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12-18-2012 at 4:08 AM
danuli8
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"Delayed cord clamping causes anemia."

For mobile users: "Delayed cord clamping causes anemia."

I kid you not, this is what my OB said to me when we went over my birth plan at my 24-week app't yesterday. She objected to delayed cord clamping because, and this is pretty much a direct quote, in her experience, babies ended up anemic after DCC and I would just have to trust her on this. (Huh????)  I thought this was utterly ridiculous and gave her an article countering the objections to DCC written by Mark Sloan (an MD and pediatrician who wrote the book Birth Story).

My problem is, I don't know how to try and persuade her, because I can't exactly tell her that her experience is wrong. I think she may be attributing the anemia she observed to DCC when in fact it was due to something ELSE. I posted a while back about my concerns with her and wondered if I should switch to a midwife. After this conversation, I am really at a loss. If she won't budge, I think this may be a deal-breaker that would cause me to look for a new provider.

Thoughts, insights, advice, anyone with a similar experience? I am very frustrated and confused right now.
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12-18-2012 at 6:49 AM
AmyRI
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Never heard of it. I have heard that it can increase any issues with jaundice.

I'd switch providers ASAP. Even if she agreed to do the DCC, I wouldn't trust her to actually do it in the moment and her attitude of "just trust me on this" is not ok. You told her what you wanted and she is refusing to accept that based purely on her anecdotal "evidence." I want a provider who is persuaded by facts, not by their own opinions.

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12-18-2012 at 6:51 AM
ncbelle
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If you are feeling uncomfortable with her now, think how you are going to feel come go time.  If she doesn't get this issue, is she going to respect your wishes on other things?  You shouldn't have to fight your provider or talk her into something.  t would switch providers - find someone who you don't have reservations about!
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12-18-2012 at 7:36 AM
+adamwife+
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I'm going to give her the benefit of the doubt and assume she meant to say jaundice.  But regardless, that's a huge logic fail that would have me questioning her ability to make good decisions about my care on her own without relying on what her peers think is right.
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12-18-2012 at 7:58 AM
BreanneL24
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I would be extremely wary of any doctor who says, "just trust me." It doesn't matter that it is ridiculous that she thinks DCC causes anemia, but just the fact that she says you'll have to just trust her is reason enough to switch providers.

I also agree with PP that she may not respect your wishes come L&D time if she has that attitude. Maybe it is just me, but I don't put my trust in a doctor.

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12-18-2012 at 8:27 AM
aylafsu88
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ncbelle:
If you are feeling uncomfortable with her now, think how you are going to feel come go time.  If she doesn't get this issue, is she going to respect your wishes on other things?  You shouldn't have to fight your provider or talk her into something.  t would switch providers - find someone who you don't have reservations about!

This.  You need to feel comfortable with your OB especially when you are trusting her to care for your during L&D.  You really need to consider switching.
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12-18-2012 at 9:41 AM
tokenhoser
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Switch. You don't trust your doctor, and your doctor doesn't trust you. Totally dysfunctional relationship. You need to be in a place of trust so that if something does go off-course, you know that is wasn't a result of your doctor.

And yes, it's related to jaundice, not anemia, so if your doctor really said anemia... get out.

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12-18-2012 at 10:33 AM
nosoup4u
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If you've already thought of switching before, then just do it. Sounds like she's a bad match for you.
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12-18-2012 at 1:11 PM
MisN
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My OB is very supportive of natural birthing but when I brought up delayed cord cutting she said that the cord goes both ways and doesn't recommend it.  I haven't really done any further research on the issue.

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12-18-2012 at 7:13 PM
pantherRN
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Basically, the research "jury" is still out on DCC. There seem to be some benefits, particularly in premature infants, but there is just not enough research out there for OBs, the ACOG etc to recommend it as standard protocol for all births. Here are some research studies that are newer that you could show her:

http://www.ncbi.nlm.nih.gov/pubmed/22673168 (this is a meta-analysis and appears very good)

http://www.ncbi.nlm.nih.gov/pubmed/22089242 (this looks at long-term outcomes)

Here is the ACOG's most recent statement on DCC: http://www.acog.org/About_ACOG/News_Room/News_Releases/2012/Time_to_Clamp_the_Cord 

Personally, I don't think DCC is going to be my hill to die on. However, if you are already concerned about her, I would switch. If you liked her otherwise, it would be different.  

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12-18-2012 at 8:14 PM
Runaway22
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This would probably be a deal breaker for me, especially if she followed it up with, "Just trust me." I'd try to find another OB or a midwife. GL!
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12-19-2012 at 12:32 PM
danuli8
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pantherRN:

Basically, the research "jury" is still out on DCC. There seem to be some benefits, particularly in premature infants, but there is just not enough research out there for OBs, the ACOG etc to recommend it as standard protocol for all births. Here are some research studies that are newer that you could show her:

http://www.ncbi.nlm.nih.gov/pubmed/22673168 (this is a meta-analysis and appears very good)

http://www.ncbi.nlm.nih.gov/pubmed/22089242 (this looks at long-term outcomes)

Here is the ACOG's most recent statement on DCC: http://www.acog.org/About_ACOG/News_Room/News_Releases/2012/Time_to_Clamp_the_Cord 

Personally, I don't think DCC is going to be my hill to die on. However, if you are already concerned about her, I would switch. If you liked her otherwise, it would be different.  

Thanks for those links, pantherRN. The Swedish study certainly seems to indicate that it is a good idea even for full-term infants. I poked around some more and found this article from the July/Sep 2012 issue of the Journal of Perinatal and Neonatal Nursing: http://www.nursingcenter.com/prodev/ce_article.asp?tid=1409724 These sentences from the abstract really made me sit up and pay attention: "Delay of cord clamping substantively increases iron stores in early infancy. Inadequate iron stores in infancy may have an irreversible impact on the developing brain despite oral iron supplementation. Iron deficiency in infancy can lead to neurologic issues in older children including poor school performance, decreased cognitive abilities, and behavioral problems."

So, in short, I have this wonderful one-time opportunity to ensure my baby has enough iron for his brain to develop optimally. Why the heck would I pass that up?

I think the root of the problem is that I am expecting my OB to think and act like a midwife, and she just plain isn't one. It's like buying a cat and expecting it to bark at strangers who come to the door. I have decided to make the switch to a CNM, and I think everyone will be much happier that way.
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12-19-2012 at 12:57 PM
pantherRN
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danuli8:

I think the root of the problem is that I am expecting my OB to think and act like a midwife, and she just plain isn't one. It's like buying a cat and expecting it to bark at strangers who come to the door. I have decided to make the switch to a CNM, and I think everyone will be much happier that way.

I think this sounds like a great decision for you. Good luck! 

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12-20-2012 at 3:30 PM
drpayne
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+adamwife+:
I'm going to give her the benefit of the doubt and assume she meant to say jaundice.  But regardless, that's a huge logic fail that would have me questioning her ability to make good decisions about my care on her own without relying on what her peers think is right.

 

this.

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