Monday, May 7, 2012

Fetal Hypoglycemia and Cutting the Cord

I've heard a lot about delayed cord clamping, but both of my boys had theirs cut within a minute after birth. I think the intention with the Pious One was to leave it until it stopped pulsing, but there was meconium when they broke my water and again when he was born, so they thought it might be better to begin looking him over for signs of distress right away. With Braveheart, I spent so much time thinking about how I felt about induction that I plum forgot about a whole lot of other natural things that I might have wanted to try.

A little bit of light internet reading turned up the following reasons for delayed cord clamping: support for the baby's iron stores, and extra oxygen to baby's brain, at least for preterm infants. I read a couple pages that suggested the white blood cells present in cord blood may benefit a newborn, also, which makes sense, but I didn't find the research.

As I understand it, blood continues to be supplied to the infant via the cord, as long as it has not been cut, for about 5 minutes after birth. The primary benefit is an increase in blood volume, which, provided that the mother's blood supply is healthy for baby (which it most likely has been for 9 months!), should be an added benefit to the baby.

What I know about fetal hypoglycemia for babies of diabetic mothers, however, is that it is precisely the mother's blood supply which stimulates an excessive insulin response in the baby, bringing the baby's blood sugar too low following separation from its mother.

So I guess the question is: will extra blood volume from the mother, especially if the mother's blood sugar is on its way up or high during and immediately following delivery, stimulate a more exaggerated insulin response from her baby? Will the baby's insulin response be changed such that it is more difficult to bring the baby's blood sugar back up? My gut says that the baby's insulin response WILL be more exaggerated, and that it will be more difficult to get the baby's blood sugar up.

But I could be missing something.

I suppose the baby's insulin response might be sufficiently insensitive that the total blood volume received from mom (and even the level of the mother's blood sugar) doesn't matter that much, but I think I would want to see something suggesting that before I put my eggs in that basket.

On the other hand, if my blood sugar is OK when the baby is born and in the few minutes following delivery, I actually feel pretty darn partial to it.

If, in the heat of the moment, the cord gets cut and I think it would have been OK to leave it, I won't be mad about it.

Unfortunately, I remember the final pushing stages with the Pious One (after nearly 4 hours...) saw a pretty sudden rise in my blood sugar, and even though Braveheart was out by the time it happened, my blood sugar also rose sharply following his birth (his blood sugar remained fine during recovery).

Don't you love it when I think out loud?

So I'm going to let the doctor make the call here, and as much as I covet the idea of giving my baby an iron boost at birth, I will bow to what seems, at this time, to be the better judgment and let other considerations take preference. I know what it feels like to have a low blood sugar, and wouldn't wish it on anyone - especially not my newborn baby.

Perhaps your pediatrician or OB has made a suggestion one way or the other, specifically as it relates to fetal hypoglycemia, and you'd like to share?


  1. Interesting thought process. I've also read that delayed cord clamping results in more hyperbilirubinemia from all those extra blood cells hat now need to break down (!) so its not entirely good stuff about it out there. In regards to blood sugars, keep in mind that the blood in the cord is not mom's blood. It's purely babies. And while sugar has crossed over to equal that of moms blood, I would imagine it reaches a pretty steady state, and it's not like those last few milliliters of blood in the cord will suddenly have a bunch more sugar than all the rest of babies blood has had in the last minutes and hours of delivery. I don't think your diabetes should factor into your decision in this case. Which is maybe a relief? For once your diabetes shouldn't matter in a health care decision?

    1. Thanks for your comment, Rachel! Yes, indeed, it would be nice to have a few more healthcare decisions that didn't revolve around my diabetes. :)

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