Childbirth practices, protocols, or "standards of care"
Home   --------   Site Map


an urgent ongoing need

fetal to postnatal circulation





Question Authority




Contact: Eileen Nicole Simon
Apgar scores of
8, 9, or 10
Cochrane Review
Comments on the
Cochrane Review
Slow birth
Apgar et al. also wrote in the 1958 paper:
“All infants with a score of 8, 9,or 10 are vigorous and have breathed within
seconds of delivery.  In this group, scores of 8 or 9 reflect a lower score for
color.  The infants with a score of 4 or less are blue and limp and have failed to
establish respiration by one minute.” p 1987
Thus, in contrast to the opinion expressed by White in 1773, it is expected that the
transition from fetal to neonatal respiration should take place within seconds of
delivery.  Despite much evidence that respiratory distress in the newborn period results
from cutting off placental respiration too soon, clamping of the umbilical cord within
seconds of delivery is still practiced half a century later.  The 2005 edition of William's
Obstetrics provides the following instruction
"Clamping the Cord. The umbilical cord is cut between two clamps placed 4 to 5
cm from the fetal abdomen, and later an umbilical cord clamp is applied 2 to 3 cm
from the fetal abdomen. A plastic clamp (Double Grip Umbilical Clamp, Hollister)
that is safe, efficient, and fairly inexpensive is used at Parkland Hospital..."
"... Our policy is to clamp the cord after first thoroughly clearing the airway, all of
which usually requires about 30 seconds. The newborn is not elevated above the
introitus at vaginal delivery or much above the maternal abdominal wall at the
time of cesarean delivery."  
From chapter 17, section IV, online version
The above policy was based on opinions voiced in one article (from 1974) that
placental transfusion raised the risk for hypervolemia and hyperbilirubinemia, especially
in infants born prematurely - see full excerpt below.
Posted: February 27, 2006
(a work in progress)
<<<  6b  >>>