(Warning for video of cesarean and a prem baby of 28 weeks).

These days delayed cord clamping in hospital births has become more normalized. The benefits for baby have been well documented in the research (with no documented risks to mom). But you don’t have to look very far on social media for discussions about how long is long enough and debates with providers about how long they feel is enough. We know from research that blood can still be passing to baby even at 5 minutes. The reality is that in a busy unit your OB may be keen to finish up and go see their other ‘patients’ - especially if they are close to giving birth. (In other countries midwives will facilitate the 3rd stage and can easily support this option as they’ll be staying with mom until she’s moved to postpartum).

Over the last few years the slogan ‘wait for white’ (#waitforwhite) has become more well known as parents request the cord be left alone until the cord turns completely white (that could be 1 minute, 4 minutes or longer depending on your baby). Given there’s enough clock watching in the labor room already why not take the pressure off you to make that timing call or reduce the temptation for a provider to clamp before baby has received their full blood supply.

Evidence suggests that delaying cord clamping until three minutes is associated with less anemia and improved development at 12 months of age and with improved fine motor function and social behavior at 4 years of age in a high income country.

Welcome to the world of - ‘intact birth’ and more parents are learning about this option.

For more options you may not have considered take the GentleBirth Masterclass.

An intact birth is a lot more common in homebirths - you may have seen photos babies still connected to their placenta right after birth - and not a clamp in sight! Some of these parents are doing a ‘lotus birth’ where the cord is left attached for several days and falls off itself (or the midwife cuts it).

An intact birth is different and unlike lotus birth - has a growing body of evidence behind it - especially for babies that aren’t well at birth (premature or full term). I’ve included some of the latest research below.

Intact births can also be part of a cesarean so babies can be resuscitated while also receiving oxygenated blood through the cord.

Birth professional Caitlin Clarke has created this helpful information sheet for parents and birth professionals.

What is an Intact Birth?

Intact birth – The entire birthing unit, including baby, cord, and placenta remain intact until after all three have birthed, and mom requests that the separation occur. This includes absolutely no clamping of the cord.

Why do parents choose intact births?

Parents choose intact births for many reasons. It prevents rushing of stage three, which can be traumatic for many moms. A calm 3rd stage of labor also facilitates oxytocin production needed to safely birth the placenta. Intact birth allows mom time to judge for themself if the cord retains blood without being rushed, which is extremely empowering for many.

However, ensuring that the cord has drained is not the primary reason parents choose intact birth. Clamping and cutting of the cord symbolizes the end of the pregnancy and birth -- being “in charge” of when this occurs is extremely meaningful for many parents. Some families choose intact birth for religious or spiritual reasons. In other circumstances, parents simply want special memento photographs of their babies attached to their placenta.

Why do birth plans indicating intact birth specify “no hemostat” in tractioning?

Specifying that no hemostat is used in tractioning the cord might seem like “micro-management,” but it’s not. It’s simply a reminder to providers that hemostats clamp the cord. So, if hemostats are used, even with a cord that has stopped pulsing, intact birth is not achieved. This is why people choosing intact birth often request that the cord be tractioned by hand. It’s slippery, so many providers use gauze or a washcloth. Other providers choose to use an instrument that will not clamp the cord, such as a ring clamp covered in gauze.

Can intact birth occur with active management?

Choosing intact birth is different than declining active management. These are two separate choices in birth planning. The only aspect of active management that can not occur with intact birth is tractioning of the cord in a way that clamps the cord. For instance, tractioning with a clamped hemostat. While many parents who choose intact birth also choose to decline other aspects of active management, such as preventive Pitocin and aggressive fundal massage, others do not.

Can an intact birth occur with a cesarean birth?

YES!

Can an intact birth occur with multiples?

YES!

Separation

In intact birth, “separation” refers to the separation of the placenta from the baby, via clamping and cutting of the cord. It also refers to the symbolic end of birth.

Parent led separation

The cord is not clamped or cut until mom says so. This is done for psychological reasons, to support mom dictating the symbolic end of the birth. It also facilitates the woman in being 100% certain that the cord is drained of blood. And, it facilitates a peaceful, uninterrupted stage three, which generates maximum oxytocin production.

For more on intact birth, including photos, please visit “The Intact Birth” Facebook Page.

Providers: To connect with other providers providing intact birth, please contact Caitlin.

Special Considerations for Intact Birth for Multiples:

During the birth of second/third babies the birthing person may hold the first baby, place the baby next to

them, place the baby on firm pillow on the floor, or hand the baby off to a “first baby holder.”

Dedicate one birth team member (partner, doula, or other team member) “first baby holder.” This team

member must be diligent to:

Hold the first baby if mom does not wish to hold the first baby during the birth of subsequent babies.

Carry the first baby while mom moves.

Communicate with the mom if their movement might unintendedly traction the cord.

Advise mom to stop moving if their movements may unintendedly traction the cord.

Remain in close physical proximity to mom to provide slack on the cord.

If there are two placentas, the placentas may be placed in the same bin to consolidate room. In hospital births, where the birthing person is in a bed, designate one person to keep an eye on the bin and keep it securely on the bed.

Additional Resources

https://www.mdpi.com/2227-9067/9/4/517/htm

https://mhnpjournal.biomedcentral.com/articles/10.1186/s40748-019-0110-z

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5263890/