This blog post is written by me, Alice, Lancashire Hypnobirthing Teacher to share with you my insights into The Birth Pause, seen during my work as a Midwife in Lancashire.
The Birth Pause is a term coined by Mary Esther Malloy, a Doula from America. Mary recognised that by unhurrying the moment of birth, birth is transformed for both mothers and babies.
- you’ve carried your baby for 9 long months
- you’ve had long hours or intense rapid minutes of birth
- your baby is suddenly sprung onto your chest
- then you finally take a breath
BUT what if that birth was slower
- you’ve grown your baby for 9 months
- you’ve been supported your hours or minutes of birth
- your baby is born between your legs
- you look down
- see your baby
- register that your own creation is HERE
- you wrap your fingers round your babies chest
- and scoop your baby up to your chest
- where your baby lies gently in skin to skin
Modern society has an urge to constantly be moving forwards, and we forget sometimes to slow down! In pregnancy too you might find yourself wishing your due date would arrive (especially in this heat!) willing yourself into labour and for your baby to arrive.
Clemmie Hooper describes too, the importance of slowing down when baby is born and your home, and suggests at least “a week in bed and a week on the sofa”. How else can we protect and support those precious first weeks with our baby.
Here we take a look at the physiology of birth, all about cord clamping and how introducing a birth pause to your birth ‘plan’ can transform how you remember those first moments with your baby.
What is the physiology of birth?
When babies are born they physiologically take time to transition to their new world. As they are born, the fresh air around them, and the squeezing of their bodies through the birth canal (or through the abdominal wall opening if born by caesarean) triggers the first breath. Much of the fluid (amniotic fluid that the baby has been taking in and out while in utero) is squeezed out during this process. Then with the first breath and cry more fluid is expelled from the airways and is normally all expelled by 3-5 breaths, and the lungs fill with oxygen filled air. The lung tissue itself loses the fluid into the surrounding tissue due to a pressure gradient (2), this takes about 4 hours typically. The transition from babies getting their oxygen from the cord, to getting their oxygen from the air and their lungs takes a few minutes, as the whole cardiovascular (heart) system reorganises itself. This includes the rapid closing of a small hole between the left and right sides of the heart (1).
What does this have to do with cord clamping?
When the babies cord is clamped immediately at birth, the flow of blood from mother to baby is stopped, and this blood flow carries babies oxygenated blood, as such, the clamping and cutting of the cord, reduces venous return (blood flow back to the heart) by 30-50% (3). Blood flow going from the heart round to the rest of the babies body is then also reduced. Then blood flow to the babies brain rapidly increases then decreases at that point, so as to preserve oxygen flow to the brain. Until the breathing establishes and the respiratory system has played catch up, the blood flow from the heart remains low till normal cardiac output is restored(3). By delaying cord clamping until ventilation is normal (so the babies breathing is established), the changes in blood flow to the lungs, and output of blood through the lung can adjust at birth more smoothly, without affecting cardiac output (blood flow from the heart) as the blood continues to flow from the mother through the cord to baby. Babies blood pressure also remains more stable during transition to breathing as a result. Delayed cord clamping also improves babies iron stores (4).
When to clamp?
When to clamp the umbilical cord has been debated for centuries, but the first ever mention dates back to Aristotle around 350BC. There are many terms for clamping of the cord timing: delayed cord clamping, wait for white, optimum cord clamping or deferred cord clamping. All these terms refer to waiting at least a minute before cutting the cord, as opposed to immediate cord clamping which remains the predominant practice worldwide. Optimal timing for delay in cord clamping in healthy term and preterm infants is not clear. For these infants it could be argued that its best to wait until the infant is physiologically fully adapted, with fully established breathing, and pink and warm. So at least 5 if not 10 minutes, but instead of timings midwives and doctors could observe the infant for those features.
If a baby needs resuscitation?
For babies born that require resuscitation (just 5-10% of all babies born in UK), most require the simplest method of resuscitation; stimulation and inflation breaths (these fill the lungs with air 5 times to aid the expulsion of water), which then stimulates respiration (breathing) by the baby. The Resuscitation Council have identified that at present there is insufficient evidence to give a time to when best to cut the cord for these infants, however it is widely acknowledged that for these babies, immediately starting resuscitation is the key need. Often in trusts across the UK, the resuscitation beds for babies are away from where the mother gives birth, as they need a firm, flat, warm, well lit surface, where the initial 5 breaths can be given with a bag/valve mask with air.
Some trusts are leading the way with bedside resuscitation stations, where babies can be safely resuscitated whilst still attached to the cord. This has the added benefit that babies are still receiving oxygen from the pulsating cord, which is then only clamped once the infant has started breathing (or the lungs are aerated). Hopefully more trusts will move forwards in this way as it certainly seems to offer the best physiological adaptation to life for babies. This is the link to Liverpool Women’s page. https://www.liverpoolwomens.nhs.uk/news/first-hospital-in-uk-to-introduce-bedside-neonatal-care/
So what is the birth pause?
So if we return to thinking about well babies, who, when born show signs of starting breathing spontaneously themselves, and are blue (not white), and have good tone at birth, these are babies we are reassured by. For these babies, whether born naturally, by Kiwi (suction cup/ventouse) or with forceps it would be AMAZING if at birth, rather than see babies immediately taken to mums chest and vigorously rubbed till they cry, if we would take a breath, pause and slowly introduce mum to her new baby. Mum (or dad) when ready and adjusted, studies her baby, touch her then reaching down, curls her hands around her body and brings her own baby to her chest, calmly and gently. For these babies, the smoother transition (often seen at water births) allows a calmer entry to the world and provided the room is warm and they are grimacing, they don’t need the vigorous rubbing, but a gentle pat to dry.
Pausing at the moment of birth allows a woman to exhale from the work of birth before she begins to inhale the presence of her child and her new identity as a mother
Mary Esther Malloy.
Even better is if mums are in a position to have babies either between their legs on the birth mat. I’ve seen babies born into their pool of water on the pad, which keeps them warm until mum is ready to transition to meet her baby. It’s such a wonderful moment, and one that keeps the birth room calm, quiet and gentle.
These beautiful images taken by photographer Whitney Hardie show what I am trying to describe better than words can!
After birth and into feeding
Once baby has been warmly scooped up by her parents and hugged and all the events of birth have been completed, with baby on skin to skin, in time they find their way to feed. Either by the breast crawl if a mum wishes to breastfeed, or by signalling hunger with lip smacking and tongue sticking out. Then comes the moment for the first feed, best still with skin to skin, in a calm dimly lit room. The breast crawl is like magic, some babies need a little help but they work their way to the breast, with an instinct driven ferocity! and so the pause continues…the pause to feed, to take stock, lovingly look at your baby and to rest after the incredible hard work of birth.
- Rudolph AM. Fetal and neonatal pulmonary circulation. Annu Rev Physiol 1979;41:383–95.
- Hooper SB, Kitchen MJ, Wallace MJ, et al. Imaging lung aeration and lung liquid clearance at birth. FASEB J 2007;21:3329–37
- Bhatt S, Alison BJ, Wallace EM, et al. Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs. J Physiol 2013;591(Pt 8):2113–26.
- McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev 2013; 7: CD004074