The Merck Manual on umbilical cord clamping -- one breath & clamp!!! Concerns of a mother and grandmother, Donna Young
What the Merck Manual (link below) has to say on the timing of the clamping of the infant's lifeline, the umbilical cord, to quote: "after first breath, clamp and cut the cord." by Donna Young, Natural Birth Education
Where is informed consent and a signed Birth Contract to say no to medical policies being
imposed on babies, and
directed by drug companies who may have a conflict of interest in any blood taken from the placenta,
trapped their by early cord
clamping.
The facts are, in most cases the mothers and the father of the child are NOT educated on the risk
taking of oxygen debt to the
brain and lungs, heart, and other organs by stopping their child's circulation system.
The facts are the baby can be deprived and provable by the evidence of the blood in the placenta, between
20 to 60 percent total
blood volume. See the Nurses Manual in my list of contents. The placentas are being sold and/or
used in burn tissues, and other
cosmetic purposes, and without informed consent, and the placenta blood drained and used practically
in medical causes, as
well.
Whose duty is it to protect the public of impaired and compromised babies that cost the public at large,
heavy tax burdens. But is
their method in the madness that baby births cost, today, in the United States, some $20 billion dollars.
Think about it, 4 million
babies born annually, at perhaps a cost of $60.00 per injection of oxytocin.
That is a lot of dollars just for one type of drug, the Oxytocins Pitocins, that are commonly used by
midwives and doctors and
ambulance medics, most likely. And don't forget the cost of the clamping tools, like Umbicut,
by Dupont, if the clamping tool is
not the reusable kind, that may also infect with viruses, if not sterilized well. Some germs not
being killed by regular disinfectants,
that could lead if not sterilized to the flesh eating disease, or other forms of super bugs, tetanus,
too.
Why clamp the pulsating and functioning cord, when it is only cosmetic, and harmful, and the need is
only there, if the cord tore, or
for placenta previa. These emergencies, too, for any other reason or excuses given for interrupting
the circulation system of the
baby, must be investigated, per child, per case, per situation if it was medical negligence, or motive
of harvesting the baby's
stem cell blood, trapped in the placenta.
The stem cells only one portion of the suspensions in the blood of many nutrients beneficial to the
well being and future growth of
the child, and longevity, without learning and behavior or health problems. Think about it. If
profits are the target for questionable
teaching, the women and the babies are the most vulnerable of our society, today, world wide. They
should not be exploited by
the class system who rule by profits, not ethics, today. Big Corporations stand to gain, if they
can fool the doctors to do their
bidding. So I believe is possible in our society. We do not have a round world, it is apparently
broken, it is crooked, as it needs
fixing, today.
We can see the take in revenues by the Politicians, who step back and have allowed unsound and not logical
medical practices.
There is organization, of so many who have allowed questionable birth practices, called "Active
Management" to be done to our
babies. This has happened for the past 3 and 4 generations, starting at about 1901, to this present
day.
This has been without investigation of normal natural child birth education and practice, with no drugs,
but warm water births, and
the mother's rights to "unassisted" births, even in hospitals, at waivers, by choice of educated
mothers in favor of no drugs, no
cord clamping, no cutting of their bodies to have a gentle birth. Not one of risk of future latent
fast or slow viruses in their system
by drugs, injected to them, and their babies, while profits may rule the day of our times. Where is
the voice of logic of those
ethically and competently trained medical persons, including nurses? Not all medical persons went
along with early umbilical
cord clamping, inserting of needles in babies, and vaccinations to babies, yet, anemic, after routinely
being clamped and blood
volume and nutrient deprived. Concerns of Donna Young, Mother and Grandmother, Canada.
Copy and Paste:
http://www.merck.com/mrkshared/CVMHighLight?file=/mrkshared/mmanual/section19/chapter256/256b.jsp%3Fregion%3Dmerckcom&word=umbilical&word=cord&domain=www.merck.com#hl_anchor
As of on line, November 19, 2003 12:01 pm
What the Merck Manual has to say on the time of the clamping of the infant's lifeline, the umbilical
cord, "after first breath, clamp
and cut the cord." Where is informed consent and a signed Birth Contract to protect the baby
of oxygen debt protection to brain,
lungs, heart, and other organs?
Mission StatementCorporate ResponsibilityCorporate GovernanceManagement CommitteeFeature Stories About MerckSupplier DiversityDiversity BrochureProduct NewsResearch & Development NewsCorporate NewsFinancial NewsExecutive SpeechesWebcastsContactsStock ChartFundamentalsFinancial News - NewsroomEvents and PresentationsFinancial ReportsSEC FilingsStockholders ServicesMedco Spin-OffFrequently Asked QuestionsWorking at MerckSearch JobsSubmit Resume/Log OnCareer ChoicesUniversity RecruitingGlobal LocationsCareer Questions?Our ResearchOur PeopleSubmit Your ResumeCompany ProfileOur Current PipelineOur Partnering HistoryThe FutureWhat Our Partners SayWhat We Can Do For YouOur Current PartnersOpportunities of InterestOur ProcessContactsThe Merck ManualThe Merck Manual--Home EditionThe Merck Manual of GeriatricsThe Merck Veterinary ManualThe Merck Index
This Publication Is Searchable
The Merck Manual of Diagnosis and Therapy
Section 19. Pediatrics
Chapter 256. Health Management In Normal Newborns, Infants, And Children
Topics
Perinatal Physiology
Initial Care
Health Supervision Of The Well Child
Growth And Physical Development
Psychomotor And Intellectual Development
Childhood Immunizations
Infant Nutrition
Common Feeding And Gastrointestinal Problems
Initial Care
At birth, the normal newborn breathes spontaneously once his airway is cleared of mucus and debris by gentle bulb suction. The umbilical cord is clamped and cut after the first breath ; one vein and two arteries should be visible on the fresh-cut surface. The newborn is dried gently and placed on a sterile, dry blanket or on the mother's abdomen; maintaining body temperature is critical. Good hand-washing technique must be used by all personnel, since the newborn's defense mechanisms against infection are not fully developed (see Immunologic Status of the Fetus and Newborn, above). Universal precautions are used and the newborn is handled with isolation gloves until after the first bath.
Life-threatening or major abnormalities, such as gross deformities (eg, omphalocele, myelomeningocele,
cleft lip and palate) and
orthopedic anomalies (eg, clubfoot or an abnormal number of digits on hands or feet) should be identified.
Other possible
abnormalities include a scaphoid abdomen, as occurs in diaphragmatic hernia, and asymmetry or increased
anteroposterior
diameter of the chest, as occurs in diaphragmatic hernia and spontaneous pneumothorax.
The newborn's general condition is noted using the
Apgar score
(see Table 263-13). Many normal newborns have transient
cyanosis that clears by the 5-min Apgar score. Generalized cyanosis indicates significant heart
or lung disease or major CNS
depression; differential cyanosis indicates specific cardiac lesions. The heart and lungs are auscultated
and the abdomen
palpated.
Gestational age is estimated (see method in Fig. 256-1); any newborn < 37 wk or > 42 wk gestation
or whose weight is
inappropriate for his estimated gestational age is likely to need special care (see Ch. 260).
Except in resuscitation efforts, a tube should not be passed to check the esophagus and stomach until
the newborn is stable (a
minimum of 5 to 10 min after birth), since this may produce severe vasovagal reflex apnea in an otherwise
normal newborn. After
10 min of life, a tube is passed to check patency of the nares and esophagus in newborns born to mothers
with polyhydramnios
or diabetes, in those born in the breech position or by cesarean section, and in any newborn with increased
secretions to rule out
tracheoesophageal fistula and other anomalies of the esophagus and stomach. The stomach, if reached,
is aspirated, and the
volume of its contents measured. Newborns delivered in the vertex position may have little fluid left
in the stomach, but this does
not rule out obstruction. The normal stomach volume of premature infants ranges from 5 mL in a 1.0-kg
baby to 12 to 15 mL in a
2.5-kg baby.
Two drops of 1% silver nitrate solution or, preferably, an antibiotic ointment such as erythromycin
is instilled in each eye. As soon
as possible, or at least in the first 1/2 h of life, the mother should be given the newborn to hold
and put to her breast, taking care
that both mother and newborn maintain body temperature (see Breastfeeding, below). When ready to be
placed in the crib, the
newborn is swaddled to maintain body temperature, being sure to cover the head, a large surface area
capable of losing
considerable heat.
If the newborn's temperature is < 35.5° C (< 96° F), an infant warmer is required. Normally,
the crib is left flat and the newborn is
placed on his side to facilitate mucus drainage. Phytonadione (vitamin K1) 1 mg IM is given to prevent
hypoprothrombinemia,
which causes hemorrhagic disease of the newborn (see under Vitamin K Deficiency in Ch. 3). The cord
is clamped with a
disposable clamp, and triple dye may be applied with a swab to the fresh-cut cord and periumbilical
area to prevent infection;
one application is sufficient.
In a birthing center, the newborn remains in the mother's room. If not in a birthing center and if the
mother is awake and alert, the
newborn may remain or may be placed in the regular nursery on the traditional postpartum floor.
A bath is not given for 6 h or until the newborn's temperature has been stabilized at 37° C (98.6°
F) for 2 h. The bath should not
remove all the vernix caseosa (a whitish greasy material that covers most of the body at birth), because
it provides some
antibacterial protection. A mild soap such as Dove may be used with thorough rinsing. Oils, powders,
and ointments should not
be routinely used.
Because normally mothers and newborns are discharged within 48 h, adequate follow-up is needed
in the first few days
at home by telephone or home visit initiated by the pediatric clinic or office. The American Academy
of Pediatrics recommends
that all newborns be seen in the office within 7 days.
Initial parent-infant interactions: Although pregnancy allows a woman to prepare herself psychologically
for the new baby and to
share that preparation with the father, important events that enhance parenting occur during and after
birth. Participation in the
birth by a prepared, knowledgeable woman and her partner allows smoother adaptation to the new role
of parenting.
An optimal environment that helps the couple to be secure and confident also helps the mother relax
and work with her body
during labor and delivery.
Parental feelings immediately after their newborn's birth vary from ecstasy to disappointment;
for some, these are
totally forgotten because of concurrent events requiring priority, such as resuscitation of the infant
or obstetric complications in
the mother. (Parent-infant bonding with a sick newborn is discussed in Ch. 257.) It has been suggested
that early physical contact
with the infant, including looking eye to eye, establishes an early bond essential to a lasting parental
love and a close relationship.
In humans, however, such a critical period may not exist. Unquestionably, mothers can relate well to
their infants even when the
first hours are not spent enraptured with each other.
Immediately after a normal birth, the mother should be helped to hold and cuddle her baby. The father
should have the opportunity
to share these moments, which may require providing appropriate garb for the father and some staff support
if he is
uncomfortable or insecure.
The first few days after birth is an ideal time to educate the parents about breastfeeding, bathing,
and dressing the newborn.
When the newborn spends the entire day at his mother's bedside, where the parents can become familiar
with his activities and
sounds, the transition to the home is smoother.
COMPLETE PHYSICAL EXAMINATION
The newborn should be examined within the first 12 h of life, including a more precise determination of gestational age using physical and neuromuscular findings (see Fig. 256-1).
Measurements: Body length is measured from crown to heel. Head circumference (largest measurement above
the ears) should
be about 1/2 the body length + 10 cm. Fig. 260-1 shows the relationship between birth weight and gestational
age
classifications. The average weight for term infants is 7 lb (3.2 kg). Measured against gestational
age, the newborn's size may
provide important clues to several conditions. For example, if the infant is small for gestational age,
an intrauterine infection or a
chromosomal abnormality may be the cause. An infant may be large for gestational age because of maternal
diabetes mellitus or
hyperinsulinism, as in Beckwith's syndrome; cyanotic congenital heart disease due to transposition of
the great vessels; maternal
obesity; or familial predisposition, as in Crow and Cheyenne Indians.
Cardiorespiratory system: Respirations are normally abdominal and range between 40 and 50/min.
Breath sounds are harsh
but should be heard equally throughout the chest. Heart sounds are audible by stethoscope, most prominently
beneath the
sternum. The heart rate is 100 to 150/min (average, 120). There may be marked sinus arrhythmia. Heart
murmurs are
frequently heard, but only about 10% are associated with congenital heart disease (see Ch. 261).
Newborns with severe
congenital heart diseases, such as aortic atresia or hypoplasia of the right or left ventricle, may
present with cyanosis or heart
failure.
Femoral pulses are palpable and their strength should be checked and compared; if the pulses are weak,
aortic coarctation or
left ventricular abnormalities may be present. Weak pulses should be confirmed with Doppler BP (eg,
using a Doptone device)
taken in all extremities. Doppler BP uses an ultrasound transducer in the inflatable cuff to detect
vessel turbulence during
deflation and thereby accurately determines systolic and diastolic pressures. Alternatively flush BPs
can be measured. Blood is
drained from a limb by elevating it until the skin pales. A previously applied BP cuff is pumped up
as in taking a regular BP; then,
with the limb placed level with the patient's body, cuff pressure is gradually reduced and a reading
(which represents systolic BP)
is taken when color returns to the limb.
Musculoskeletal system: The extremities should be symmetrically placed and actively mobile. While
the infant is supine with
the hips and knees flexed, the thighs should be completely abducted to the surface of the examining
table; limited abduction and
a palpable "clunk" as the femoral head slides into the hip socket are the cardinal signs of
congenital hip dislocation. (See also
Musculoskeletal Abnormalities in Ch. 261.) Female infants and those delivered in the breech position
are particularly prone to
have a dislocated hip. If hip mobility is in question, an ultrasound should be obtained and an orthopedist
consulted. Using double
or triple diapers may be adequate treatment for minimal congenital dysplasia of the hip joint. In more
severe cases, an
orthopedist should apply an abduction splint, but only after reviewing the ultrasound. If an orthopedist
is not available immediately,
triple diapers should be used 24 h/day until a splint can be applied. If disposable diapers are used,
a disposable one should be
placed closest to the skin with two cloth diapers as outer layers, providing the bulk. If clubfoot or
any other significant orthopedic
abnormality exists, therapy should begin immediately. (See Musculoskeletal Abnormalities in Ch. 261.)
Nervous system: The Moro, sucking, and rooting reflexes should be elicited. Normally, the deep
tendon reflexes are present
and equal. (Neurologic congenital abnormalities are discussed in Ch. 261.)
Skin: The skin is usually ruddy, and acrocyanosis is common in the first few hours. Dryness and
peeling often occur in a few
days, especially at wrist and ankle creases. Petechiae may be seen over the scalp and face in a vertex
delivery because of
pressure exerted during delivery but are not normally present below the umbilicus. Vernix caseosa covers
most of the body after
24 wk of gestation, diminishing at and beyond 40 wk.
Head: In a vertex delivery, the head will be molded, with overriding of the cranial bones at
the sutures and some swelling and/or
ecchymosis of the scalp (caput succedaneum). In a breech delivery, the head is usually unmolded, with
swelling and ecchymosis
occurring in the presenting part (ie, buttocks, genitalia, or feet). The fontanelles may vary in diameter
from a fingertip breadth to
several centimeters. A cephalhematoma is an accumulation of blood between the periosteum and the bone,
producing a swelling
that does not cross suture lines. It may present over one or both parietal bones and occasionally over
the occiput.
Cephalhematomas are usually not evident in the first few hours and until the edema disappears, then
they gradually disappear
over several months and should not be aspirated.
Because of in utero positioning, facial asymmetry may be present. Facial nerve palsy should be suspected
when there is
asymmetry of the nasolabial folds and the creases around the eyes when the baby cries.
The eyes should open symmetrically. Pupils should be equal and react to light, and the fundi should
be visualized. If a red reflex is
obtained on ophthalmoscopic examination, lenticular opacities can be excluded. Scleral hemorrhages are
common.
The ears are inspected for gestational age determination and positioning (see Fig. 256-1); low-set ears
often signal a renal or
genetic abnormality. The ear canals should be patent and the tympanic membranes visible. Although inexpensive
portable
devices can test the newborn's hearing, their reliability and validity have not been demonstrated for
general screening purposes.
Auditory evoked brain stem response testing (see in Ch. 82) should be used for high-risk patients, who
should be identified by
careful history of family deafness, fetal rubella, neonatal jaundice, or maternal or neonatal treatment
with aminoglycosides.
The mouth should be inspected for an intact palate and uvula, gum cysts, and a congenitally short frenulum
(tongue-tie). Small
pearl-like elevations (Epstein's pearls) and small ulcerations (Bednar's aphthae) on the hard palate
are normal. The infant's ability
to suck should also be evaluated.
Abdomen: Ten percent of all newborns have anomalies or findings that require close monitoring
during the first few days of life,
including abnormal shape, size, or position of the kidneys or other organs. (See also Renal and Genitourinary
Defects in Ch.
261.) Normally, the liver is felt 1 to 2 cm below the costal margin, and the spleen tip is easily palpated.
Both kidneys are ordinarily
palpable, the left more easily than the right; if they cannot be palpated, agenesis or hypoplasia may
be present. Large kidneys
may be due to obstruction, tumor, or cystic disease. Failure of the male infant to void may indicate
posterior urethral valves. An
umbilical hernia, due to a weakness of the umbilical ring musculature, is common but rarely causes symptoms
or requires therapy.
Genitalia: In the full-term male, the testes should be present in the scrotum. Hydroceles and
inguinal hernias often occur in the
newborn. A firm, discolored scrotal mass may represent testicular torsion, particularly in breech deliveries.
Although rare and
apparently not painful in the newborn, torsion represents a surgical emergency. Torsion can be distinguished
from simple
bruising by the distribution of the ecchymoses and the firmness of the testes if torsion is present.
The mass will transilluminate if it
is a hydrocele. In females, the labia are prominent. Mucoid and occasionally serosanguineous secretions
(pseudomenses) may
occur and are transient and nonirritating. Blood clots, however, deserve evaluation. A small tag of
tissue at the posterior
fourchette, believed to be due to maternal hormonal stimulation, will disappear over the first few weeks.
THE FIRST FEW DAYS
Screening tests for metabolic and hematologic disorders should be undertaken (see Screening, below).
Weight: Loss of 5 to 7% of birth weight in the first few days of life is considered normal and
is common for most newborns.
Passage of meconium (a sticky green-black substance that contains lanugo and squamous epithelial cells
from swallowed
amniotic fluid and intestinal secretions), loss of vernix caseosa, and drying of the umbilical cord
account for some weight loss, but
most is due to urinary and insensible water losses.
Umbilical cord: The plastic cord clamp should be removed in 24 h to avoid undue tension on
the drying stump. Daily
application of 70% alcohol to the stump hastens drying and reduces the incidence of infection.
The cord should be observed daily
for redness or drainage, since it is a portal of entry for infection; it is the first area to colonize
with bacteria and usually is the site
cultured in infection-control programs.
Foreskin:
Circumcision usually is requested by the parents and is rarely indicated medically
. Some cite an increase in
incidence of UTI among uncircumcised males as an indication. It is generally performed within the
first few days of life
under local anesthesia. It should be delayed indefinitely, however, if there is any displacement
of the urethral meatus,
hypospadias, or any other abnormality of the glans or penis, since the prepuce may be used later in
plastic repair. It should not be
performed if a family history of hemophilia or other bleeding disorders exists or if the mother is taking
long-term drugs associated
with coagulation disturbances, such as anticoagulants or aspirin.
Skin: Erythema toxicum, the most common neonatal skin lesion, is a benign self-limited rash and
may occur at any time during
the first week but most often on the second day. Usually found where clothing rubs the arms, legs, and
back and rarely on the
face, the rash appears as a blotchy erythematous wheal with a central papule that may become prominent.
A Wright's-stained
smear of the papule contents reveals eosinophils. A family history of allergy should be sought in severe
cases; if found, use of
lotions, powders, perfumed soaps, and plastic should be avoided.
Subcutaneous fat necrosis may occur over any bony prominence subjected to trauma or pressure, especially
the head, cheek,
and neck where forceps are applied during delivery. Lesions are indurated, isolated, and well
demarcated. A lesion may
rupture through to the skin surface, releasing a clear yellow sterile fluid that should disappear spontaneously
or with use of a
pressure-doughnut dressing.
Slight jaundice may occur in normal newborns but is of concern if it appears before 24 h of age and
if the serum
bilirubin is > 12 mg/dL (> 205 µmol/L) in a term newborn (concern is greater at lower levels in
a premature newborn
and under other circumstances--see Hyperbilirubinemia under Metabolic Problems in the Newborn in Ch.
260).
Urination: The first urine voided is concentrated and often contains urates, which turn the diaper
pink. Failure to void within the
first 24 h of life must be investigated thoroughly. Delayed voiding is more common in males and may
result from a
tight foreskin
or from edema and swelling of the penis in the recently circumcised infant.
Defecation: Every infant should pass meconium by age 24 h, although an infant who is meconium-stained
at birth may delay
defecating. Delayed defecation is most commonly the result of a plug of inspissated meconium (see under
Gastrointestinal
Defects in Ch. 261).
http://www.merck.com/mrkshared/searchresults.jsp
_____________________
contact:
Donna Young, Mother and Grandmother
Home: www.lotusbirth.com
References of research: www.lotusbirth.com/doc/FEB2003Lotusbirth-110.htm
A medical web site to visit:
Note: PETITION www.thepetitionsite.com/takeaction/102580814
Please ask this site to have a Medical Alert Petition Site: petitions@earth.case2.com
Related Links on Umbilical Cord Clamping and Anemia in babies:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Display&dopt=pubmed_pubmed&from_uid=13679933
