At the #HealthFOO unconference this past weekend, one presentation officially blew my mind. For an organization that studies technology, it's important to remember that often simply NOT acting is actually in the patient's interest.
For example, one of my first conversations was with Paul Levy, former CEO of Beth Israel Hospital. He told me about a intervention by Intermountain Health in Utah to reduce the number of c-sections before 39 weeks. Essentially they put in place a protocol to prevent c-sections before 39 weeks unless absolutely medically necessary, and due to this additional waiting time reduced costs and improved health.
In the #IGNITE talks, Dr. Greene's presentation centered on the idea that tiny changes can change the world. For example, 'optimal cord clamping'-- instead of immediate cord clamping after birth. It's a simple protocol of waiting for 90 seconds or until the umbilical cord stops pulsing. It's something many doulas, midwives and ob/gyns have been aware of for a while. The rationale is profound when you first hear it and again when you consider the implications. When a baby is born 2/3 of its blood is actually still with the mother (either in the placenta or in the umbilical cord). That means the blood, full of iron, oxygen as well as invaluable supplies of stem cells that shore up defenses for a lifetime-- are still with the mother! Dr. Greene notes that in many cultures and indeed in other mammals, the instinctual process is to wait to separate mother and infant. So what does that mean? That implies that 1/3 of the infant's oxygen, iron and stem cells may be kept from the baby and quite literally thrown away. The implications are absolutely profound and get right to the heart of many leading causes of newborn morbidity and mortality:
LESS IRON leads to anemia
LESS oxygen leads to asphyxia
LESS stem cells leads to lessened ability to repair the body throughout life
A 2011 Journal of Midwifery study looked at two decades worth of studies and found that "term infants had less anemia at 2 months and increased duration of early breastfeeding." For preterm infants they found that " benefits associated with delayed clamping in these infants included higher hematocrit and hemoglobin levels, blood pressure, and blood volume, with better cardiopulmonary adaptation and fewer days of oxygen and ventilation and fewer transfusions needed." This issue is also well-covered on mothering and midwifery blogs. What's a little more disturbing is that the U.S. developed cord clamping in the early part of the 19th c. and exported the practice around the world without an evidence base to support it.
Think about it. The moment when we cut the cord is a moment that sets the trajectory for the rest of the infant's life. The initiative that aims to spread this idea is called TICC TOCC. This stands for Transitioning Immediate Cord Clamping to Optimal Cord Clamping. We'll be revisiting this idea and this campaign, but for now, it's an important reminder that doing nothing can save lives.