Jackie Kemp: Cutting the cord linked to convention

CHIMPS do it, bonobos do it, even the orangutans do it. But should we do it? Would you consider letting your newborn baby hang on to the placenta for a few days after birth?

Medical opinion is changing over the benefits of lotus birthing

In “lotus birthing”, the placenta is washed and rubbed with salt and herbs such as lavender, and left to dry out while remaining attached to the newborn for up to a week.

Lotus birthers see the placenta is a source of valuable nutrients and stem cells but they also refer to it as the “tree of life”, imbued with spiritual significance.

Lotus babies are often kept in one place, generally undressed, wrapped in a shawl, under low lights and attended by immediate family only, as visitors are not encouraged until the baby has “lotus birthed” – as that moment of parting from the placenta is referred to – up to a week later.

This is rare and at the extreme end of the natural birth spectrum. It is not compatible with the lives of most busy, multi-tasking 21st-century mums, keener perhaps to trail a laptop or smartphone along with the new arrival than a rotting placenta.

And yet it is happening. It is currently the subject of some lively debate on internet blogs and news sites.

One practitioner of lotus birthing, a yoga teacher from Brighton called Adele Allen, recounted her experience last week in a blog. She wrapped the placenta in plastic and admits it “did not dry out as well as it should have” and there was “a slightly musty smell”. But otherwise, the process worked well, with baby Ulysses finally severing his own cord at six days old.

Allen wrote: “When we clamp and cut the cord too soon, we risk losing a precious fluid and gas exchange.

“Some wild animals such as our closest relatives, the chimpanzees must know this instinctively as most of them continue to carry around the placenta with the cord attached to their babies until it naturally drops off and is returned to the earth; what we otherwise refer to as a lotus birth.

“Other animals do chew the cord off shortly after birth, but as a vegan this option did not appeal to me.”

It is easy to mock of course, but the accounts by women who do this make fascinating reading and the theory is based on some interesting ideas, including a re-evaluation of the western convention of cutting the cord within 30 seconds of birth.

Almost every new mother has her “nobody told me about this” moment.

Mine came a few minutes after giving birth to my first child. I was okay, the baby was screeching like a trainee Justin Bieber fan, and I figured it was time for my tea and toast. “Oh you’re not finished yet,” the midwife said. “Now you have to deliver the placenta.”

This was a few years ago and the fashion was to make the father feel more involved by offering him the chance to cut the cord. My husband was invited by the medics to do this and said he felt rather odd, as if he was being asked to cut the ribbon at a supermarket opening.

However, he obliged and recounted that it took a surprising amount of pressure with the scissors to cut the gristly, pulsating vessel which was still engorged with blood.

Dr Sarah Buckley, a New Zealand GP and early pioneer of lotus birthing, writes on her website: “I remembered my time training in GP obstetrics, and the strange and uncomfortable feeling of cutting through the gristly, fleshy cord that connects baby to placenta and mother.

“The feeling for me was like cutting through a boneless toe, and it felt good to avoid this cutting with my coming baby.”

Now it seems medical opinion is altering on that convention. There is not much evidence it seems that routinely cutting the cord within seconds of birth is a good idea.

It is a time-honoured practice of western medicine, which has been exported all over the world but it is not supported by clinical evidence.

Work is now starting to be done and studies which compare cutting within 30 seconds to cutting a few minutes later have proved that the delay is beneficial to the baby.

Cord blood protects the baby from anaemia and potentially from other conditions too. Delayed cord clamping is becoming popular, although in many hospitals in Scotland, women still have to ask for it.

There is no evidence yet to support a longer delay in cord cutting than three minutes.

The Royal College of Obstetricians and Gynaecologists warns women to beware of possible infection to the newborn if they decide to practise lotus birthing.

But lotus advocates respond that cord cutting leaves an open wound. It is true that poor care of the stump, particularly in developing countries, helps to make neonatal tetanus a major cause of death.

Another area of concern is postpartum haemorrhage, a major cause of maternal death worldwide.

When immediate cord-cutting is compared to three minutes later, there is no observable effect on this. But some suggest that cutting the cord before the placenta is delivered may lead to it not coming away evenly from the uterus wall and increasing the risk.

More research is needed into this important area.

Lotus birthing, perhaps, will always be a step too far for most mums. But does the placenta really need to be whipped away so urgently?

Is there a case for letting the organ which has triumphantly nurtured the baby for nine months shut down a bit more slowly over three to five hours as is done in some other cultures? Medicine must produce evidence on this rather than simply relying on convention.