Optimal Cord Clamping, with Amanda Burleigh

When to clamp the cord that leads from placenta to baby has become a contested issue in recent years. Today’s guest, Amanda Burleigh, has fought long and hard to introduce evidence-based practice and advocates delayed cord clamping for better baby health.

Amanda talks openly about her personal journey to discover the benefits of delay and how it works in practice. We also bust some myths that women have encountered during delivery, including the facts behind cord blood donation and storage. And finally we give you the tools you need to advocate for delayed cord clamping.

Find out more from Amanda at https://waitforwhite.com/

Please subscribe, rate and review, so we can get this vital info to as many parents-to-be as we can!

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Transcript

Megan Rossiter  00:00

Ad - This episode is brought to you in partnership with iCandy. I've been using our iCandy peach pushchair almost daily for the last seven years and counting. And I've really put their five year warranty to the test using it for both my boys on muddy walks in aeroplane holes in and out of my car boot and aside from being completely filthy, my fault not theirs. It's still going strong. I can't wait to tell you more about my experience with eye candy later in the show. 

Megan Rossiter  00:29

You're listening to the Birth-ed podcast. I'm your host and founder of Birth-ed, Megan Rossiter. If you're looking for the evidence, the nuance the detail that's missing from your antenatal appointment, then I've got your back. The Birth-ed podcast is here to help you sort the facts from the advertising the instinct from the influences and the information you're looking for from the white noise of the internet. I hope you've got a cup of tea in hand and a notepad at the ready. Let's dive in.  

Megan Rossiter  00:55

Hi, everybody. Welcome back to the Birth-ed podcast. I am delighted to be joined today by midwife, Amanda Burleigh She is a midwife and registered nurse with over 30 years practicing as a clinical midwife. She is also founder of the campaign, which for white and has been working for the best part of 20 years to improve chord care and optimal clamping practice for newborn babies, which is the topic of our conversation today. Amanda, thank you so much for joining me.

Amanda Burleigh  01:22

Thanks for inviting me, Megan.

Megan Rossiter  01:24

Not at all. So I wonder if you could sort of if we could start by scooting back maybe 20 years or so. And if you could share a little bit about what was going on then and why your interest in cord clamping was piqued initially,

Amanda Burleigh  01:39

oh, I trained as I was a registered nurse. I trained as a midwife in 1988. So it was 18 months training. And I practiced immediate cord clamping as we were taught for 16 years. I was a very diligent midwife, I was a very woman centered made by if I was a very, you know empowered women, I did all the things we were supposed to do. And I thought yet, you know, I'm quite good at my job. Anyway, I had two children, some are nuts. And they both have ADHD. And before I go any further, I will say that I don't think immediate poor clumping causes ADHD, although I don't think it particularly helps. But I also noticed that my colleagues and friends seem to have a higher percentage of children who had difficulties, or both my children went to different schools. And because they had needs, I was involved with the educational, you know, the the school, the math, and at the end, then two different schools. And they were both saying the same things, that there was something not quite right. Every classroom had a table of children who have behavioral learning problems. And they thought that something was going on. Because I did this to myself, I was a job share. There was six of us doing job shares, we had 15 Children, six girls and nine boys. And I think eight boys. Seven of them had learning problems of some type in a dyslexia or ADHD, one was chromosomal. But there was just something it just didn't seem, you know, I'm quite forensic by nature anyway. So I started looking at lots of different things, you know, whether we were going to do with tea and coffee, whether people were drinking alcohol, whether it was sugar in the tea, whether it was a hibiscus in theater, whether there was anybody smoking maki Bucky was the alcohol, and it was like a needle in a haystack. And then one night, I watched a film called Vera drink, which was about an abortionist in the 60s, that was really good film. And she was an abortionist in the 60s. And she just thought that she was an altruistic practitioner. She knew how to do abortions. She told that women were either single and didn't want to be pregnant, or they were married and has loads of kids and didn't need them to the pregnancy, though she has to offer the altruistic service of giving them an abortion, didn't ask for any money. Did the deed went on the way. And then she was caught and she was in prison. She was imprisoned. And then the end of the end of the film two other abortionist came up and said, did your women die? And she said What do you mean? And they said Why are women dying? Did your women die? And that was it. I saw that she had a light bulb moment where she realized that what she was doing, I thought was helpful was actually harmful. And I was in the Lake District that we can ultimately reflected which was supposed to do on our practice and I thought we'd cut the cord as soon as baby's born. And then I started looking to see what evidence did was to support that action. And of course it was known in fact the the evidence there was a man in America as a consultant George Morley had written that the he had done research on monkeys where they did immediate cord clamping and they there had irreversible brain hypoxia, lack of oxygen, or they died. And he said that the coal plant was the most dangerous piece of equipment that had ever been invented. Well, I was like, Oh my God, because we were taught that you know, we were taught by midwives who were very strict in their practice. We Good training. But if we didn't get the clumps on quickly, you know, we wouldn't process sometimes we used to get on slots. And these babies had codes clump that were full of blood before they take their first breath. And now I look back, you know, I knew at the time I thought we'll look back and think this is completely bonkers. But then I thought, right, okay, evidence based practice. This is what's supposed to do this is gonna be easy to change. And I couldn't be further from the truth really, I wrote to a consultant obstetrician, a neonatologist and a nice to test. And the midwife who directs the midwifery had a midwifery. The head of midwifery trained at Wakefield, which was an adjacent trust, and it was a small one and they didn't do immediate call clumping is the only place I've heard that they used to the immediate call clumpy came in when oxytocin came in because they used to get the oxytocin to prevent hemorrhage, which of course did work, because hemorrhage was one of the leading causes mortality, particularly in home births, but they deciphered it differently. They deciphered that they get the oxytocin after the cord and stop pulsating. So they it's the only hospital I found were done by trial or error, or by common sense. They chose to do it differently to everybody else. But everybody else that we knew right across the world was doing immediate cord clamping. So the so she's the one we do that, you know, we do that anyway, so but we didn't get it changed. And then the obstetrician used to come through the water and trying to hide from me. The anesthetist said to me, you're probably right, but I won't say anything. And then in a solid dress, Simon Newell sat down to chat with me. And he said, You need evidence to prove what you're saying he's right. And it's all the culture, we haven't got any evidence to say what we're doing is right. But he was anyone that give me the time, I don't really I had a really interesting conversation. And he wrote a letter A paper to my managers to say, I had an interesting theory, and we need to get evidence. But then I was working as a community midwife, and I worked in different areas of community and women were coming in asking for did I call plan Polonius to say, you know, we've got the evidence that shows that immediate problem, because there's anemia. And it's the research said, It's better to leave the cord and people got it like that, you know, I mean, it's not this is not rocket science. But then when the women who haven't zero in sections, who also got it were coming in, the doctors were going down and knocking on the door to their midwives office saying, Who is this midwife shutter up. At the same time, I was working with a group of consultants. In 2010, we, we invented the basics trolley, which is the livestock trolley, which is a mini riskless attack that goes next to the mom when the baby's been born. And it means that the baby can have intact cold resuscitation at the same time, as the percenters decline the baby with the oxygenated blood volume, which they need, because we realize that premature babies and compromised babies were the babies that really needed that blood volume. You know, any birth worker that's been in a room that a baby comes out white and floppy, the baby is white and floppy, because the blood is actually still in the placenta, you know, you look at shoulder dystocia, where the call is being compressed and the backs up in the placenta and the baby comes out, we cut the cord, premature babies as well, they think that they have at least 50% of the blood in the placenta. And the research has shown that. So we knew that these babies were the babies that really, really needed delay call clumping. And that's why we've reduced it when it's in production in 2011, when we won an award for that, and it's 2004. And a handful of hospitals have got the beds the rest of the Resistance has where they should be in every hospital, they should be there's no two ways about it. The resource allocation guidelines now say that the baby's poor should be left in sub 60 seconds, which includes stimulating the baby with a cord in chapter six, five rescue breaths, which can easily be done and should be done with recording sounds. But it's quite a rare occurrence. We still have this these scenarios where babies are born flat, and we cut the cord immediately rush them over to the rest of the tower. Whereas if we leave them attached to them and let the placenta do their job, which they've been doing all the way through nine months, they've been on delay boat, you know, they've been retrieving these babies from decelerations and doing their own thing. And instead we decided that we know best and we cut the cord. There was some research done by in Sydney that showed that babies that had wrist are set compromised and premature babies that 100 Delayed cord clamping they would we think that they would save at least 100 I think it's 150,000 babies a year pattern delightful campaign. So well. The evidence is out there. 

Megan Rossiter  09:36

Yeah, I mean, what you were saying that about? The kind of situation that we're in is that it was brought in without evidence base like quite a lot of surprisingly quite a lot of things in maternity care brought in without an evidence base. And you know, at one point, I think I'll ask the question here, What are the benefits of leading leaving the cord intact, but even the fact that that would be a question kind of highlights this issue that we Haven't maternity care is that we are asking you, or asking somebody to prove that nature is better than intervention, even when intervention was brought in for no reason, because this is how we've always done it. But when we say always done it, we're talking about the past kind of 50 to 100. Year. So most things, aren't we, just to kind of summarize if somebody's coming to this kind of episode, and this is the kind of first conversation that they're having about cord clamping, they didn't even realize that it was something that they might actually have an input over or a conversation that they might want to start exploring. Are you able to kind of sum up the sort of potential downside to clamping and cutting the cord immediately after the birth? Sort of as you have done, but just in a kind of almost listing way? In a listening way? 

Amanda Burleigh  10:47

Well, we know I mean, the to this tone babies in premature babies. The evidence for the term babies is the most of the evidence is for perishable babies, because they're the babies and most most of the research. Studies have been on that any better. I think when it's natural, you know, we talked about transition. You've got two scenarios, the baby comes out and the Caldecott immediately, or we do we do wait, what we'd call it wait for why were the baby transitions, he put the baby on the chest, the presenter continues to give oxygenated blood until that baby's lungs have taken over. In that time they they receive a third of their blood volume. If they don't receive a third of the blood volume. They are the research shows that they're anemic, that they can be anemic at 12 months or four months. And they're shown to be anemic. All around disenzo researcher in Sweden and he looks at immediate costs on prolong babies, and he looked at 382 babies and four months, it showed that the babies could be anemic. Anemia is a massive and massive subjects on its own. The World Health Organization at that time said that 43% of the world's population of undefined were anemic. And they said to UNICEF said it was because of immediate core clumping, this was about 2012. And we thought Great that you know this will stop it but it didn't. But if you look at anemia, in itself, it has such an impact on persons productivity, their chances of surviving of achieving or being well. And really as a public health concern. Allah, Anderson did research at the age of four on the same babies that he'd looked at, at birth. And it showed that there had to cream finds it decreased fine motor and social skills, does more research that needs doing, I think, intervening at such a fundamental part of life. When the baby is transitioning from life inside the womb to outside the womb, there's a lot of research needs to be done. Because we need to stop clumping the card, we say that the code can be a one minute, there's no evidence for one minute either. So babies that have if they get their third of the blood volume, a bit premature babies will have decreased blood transfusions. The blood volume that they get contains over a million stem cells. If you cut the cord, immediately your baby loses million stem cells that's a subject on its own, which I won't touch on delay call clumping babies Wait, it's waiting for white the cord is empty. Of course that's been earliest full of blood, so you've got more chance of having infections. Immediate call clumping babies have increased a kidney at which it's breathing problems. Delay clumping is best perfusion. Because if you think you're depriving your baby of first, a third of its blood volume, the blood volume is going to go to the major and the major organs as in anybody that loses a third of the blood volume, it will it will go to the major organs to make sure that the baby is stable. And organs aren't as essential have decreased blood volume, which is why you get necrotizing enterocolitis because the gut doesn't get the blood volume it needs. So babies have immediate cord clamping you've got more chance of getting necrotizing enterocolitis, which are causing Previn babies is a big killer. I'm sure there are more. But babies that have immediate cord clamping and more likely to be cold. So you know in theater, if you've got baby that's got a third of his book volume, eating in theater or in the delivery room is an important factor. But if you've got a baby, that's world views, and it's got that blood volume, it's less likely to cool down as quickly as the baby there's lots of third of its blood volume. I did a talk for paramedics, because they were always trained initially to cut the cord immediately. And I said if you go to a road traffic accident, and you've got a person who needs resuscitate thing, and they've not lost any blood, or you've got a person that needs resuscitating and the loss of third of the blood, who are going to be able to resuscitate more successfully. So I could go a bit off tangent there but you can pull me back on

Megan Rossiter  14:35

No I think that's that's it isn't it is that when you make comparisons to us as adults, it certainly puts it all into perspective that you're like, you know, even when you go and donate blood, you're only allowed to do a pint or whatever it is and then you have to sit there with your legs up and you have to make sure you've had a biscuit and a sugary drink and it's like all of this care and support goes around somebody that is donating much much less than a third of their blood volume. Yet, in babies, it is kind of seen still, you know, even 20 years after you started this work, would you say the vast majority of babies are still having kind of a minute or less cord clamping. 

Amanda Burleigh  15:14

The NICE guidelines say one minute. Down forward did some research in 2010 that showed that they weighed babies for five minutes with an intact cord. And it showed that babies that were born there was one baby that was born at 3.4 kilograms. And after five minutes, it was 3.6 kilograms. And it was a steady graph. It's a really important graph, it should be on the delivery to be on the Labor Board. It should be on every wall in the labor wards. Because it shows it shows how much they've lost. And after a minute is still goes up, there's actually no reason why the baby's cord is cut at a minute. And the other thing that we need to get away from his minutes, every baby is different. And really, we should be looking at the baby, not the clock, because it's a lovely thing to do is to watch the baby, a baby that has an actual transition because they are put in the woman's skin to skin. And they pink up in their own time, there's less crying, they look around the room, they're much more aware of their environment. And my last experience as a midwife center birth center, where I watched this, bearing in mind that for the first 16 years, I got calls immediately. And I can say without any hesitation that the babies that were born that I you know, were shocked to have the core cut, they aren't being oxygenated anymore, they have to breathe. Some textbooks said that crossing the call facilitated breathing, which is bonkers. But the how babies have to breathe. So they would take an almighty breath. And then they you know, they've lost a third of their volume and then they do the first feed. And then of course they don't say sleep, you know, they don't breastfeed as well. Judith Mercer in America, so the babies that have delay clumping breastfeed better as well.

Megan Rossiter  16:52

Because well, more more of everything. And I wonder if you could just talk if somebody doesn't really know anything about that transition and what is happening for a baby, can you give us the sort of the basic outline of how babies receiving that oxygenated blood on the inside and what changes in their body so that they start breathing and why that transition is a sort of gentle one that happens over the first few minutes or hour or so after the birth rather than a kind of instant switch just so we kind of got a picture of what the difference is between cutting that supply so quickly.

Amanda Burleigh  17:31

And natural transition babies attached to it for center for nine months and the baby's ball. We look at the baby when it's first born, but the potential is still feeding that baby oxygenated blood you know people can they will read because the baby's cord around the neck. Lots of babies have the cord on the neck, it doesn't make any difference because the cord is actually feeding the baby the baby isn't breathing. When the baby comes over, usually there's some stimulus stimulus and the cold air, baby will realize it's outside long, and 99.9% of the time the baby's more brave. Okay, so simulate the baby, the baby the cold continues to pulsate, the lungs take over, there's lots of lots of different changes in pressures. And that blood volume is crucial for that as well. Because the volumes that are coming through from the placenta, they're all changing. So the lungs become the lungs become oxygenated and become the blood goes in. There's lots of lots of different changes that I would have to go into a textbook to revise to do it, but it's the longest takeover and the baby starts breathing. The potential continues to feed the baby. There's a lots of colds that there's vessels coming up from the cord into the lungs and into the liver around the liver into the aorta that after the baby has taken over and is sustaining itself. Those vessels actually shrivel up and disappear. And the baby has lost Seiko Well, we do measure babies up girls, which is five different things. It's like muscle tone, Breathing Color, the spark different things in the breathing and the color. I never ever put nine out of 10 for a baby because the color was never 10 out of 10. You'd have two points for each. So I always gave the babies that I was with two points out of the two, one point out of two instead of two. Because they were never pink. They always have blue feet and blue hands. And on the birth center. Babies were getting two out of two because obviously they got the full blood volume. And I can tell now looking at a baby in the first 24 hours whether that baby's had immediate cord clamping or delay. 

Megan Rossiter  19:29

Yeah, I mean, there's an amazing photo. I'll see if I can find it when I share this episode of two twin babies where one did and one didn't. And they look like different babies. One of them is like very pale and one of them is very pink.

Amanda Burleigh  19:43

Yeah, you do. I mean my grandson was born and he was he was very pink. And compared to the other babies we're just getting a minute people come in to look at him and I did say to a friend in Australia and he was my counterpart was I don't know if nobody's really paying. She said we're able to get in today levels you know And that one, he could take the top off a bottle and put it back on, which is incredibly, incredibly skills for one year old baby. And that's the way it should be. There was lots of when we first started talking about it and lots of people saying, oh, you know, babies will get too much problem they get too jaundiced. But babies that have immediate clumping at jaundice, you know, had lots of babies that got jaundice when we did immediate cord clamping. And there is some research that says it's a protective factor and babies are less likely to get jaundice. I know Warwick did some research before they brought in delayed cord clamping this is, you know, 12 years ago, and they showed that babies that have delay in delay called plumping there was less chances of having jaundice. And they did that at least as well as you know, at least hospital when I was and doctors did some research. And it showed there was less shortness in the babies after they'd been born. 

Megan Rossiter  20:49

That's really interesting. Yeah, cuz that's definitely something that's often kind of thrown around. I'm going to throw a few at you actually have the reason there are many, many reasons that people are told why they can't have delayed and then we call it delayed, which is a bit silly, because it's we're delaying it in comparison to what is happening in maternity services. We're not delaying it in terms of what would normally happen in a human body.

Amanda Burleigh  21:12

When we first started talking about it. We had to call it delayed. Because if you'd have asked people what was the the right management there was an immediate so we had to give them something to take it away from immediate because immediate called plumping was recommended by nice by the cog by the RCM. It was the World Health Organization, they all recommended immediate cord clamping World Health Organization were the first people to change in 2007. Our co2 change in 2009. RCM said in 2012. And nice didn't change that until the end of 2014. I set up a petition, they told me to be quiet I was I got a lot of pressure to be quiet, and managers. And I thought, well, I can either be quiet or I can get louder, and I chose to get louder. And so I got petition up against nice. And that was signed by I think about four and a half 1000 People in 44 Different countries because this is a global problem and it's still happening globally. They're still cutting the cord immediately America are only 30 seconds, completely not evidence base. 

Megan Rossiter  22:17

We can go into more detail in a minute, but I just wanted a true or false. And if you can't do true or false, you could do a small sentence. Two things that I have been told by people or that I've heard myself in practice. Reasons Why You can't have delayed cord clamping so you can't have delayed cord clamping if you're rhesus negative, false. You can't have delayed cord clamping if you're having the injections to birth, the placenta false. You can't have delayed cord clamping if your baby needs to be checked over for some reason right away. False. You can't have delayed cord clamping if you're having a cesarean birth both. You can't have delayed cord clamping if they need to take blood from baby's cord pulse. You can't have delayed cord clamping This one's my favorite, because if you leave it too long, baby's blood will drain back into the placenta. Absolutely false. That last one was a bit of a joke. But this is actually something that I know women have been told and not just one woman like multiple people that I've supported have been told this, which is just completely insane.

Amanda Burleigh  23:25

I can my own research and I was trying to bring that into practice. And it was a very basic research thing. And I was told that immediate Copland was carried out because the birth was fast, immediate call conference carried out because they needed to go skin to skin immediate call clumping, because we've always done it like that. And they were frightened to leave it. And immediate conflict because of global drone blackout. 

Megan Rossiter  23:47

Yeah. Yeah. I mean, it's when you even you only need very basic physiological understanding to know that those cord vessels are constricting, which is why the blood is not going to go back into the placenta as the don't transfer infection

Amanda Burleigh  24:04

we used to do is to their infection, we'd hold the baby up, you know, and if you could still, you know, the presenters still, though, they don't recommend that now, there is some research done on the optimal level, for delayed cord clamping skin, skin spine, if you've got friend COVID Some of the dots, some of the practitioners have put the baby a bit further down because gravity can help. You know, with Yeah, transfer

Megan Rossiter  24:25

is that is that more that the blood that's trying to get into the baby finds it harder rather than the blood that's already in the baby is draining out or

Amanda Burleigh  24:33

it's to get the blood into the baby. Yeah, yeah. It is a circulation. But just to encourage I've never had to do that, you know, it's different practices in different countries, you know, then you could go on some things about milking and stuff like that. If you've got a baby that doesn't need that, but no, there's no reason. There's only one valid reason for immediate call clumping. And that is this a call times? Yeah. Because then your baby's gonna bleed out some form. It's such a rare occurrence, but that's the only valid thing. I used to think that if you did this as their infection and you went through the presenter, but Susan Bewdley, who is the consultant obstetrician said, No one can manage now, when you've got twins that have a little bit more that has to be managed on an individual basis, because you can have twins twin transfusion. But that's a very basic that out to be on a very individual basis. You know, if you've got babies, you've got twins that are sort of the same size. The chances of the twins twin happening at birth are incredibly rare. But again, that has to be more carefully considered. 

Megan Rossiter  25:34

Yeah, yeah.

Megan Rossiter  25:35

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Megan Rossiter  26:50

So let's get back over my really long list. And you can give us a little bit more info if there's anything else you want to share. So if a mother has racist, negative but so you would know this, if you've had a blood test in your pregnancy or you've donated blood, you've done anything where you might know your blood group, and you get your your group which might be Oh A or B and then afterwards, you'll have positive or negative. And the concern sometimes it's shared with people is that if baby isn't known to be rhesus negative as well, and they were Rhesus positive and the blood mixed, then that could be kind of detrimental to the mother for future pregnancies. So that's the sort of concern. What do we know about how that would impact the way that the cord is clamped?

Amanda Burleigh  27:39

Baby's circulation among circulation are completely different. You know, and I realized quite early on that people's understanding of physiology, physiology, you know, even clinicians, was quite sketchy. And they thought that there might be some transfer, but babies babies circulation is baby circulation. Mom's circulation is mom's circulation. So we'll leave that one.

Megan Rossiter  28:01

Yeah, so no need and if you're racist, negative, even if your baby is resus positive, you can still

Amanda Burleigh  28:06

the other thing is, you know, you know, the check number do all the answer D and things like that, you know, they check a decline hour at birth to see if there's been any mix, you know, because sometimes because the pressures, I'm not quite sure, but you know, they do check to make sure there's been no, and then they treat you in that pregnancy, which protects further pregnancies. 

Megan Rossiter  28:22

Yeah, yeah, absolutely. So the other one, I suppose that comes up for probably quite a lot of people is if they are and this did actually happen to me, if you are having a Syntocinon in debt injection for the birth of the placenta, so it kind of active or managed third stage of labor. What about them, active management

Amanda Burleigh  28:41

is not it's not an indication to do immediate cord clamping at all. Nice guidance says give the oxytocin with the anterior shoulder, which is so archaic, because I will say that if you give one, it's pretty physically impossible to give the injection when there's children's out because you're looking at the baby. But if you are, if you actually give the injection with the anterior shoulder with the babies, that you've actually made a decision to shut the placenta down before the baby's been born, you don't have a lot of babies still needs that per sensor. But the nice guidelines, say kids at the offseason immediate and then you can come and cut one to five minutes. Okay. So you've got it written in NICE guidelines that is safest because some people don't want to question the status quo. But if it's written down in the guidance, my practice as a midwife, especially, it's about risk management. So if you've got a woman who's had a really, really long labor, or was having twins or agile, previous postpartum hemorrhage, I might give that oxytocin often Yeah, that'll set us in Syntocinon. Earlier sooner rather than later. But working in a birth center, where you've got low risk or no risk. Baby would be born would discuss it beforehand and say would you like adaptive management, which is where you give the injection and you deliver the baby after the uterus has contracted with the injection and the dinner placenta? to delivery or physiological where you have no drugs and the baby is born, and then the presenter follows in a varying amount of time, it could be five minutes, it could be an hour, it could be a bit more than an hour. Usually it's delivered within the hour. Normally, I would say probably about 1520 minutes. But there's actually no rush. And parents can change the mind. So I think after the baby's born, it's sometimes quite nice to revisit and say, you know, we've had this discussion before, would you like the injection? Or would you not? Yeah, majority women say, actually, I've had enough now we'll sort it out. But by that time, the babies come around, it's transitioned the colds whites, and then give the injection. So I used to do something called delayed active management. And there's no, there's no evidence to say that that's a problem, I think, where the practitioners have to be careful as if there's an indication that the lone woman might be doing a previous postpartum hemorrhage or a long labor, and they've got more chance. And then I would be thinking, you know, you've got, you've got the risk management, about maybe having the injection a bit long bit sooner. But again, you can leave, you can leave the cord, one to five minutes.

Megan Rossiter  31:07

Yeah, yeah. And I've got a story to tell about that. But I'm actually going to, I'm going to tell it a little bit later towards the end. So I'll just carry on through my list. If baby needs to be checked over right away, maybe because there is a known concern that's come up in pregnancy, or they were having heart rate issues in labor, or it was an instrumental birth or a reason why a pediatrician or midwife might need to check the baby over? 

Amanda Burleigh  31:35

Well, in the first minute, we will recommend any baby every every single baby should have at least a minute, every baby should have at least a minute when I was at Bradford, which is the hospital that did that graphs that a lovely graph. I was quite shocked by the fact that they did it one minute for every baby. And I said you've just done the most important piece of research in the world and you're only doing a minute, but not in the birth center that babies all the babies got wait for right. But what used to happen is a pediatrician to come in if a baby was flat, the pediatrician come in. The court has remained in touch stimulate rescue breasts, and I never saw anything. The pediatrician has set the conference up without even seeing the baby and leave the room. Because the placenta is the body you know. So there's a hospital in north northeast of England ones back and they brought in delayed cord clamping three minutes for every baby in 2009 dimensional conference. There was an obstetrician neonatologist and a midwife and they went to a conference by David Hutchinson who has done loads of research. It's fantastic. And they all looked at each other. And when they were all doing immediate contract, they looked at each other and they came back and changed it overnight. And that hospital now, if a baby has immediate core plumping, it's a de tech situation. And they they when they do an induction for any staff, all the staff are told that we do we do delayed for three minutes. And they consider it a database if a baby has immediate cord clamping and a learning exercise to find out how that can be avoided. 

Megan Rossiter  33:06

That's amazing. Because if it doesn't, from my perspective doesn't feel like it's spreading anywhere. But maybe drip drip. Maybe we're getting a little bit closer. 

Amanda Burleigh  33:17

Australia, in Australia, in Western Australia, and they delayed clamping to three minutes, which is fantastic. It's still not wait for White. But it's fantastic. Because it gets away from that one minutes. I know these are in turn babies, but we'll talk about in a minute about cord blood donations. 

Megan Rossiter  33:37

yeah, yeah, we're gonna definitely get to that. So what about if you're having a cesarean? 

Amanda Burleigh  33:43

Caesarians are fine. Leeds when I did my, my work, all the babies have parents I say get weight for why the baby just needs to go on the legs. warm towel, you know, wrap the baby up. And because the management in theater, it's so they give the oxytocin intravenously it's all over quite quickly. And others sometimes I can do a scoop, you know, a lotus birth I remember someone asking for a license back in 2011. And they were horrified but to be honest a lot of benefits there infections the easiest thing to do but could be prevented just follow the baby. 

Megan Rossiter  34:18

And yeah, I've I've supported I'll try and share a story when I share the podcast of somebody who have supported who had wanted a lotus birth with a caesarian and got one. 

Amanda Burleigh  34:27

Yeah, the other thing that's again all around the sun did some research and he showed that babies exosomes section that helps 30 seconds delay, have the same blood volume have the same results for the baby and vaginal birth that has one and a half minutes, 9090 seconds. And I was talking at a conference and they said oh they're not really sure why that happens. And it was a doula said, Well, it's obvious, she said because the baby has been squeezed through the vagina and the blogland back to the presenter. And it's absolutely, you know, common sense common sense. 

Megan Rossiter  34:57

Yeah. So it's usually quite the easily explainable, isn't it through just the basic, very basic physiology everyday

Amanda Burleigh  35:04

that's called a, you know, this little thing. This is basic knowledge. 

Megan Rossiter  35:08

Yeah, yeah. So sometimes people might be told that they need to have a, sometimes it's what's called a cord blood sample taken, say blood taken like a blood test with a needle, but not from the baby's blood vessels, but from the vessels that are within the cord. And they might be told that they need blood to be left in the cord so that this can happen. How about that situation?

Amanda Burleigh  35:32

I have heard stories, that defensive passes are all babies having the pH measured, which is defies any form of justice, really. But you can, you can do blood samples on an intact card. Because I would say, you know, you can do both sides, you can identify the vessel very clearly, you use fireball needle, which is an orange needle, you locate them, you will have to take time, a lot of blood, and then you put a little bit of a swab on, just hold it gently so that you don't compress the cord. Because when we're doing that, you know, people say that needs to take a chunk of the card, but you don't because you don't say blood or somebody's arm and then chop their arm off to do the same thing. Again, it's thinking is really thinking about your practice and what you do. So they can do it, it's a little bit more tricky. And the most important thing when the practitioner is doing that is to make sure that they don't do a needle stick injury. So that helps them maybe put something around the back of the car so that they didn't go straight through according to their own finger. 

Megan Rossiter  36:25

Okay. Yeah. And it's, it's funny, isn't it, because often that will be happening, because the baby might be compromised in some way. So again, probably even more necessary, that that cord remains intact. And we've done the blood going back into the placenta church. So is there anything else that you sort of myths that you'd want to bust about cord clamping?

Amanda Burleigh  36:48

No, I think it's just, you know, wait for why is something that people understand across the world. We do give oxytocin and oxytocin on drugs, that everybody has a routine. I do think, you know, if people thought more about it, and we could wait, you know, they should be more selective, maybe more selective, so that there was kind of a natural transition, because we don't know what giving the hormones are. And I, I would like to do some research about oxytocin deficiency, because if you're cutting the cord before, there's so much oxytocin around, and oxytocin going from mom to baby, and I always think that maybe, you know, cutting the cord interferes with the oxytocin levels that pass through. So the baby oxytocin is incredibly important for those the things that everybody know, but also carbohydrate metabolism. And I wonder with our interference in birth, it's causing interference in childhood volume in child health, that can we have to do that? So that's the the research I'd really like to do.

Megan Rossiter  37:46

Yeah, fantastic. So we did mention already, and this, again, is something that does come up for people. And this is stem cell collection or donation. So this can happen in one of two ways. There's a couple of hospitals in the UK and probably worldwide where the answer is Anthony Nolan, isn't it the charity? Well, you can donate the placenta in the cord to the charity, and they will collect the stem cells from the cord so that they can be used donated to people that need stem cells, or there is a massively growing industry for privately collecting stem cells for your own use in the very, very, very, very tiny number of cases where somebody, your child may need stem cells at some point in their life. How is this affecting the kind of practice of cord clamping, and any insight that you'd like to give into that situation?

Amanda Burleigh  38:47

Yeah, I feel very, very strongly about this naturally. And it's like you say this to Meghan, you're completely right. There's a cobra companies, where you pay a large sum, usually, I think it's about 2000 pound, they're very persuasive by the cord blood, you look at the websites, and they say that it doesn't affect the baby in any way. They do research, you know, one of the commonest has been done for mis selling twice. And there's another case that ongoing and because they give these research to say that I will help with autism and stuff like that, and it's not been proven. And the other thing is, they like to clock the cord at one minute to collect this, this blood. They're very persuasive. And you know, I think at the end of the day, it's it's informed choice, that parents need to look at it and really look at the information and make their own choices. But if they looked at all the evidence and things like that, I'd be very surprised if people did it to be honest. Because there is a company that said that they can take 10 mils or 20 mils and the pathology they've got they can expand that but they don't that costs more. And I've heard that they don't really encourage that. They encourage the standard called bloatware. They try and get as much as possible. They say that little delay call clumping but the thing is You're storing your baby's blood in a laboratory, and I've been through them, it's like, doctor who they've got these big tanks where they store all these samples for the future in case your child gets ill in doing that your baby losing over a million stem cells, the stem cell, the building blocks for the future. We don't know exactly what these stem cells do. We start intermediate called clumping in the late 70s, early 80s. So 2044 4550 years ago, those stem cells are there for a reason, we don't know what inputs, you know, do you run out of them, you don't know, anyway, that we've yet to find out. But I think it's a much more cost effective way to solve those stem cells and your baby's bodily. Because if your baby's needs them, they've got them on hand. And I think they're really, really important when babies are born, and there's any damage in the body, or the brain or the stem cell shoot offs, that can change the, what they do, they shoot off and repair damage in the baby's body. So if you've taken a million stem cells away, Judas mostly said, it's a million, that it's more, if you've taken those stem cells away, you know, that baby hasn't got to retrieve. And also, I think with the evidence that shows about the anemia, and the learning problems on the fine motor insurance, social skills, it makes you think that you know, would you rather have something in a lab waiting for a very, very small chance that will be needed? Or would you bet it would you rather give you a baby, it's for Bluecoat, and the best start at life and save yourself a boatload of money in the future in the in the in the prospects? So again, let's say it's informed choice. If you do look at the websites, and they say, Well, how many baby do look at all the eroding evidence because they don't give the evidence to say, you know, the other one is the donations, which is a scandal really, to be honest, and the Anthony Nolan trusts are in for hospitals in the UK, they have targets of 150 mils per baby. They tell the parents that it's no. It doesn't make any difference to the baby that they're giving life to two people in one day. It's all very persuasive, you know, well harm your baby, you're gonna help other people. They try and target everybody in the hospital in nationally, 150 minutes, because I wrote for them. It's under 50 milligrams, which equates to 144 mils. Day, the term baby has around 90 mils per kilo, say 100 mils to make it easier. So 3.5 baby will have served 350 mils less COVID-19. And Anthony Nolan have targets of 150 mils. And I have the evidence for that. Because I've got the day one sent a newsletter to say that they weren't hitting the targets. And they didn't know why. The reason they weren't hitting the targets is because I've done a massive conference two months before in Leicester. And when I told everybody about it, the Congress said they had no idea students would write to me to say that people have in competition to see how much proof they could get from the babies. And 150 mils, if you're taking 150 mils, that's 30. But that's at least 30% of a baby's blood volume. And it's not evidence base. The other thing about both of these, I can't I don't know with Anthony Nolan, but I do know that the Cobra companies pay the trust to advertise in there, there's a monetary benefit. Because when Leeds did it, in fact, I that's one of the reasons that I finished my job because I wasn't really really crossing it. And I wrote to my MP and he said that we're the NHS, we're allowed to make profits were they caught?

Megan Rossiter  43:36

I have found it quite shocking, what's allowed to be advertised in the NHS. You know, we I accept pod sponsors for the podcast and often kind of work with brands. And I cannot tell you how many times I've been approached by stem cell collecting companies, companies that make induction machinery type things that want to sort of make it and you know, fortunately, I'm kind of in a position that I'm very, very, very picky about who I kind of collaborate with, but it is, you know, if they've got money to spend, there's people that are willing to accept that money. And that's how misinformation.

Amanda Burleigh  44:15

Yeah, how was offered, they got in touch with me. They said, Oh, you're interested in coal from we'll give you 250 is going on to the hospital and each birth, you know, 1000 pounds for babies. And I said you've got the wrong midwife. It's I don't know, but you're interested in stem cells? Yeah, I liked them in the baby. Yeah, yeah. John Adams 50 For people that have got less integrity, and there are a lot of people out there that are swayed by money. And, you know, it's it causes massive eruptions in the birth world. And that's how they get their leverage.

Megan Rossiter  44:45

And it's tricky and you know, and people need money. So it's that kind of weighing up, but I think it's something that the way that you've been speaking which has been really reassuring, as I think it's is it Rachel read that said, it's not cool. Blood is the baby's blood. And I think yeah, that is the kind of really key, really key difference to make. And the way that a lot of that kind of marketing language is used as it's talked about as code plus, like it's blood that belongs to the cord. And the way that Rachael Ray describes it, as you don't call it arm blood, like blood in your arm isn't arm blood, it's just blood. And if that blood is in your baby's circulation, then that is your baby's blood. So what we're, what we're requesting, is that, would you donate a third of your baby's blood to somebody else, or to kind of just store? I think you can see how, how it started initially, right? If every single baby was getting immediate cord clamping, and it was then just ultimately going to be thrown in a bin. In those situations, you can see why actually, okay, yeah, giving it to somebody that might be able to use it does make a lot of sense. What has kind of been missed along the way is that now we are much more aware of why that blood is so important that it goes into a baby's body. And that's why we found ourselves I suppose, in this predicament, 

Amanda Burleigh  46:12

you know, they did for years, I mean, especially when I started out, it was considered a waste product. Yeah. And the person that invented the clump, they also stipulated, I think it was like 1900 or early. And they stipulated that the culture wouldn't be the costume of the clumps until it stopped pulsating. 

Megan Rossiter  46:29

Yeah. So I've got one final thing. So if somebody's listening to this, they're probably thinking, Okay, I really don't want my baby's cord to be covered any earlier than it needs to be. So I wondered if we could just kind of touch on what, what is important to be able to kind of communicate this with your midwife for your kind of care providers. So sort of like personal anecdote, I have had two babies. One of them, their cord was clamped at most a minute, but I'm pretty sure it was much less. And the other one, it wasn't clamped, and cut until after the placenta had been born. And that was as a direct result of how things happened the first time. So the first time I had done what I thought would be enough, I had written into my birth plan that was shared with the midwife and read by the midwife that I wanted to have delayed cord clamping and even, I don't even think I'd set it for that long, just just some kind of delayed cord clamping. And then, but I had put it in there that I hadn't decided how I wanted to give birth to the placenta, whether or not I wanted the injection was a decision that I wanted to make kind of a bit like at the time. And then as he was being born, she sought consent to give me the injection to birth the placenta whilst he was halfway out of my body. So I was not in a fit state to be making any kind of decision. And the question was, do you want to have this, that the injection for the placenta? And I was sort of like, oh, yeah, okay. And then, as a side note was, but you won't be able to have delayed cord clamping, while I was mid contraction, and there was probably crowding at this point in time. And so then he was born and his cord was clamped, and he was put on my chest. And the injection was given before I'd even probably properly met him. And then about 510 minutes later, when I said, Oh, I'd love to see my placenta, I was told that it was already out the room and in a bed somewhere, which then led to second time, being very, very, I was like, nobody's touching this baby this cord until the placenta is out. That's the only way I can feel sure that it's not going to be messed around with or that I'm not going to have to advocate for myself like this is what's happening. So yeah, is there anything that you would like to share in terms of how people could communicate what they want with their care providers?

Amanda Burleigh  48:59

I think there is a lot of risk, there is still resistance. I mean, there's still a lot there's a lot less resistance than they used to be. I know when I first started, I had a file that actually had to put his hands over the cord to stop the midwife cuts in it. And when it comes to when they came after the second and third baby, they were like, oh, yeah, yeah, we do delay clumpy nerves. Fine. Third one, it was Wait, why? I think the resistance because every practitioner is different, and some people understand it. And some people I would say the majority of people don't really understand the evidence behind it. I've got a website called to its weight for white, with lots and lots of parent experiences on there. Apparently people find that quite helpful. And because it's parents that have fought for it because every parent that has fought for delayed cord clamping or wait for it in the past, is actually an advocate, you know, they helping change practice as much as anybody else. And particularly in Sudan sections. The first parents that convinced the doctor that delay call humping or wait for white and 30 is a good idea. can often you know, meet resistance, but then when they actually see it in practice, when this baby comes out, it's like little blueberry, and then pinks up in front of their eyes, that can change the whole ruins practice in one go. A lot of people don't like rattling the status quo. But nice guidance is one to five minutes. So if you're with a practitioner, they're saying, Well, I think one's enough, or you're gonna get this or you're gonna get that or you're in the position where you know, you were, you can say, well, actually nice recommends one to five mile five, please, you know, and that gives you a bit of wiggle room, because five minutes after the birthing sorts of the baby, yeah, will work more, wait a bit longer. I think it's educating yourself. There's a really, really, really good piece of research, which is dead easy to understand this boundary of this mirth. And it's called rethinking potential transfusion. And I would recommend that everybody prints out it's quite old, it's about 10 years, but I would recommend everybody prints out and reads it because it covers everything. It covers the stem cells, it covers your your jaundice, it covers the blood, every every aspect Alif they've got anybody that's really busy thing you could give it to them. I think the resuscitation one is delaying for 60 seconds is incredibly important. But you are likely to come across practitioners who think it's immediate, you know, much more likely I've just presented after spin an expert witness for a midwife who advocated 60 seconds delay with educated parents, the dots and they are paths holiday, you know, a bit of a sector because the dots say no, no, no, no, we've got to remediate. We've got to remediate. Anyway, they eventually agreed on the 60 seconds, which is in the resource section and guidelines. And that's what they recommend, you know, stimulation, that second stimulation, 30 seconds, rescue breaths, and it's the person I supported, the babies didn't even need resuscitation, but they said that she was obstructive for giving evidence base calf, so they may find themselves a little bit more resistant. And I think the best way you can protect yourself is by be by by being really informed. And even then you can have other friends daughter who is they'd be have severe jaundice in a hospital that just did like or clumping but they want to wait for it and they were told that they couldn't their baby jaundice. It wasn't anything, you know, there's no paper on jaundice, made the paper hens feel really guilty. Luckily, they were really educated and they knew that it wasn't. And the baby actually had a little condition that gave prolong jaundice and caused anemia. And mom realized from that, that she'd been the same treat at it all the life. So you can get resistance, and be prepared for that. But just make sure that you know, your facts and figures, you know, I do, I do help people if they write to me, and it was, so what they got the website,

Megan Rossiter  52:51

and I'll link to all of your website and everything. And I think it's also getting whoever your birth partner is making sure that that because it's you're off, it's often happening at a time where you are not able to advocate for yourself, it might be a conversation that's happening in advance, but ultimately, the moment that it's happening, you're a little distracted, maybe with other things.

Amanda Burleigh  53:13

I've just done the midwives here in Glastonbury and you know, you got really fed up with saying the same things because we know that you know, unless we say something, you're but you've got much higher chance of your babies copying clumps at one minute, it's not informed choice. So we were telling him that in union partners, particularly they were taking it on board or a giant picture of a white cord, and they were taking it on board. And it isn't like say it's not rocket science. People get it like that. And they you can see them, they get onto it straightaway. But they don't want people to intervene. So it's a bit about being prepared. I used to write it in my notes. While I use it. I used to get the women and their partners, the evidence and say go away think about it when you come back or write it in the notes or counter sign it because obviously I was in a position where I was accused of coercing parents into delay comping community they went into they told all my women, all the women that I looked after that I was wrong. And that delay Kasamba was dangerous. That was in 2014 that we used to write it in the notes and we used to counter sign it, I'd say to the parents, and I'll tell them why we were doing that. But, you know, parents become activists, in our ad women that were from all over from Poland from Latvia, and they were doing their own research to see what was going on in their own their hometowns, some kind of content, they were doing delight, but most of them were doing immediate call clumping, but then they were going back and telling all their friends in different countries, you know, leave the cold alone. So it's spread out. It's spreading out, you know, we have activists in Tunisia, signed her she was activated in WaveLight delivering the defense before the baby's born and all the all the women were both in endless ostomy and all the partners which were men, obviously in tune as it were in the carpark they weren't even allowed on the both suite there. She was doing it. So it's about the more people that ask for evidence based practice, the more will change things. And yeah, like you said earlier on, not everything is evidence base a lot of things that aren't evidence based.

Megan Rossiter  55:12

Yeah. So take this episode and send it to five people that you know, who are about to have a baby. And we'll together spread the word. Amanda, thank you so much for joining me. If people would like to find you or follow your work, I will put links to everything in the show notes. But yes, let let us know as well where they can find you. 

Amanda Burleigh  55:30

Yeah, well, I put my email address as well, because I think the email address on the website isn't working. But there's different ways of you know, getting the information. And I think on the website, there is a list of the research shows when you can do your own research.

Megan Rossiter  55:47

What's the website? Wait for White?

Amanda Burleigh  55:49

yeah.com.com.

Megan Rossiter  55:52

There you go. All right. I will put a link to that. And yeah, please go away. Take this information and utilize it for your own birth 

Amanda Burleigh  56:01

really, really important. And let your baby have its blood. Not the stem cell companies. 

Megan Rossiter  56:05

Yeah, absolutely. Thank you so much. No problem. Take care. Bye.

Megan Rossiter  56:16

Thank you so much for listening to today's episode of the Birth-ed podcast. It's my actual life mission to get these conversations in front of as many expensive families as possible and you can be a part of this mission. Don't worry, I'm not recruiting you into my cult. But if you leave a five star rating and review of the podcast then we creep up the charts getting more ears, change more births, change more lives and come on, you know you want to be a part of that change.