean section, hemoglobin, hematocrit value, and
blood pressure have frequently been found to be lower than in infants
delivered per vaginum … due to a loss of blood into the placenta, since the
uterus is not contracting."

"Asphyxiated newborn monkeys resuscitated before the last gasp show little
or no cerebral damage.  On the other hand prolongation of asphyxia for as
short a period as four minutes after the last gasp is accompanied by
widespread tissue damage and abnormal behavior in the surviving animals.  
Thus for the newborn monkey the 'safe' period of anoxia is short if functional
integrity is to be maintained."

                                         – – – – – –


1976
Beischer, Norman A & MacKay Eric V. (1976) WQ 100 B 4230 1976
Obstetrics and The Newborn: For midwives and medical students.  W.B.
Saunders: Sydney, Philadelphia, Toronto, London, 1976

P 261 -  "The umbilical cord is usually clamped some 30 seconds after
delivery, after nasopharyngeal aspiration has been carried out."

p. 259 – illustration 41.6
"J.  The mother has been turned into the dorsal position and the cord is
checked for pulsations.

K.  The cord is divided between clamps, or, alternatively, when pulsations
cease, the cord is clamped close to the baby's umbilicus using the plastic
device shown in figure 41.6 L."

395 – "The optimal time for clamping (or tying) the cord is not known for
certain.  Late clamping of the cord results in an additional volume of blood
reaching the infant.  This is harmful in premature and erythroblastotic infants.  
In the asphyxiated infant, early clamping allows rapid transfer of the child for
resuscitation purposes.  In other patients, the cord is clamped when
pulsations cease."

1983
Bodyazhina V (1983)  WQ 100.3 B667u 1983
Textbook of Obstetrics: Translated from the Russian by Alexander Rosinkin
(revised from the 1980 edition). Mir Publishers, Moscow

156 -  "The umbilical cord should be tied up after its vessels stop pulsating,
which occurs in 2-3 min following the delivery of the infant.  In the course of a
few minutes that the umbilical cord pulsates, from 50 to 100 ml of the blood is
delivered into the vascular system of the foetus from the placenta.  As soon
as the pulsation discontinues, the cord should be cut off and tied up in
asceptic conditions."

1986
Beischer, Norman A & MacKay Eric V (1986) WQ 100.3 B 4230 1986
Obstetrics and the Newborn: An illustrated textbook, Second Edition.  WB
Saunders Company, Sydney, Philadelphia, London, Toronto, Tokyo, Hong
Kong, 1986.

p. 381 -  The optimum time of clamping is 30-60 seconds after birth:  This will
provide some 80 ml of extra blood to the baby.  Excess blood volume in the
baby can be a disadvantage, producing polycythemia and hyperviscosity, with
such attendant problems as respiratory distress, heart failure, jaundice,
convulsions and apathy."

p. 546 – "The optimal time for clamping (or tying) the cord is not known for
certain.  Late clamping of the cord results in an additional volume of blood
reaching the infant.  This may result in hyperviscosity, jaundice and
cardiorespiratory, neurological and renal problems.  The extr blood
specifically aggravates jaundice in premature infants and in those with
erythroblastosis, so early clamping of the cord is advised in such infants."

P 710 –
Q.  What is the significance of continued pulsation of the arteries in the
umbilical cord at birth?
A.  It means that respiration has not commenced.  The physiological stimulus
causing closure of umbilical arteries (and ductus arteriosus) is an increase in
oxygen saturation of the blood which occurs when the lungs expand with air."

P470 –
"Apgar scores are recorded at 1 minute and again at 5 minutes, timing the
observations accurately (see chapter 43, table 43.1).  Also the time to first
breath and time to the establishment of regular respirations are recorded."

"Permanent cord clamps or ligatures (Figure 26.27) or special bands are
applied to the umbilical cord as soon as possible after birth…"

pp 734-5
"Routine practices concerning the time for clamping the umbilical cord vary.  If
the child's condition is satisfactory cord clamping and severing can be
delayed until pulsation has stopped and the infant is position at or below the
level of the mother.  The additional blood transfused from the placenta can
be as much as 100 ml.  The benefits of this are not fully evaluated but the
additional volume may be harmful in preterm infants.  Early clamping
facilitates prompt resuscitation, if required, and transfer to the mother's
arms…"

1987
(3rd ed) p 258 – Needs of the term infant, by Ernest N. Kraybill
"… with present information it seems reasonable to avoid the extremes of
immediate and of very late clamping.  The first 30 to 60 seconds after delivery
are well spent in suctioning the airway … The normal newborn invariably cries
during this interval …"


1988
Hibbard, Bryan M (1988)  WQ 100.3 H624p 1988
Principles of Obstetrics.  Butterworths, London, Boston, Durban, Singapore,
Sydney, Toronto, Wellington.

P 470
"Apgar scores are recorded at 1 minute and again at 5 minutes, timing the
observations accurately (see chapter 43, Table 43.1).  Also the time to first
breath and time to the establishment of regular respirations are recorded."

"Permanent cord clamps or ligatures (Figure 26.27) or special bands are
applied to the umbilical cord as soon as possible after birth…"

pp 734-5

"Routine practices concerning the time for clamping the umbilical cord vary.  If
the child's condition is satisfactory cord clamping and severing can be
delayed until pulsation has stopped and the infant is positioned at or below
the level of the mother.  The additional blood transfused from the placenta
can be as much as 100 ml.  The benefits of this are not fully evaluated but
the additional volume may be harmful in preterm infants.  Early clamping
facilitates prompt resuscitation, if required, and transfer to the mother's
arms…"

1994
McGregor Kelly, Joan      WS 420 N441 1987, 1994
General Care (chapt 22) in Avery GB, /fletcher MA, MacDonald MG, eds .  
Neonatology, Pathophysiology and Management of the Newborn, Fourth
Edition.  J.B. Lippincott Company, Philadelphia, 1994 (1987, 1981, 1975)

P. 301 cites Cunningham et al. (Williams Obstetrics, 18th ed.)

"…As soon as possible after suctioning, the cord is clamped…"

"… consequences of a significant shift [of blood volume] toward the infant
include polycythemia, circulatory volume overload, and hyperbilirubinemia,
and these generally outweigh any potential advantage of augmenting the
infant's iron reserve…"
http://placentalrespiration.net/
From the bibliography for
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