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Lotus Birth: A Case Series Report on Umbilical Nonseverance

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Lotus Birth: A Case Series Report on Umbilical Nonseverance

Abstract

Lotus birth is the practice of leaving the umbilical cord uncut until separation occurs naturally. Our case series report describes delivery characteristics, neonatal clinical course, cord and placenta management, maternal reasons for a lotus birth, and desire for future lotus births. Between April 2014 and January 2017, six lotus births occurred. Mothers (four of the six) were contacted by phone after giving birth. A chart review was completed on each patient to evaluate if erythromycin ointment, hepatitis B vaccine, and vitamin K (intramuscular or oral) were administered, treatment of the placenta, maternal group B streptococcus status, postnatal infant fevers, infant hemoglobin or hematocrit levels, jaundice requiring phototherapy, and infant readmissions. Three of the six families decided to cut the cord before hospital discharge. No infections were noted. All contacted mothers would elect for a lotus birth again (4/6). One hepatitis B vaccine was given; all others declined perinatal immunization.
https://doi.org/10.1177/0009922818806843
Clinical Pediatrics
2019, Vol. 58(1) 88 –94
© The Author(s) 2018
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DOI: 10.1177/0009922818806843
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Article
Introduction
Lotus birth or umbilical nonseverance is the practice of
leaving the umbilical cord uncut so that it and the pla-
centa remain connected to the baby until it detaches
naturally,1 usually up to 10 days after birth.2 The pla-
centa is often wrapped in fabric or a bag3,4 and may be
treated with salts, lavender oil, rosemary, or other herbs
to decrease odors.2,3,5
Very little information has been published regarding
lotus births. In one study, mothers who had or were
planning homebirths, including several who had
elected a lotus birth, were interviewed.4 Mothers
reported viewing the placenta as belonging to the baby,
rather than being a medical by-product; thus, the pla-
centa and umbilical cord were something the baby
should release when he was ready and not before.
Women spoke of the practice in spiritual terms; cleanli-
ness and medical benefits were often secondary con-
cerns. Women in other reports echo this tone,
emphasizing the baby’s control over the placenta and a
spiritual aspect of the experience.3,5
Though these are certainly worthwhile benefits to
mothers and babies, it is also important to consider
whether there are any health outcomes, positive or nega-
tive, associated with lotus birth in order to best treat
patients who request this method of managing the pla-
centa and umbilical cord. No evidence-based research
devoted to clinical outcomes has been published on the
subject. Once it has been delivered, the blood in the pla-
centa is no longer circulating, and the tissue is nonvia-
ble. At this point, the placenta may be at risk of becoming
infected, which could theoretically then spread to the
baby1; however, the likelihood and severity of such an
infection are unknown. The closest comparable data
would be on omphalitis, which is estimated to occur at
1/1000 in high-resource countries.6 There have been no
major documented cases of adverse outcomes related to
lotus births in terms of hemorrhage or infection,2 until
2015 when a case report demonstrated a possible link to
806843CPJXXX10.1177/0009922818806843Clinical PediatricsMonroe et al
research-article2018
1The University of Michigan, Ann Arbor, MI, USA
2C.S. Mott Children’s Hospital, Ann Arbor, MI, USA
Corresponding Author:
Kimberly K. Monroe, Department of Pediatrics, C.S. Mott Children’s
Hospital, 1540 East Medical Center Drive, Ann Arbor, MI 48109,
USA.
Email: monroek@med.umich.edu
Lotus Birth: A Case Series Report
on Umbilical Nonseverance
Kimberly K. Monroe, MD, MS1,2 , Alexandra Rubin, BS1,2,
Kerry P. Mychaliska, MD1,2, Maria Skoczylas, MD1,2,
and Heather L. Burrows, MD, PhD1,2
Abstract
Lotus birth is the practice of leaving the umbilical cord uncut until separation occurs naturally. Our case series
report describes delivery characteristics, neonatal clinical course, cord and placenta management, maternal reasons
for a lotus birth, and desire for future lotus births. Between April 2014 and January 2017, six lotus births occurred.
Mothers (four of the six) were contacted by phone after giving birth. A chart review was completed on each patient
to evaluate if erythromycin ointment, hepatitis B vaccine, and vitamin K (intramuscular or oral) were administered,
treatment of the placenta, maternal group B streptococcus status, postnatal infant fevers, infant hemoglobin or
hematocrit levels, jaundice requiring phototherapy, and infant readmissions. Three of the six families decided to cut
the cord before hospital discharge. No infections were noted. All contacted mothers would elect for a lotus birth
again (4/6). One hepatitis B vaccine was given; all others declined perinatal immunization.
Keywords
Lotus birth, umbilical nonseverance
Monroe et al 89
neonatal idiopathic hepatitis.7 Some anecdotal reports
have suggested benefits that may result from avoiding
the psychologic trauma of cord severance5; however, no
evidence-based research has been published to support
these claims. In 2015, the American Heart Association
and the American Academy of Pediatrics revised the
neonatal resuscitation guidelines to include the recom-
mendation of delaying cord clamping for 30 to 60 sec-
onds in vigorous term and preterm newborns. For term
infants, the benefits of this delay include increased
hemoglobin levels at birth and improved iron stores for
several months after birth, which may favorably affect
infant development. For preterm infants, delayed
clamping may improve transitional circulation and help
increase red blood cell volume. However, as delayed
cord clamping could lead to a slight increase in the
number of cases of jaundice requiring phototherapy in
term infants, the adoption of mechanisms to monitor
and treat neonatal jaundice is recommended.8,9
To our knowledge, no research exists on the practice,
consequences, or benefits of a lotus birth. Due to this
lack of literature, newborn providers may be at a loss
when counseling mothers who elect to have a lotus birth.
The purpose of this descriptive study is to better under-
stand patients’ experiences and outcomes with lotus
births. This information may be used to develop hospital
policies regarding the practice, as no current standard
guideline has been established.
Methods
This institutional review board–approved study is both a
retrospective and prospective chart review of lotus births
at the University of Michigan C.S. Mott Children’s
Hospital in Ann Arbor. A retrospective chart review was
conducted on lotus births that occurred at C.S. Mott
Children’s Hospital from April 2014 to January 2017.
After July 2016 and through February 2017, the research
team was notified of a lotus birth via email, phone, text
page, or verbal notification either while the mother was
in labor or once the baby was delivered. Hospital faculty
on the newborn delivery unit were notified via handouts
and email to contact the study team when a lotus birth
occurred. All mothers were mailed a handout explaining
the study, including a consent form via US Mail. There
was no face-to-face recruitment.
Mothers were contacted by phone at least 1 month
after giving birth. The consent handout was reviewed
with the mother at this time. After obtaining appropriate
consent, mothers were surveyed about their manage-
ment of the placenta and umbilical cord, the day the cord
separated, their desire for a future lotus birth, and reason
for desiring the current lotus birth (Figure 1). In addi-
tion, a review of the infant’s chart was conducted to
collect data on other birth-related care. We recorded
available information on gestational age, birth order,
delivery method, mother’s group B streptococcus status,
administration of erythromycin eye ointment, hepatitis
B vaccination, vitamin K administration (intramuscular
[IM] or oral), infant hemoglobin or hematocrit levels,
blood culture (if drawn), postnatal newborn fevers,
infection at umbilical site, granuloma development,
hyperbilirubinemia requiring phototherapy, transcutane-
ous bilirubin and total serum bilirubin in relation to hour
of life and light level, mother’s blood type and baby’s (if
known), treatment of the placenta, and infant readmis-
sions. Vaccination records were obtained through the
Michigan Care Improvement Registry (MCIR)10 to eval-
uate for further vaccinations administered in the outpa-
tient setting.
If we were unable to contact a mother via telephone,
we used only the data available from the baby’s chart.
All data obtained from phone interviews and chart
review were recorded in Microsoft Excel. In addition to
collecting data on lotus births occurring at our institu-
tion during the study period, our team also developed a
protocol for the management of lotus births and plain
language patient education materials for families. The
protocol was created using the available lotus birth
literature.1-5,9,11-15 The consensus protocol was reviewed
by experienced pediatricians who practiced in the
newborn nursery and had cared for babies who had
undergone a lotus birth, and nursing staff. It was
reviewed and approved by the committee who over-
sees our newborn nursery and by obstetricians and
nurse-midwives. See Figure 2 (available in the online
version of the article). A patient handout was created
1. What day of life did your baby’s umbilical cord fall off?
2. Did your baby have an infection at or near the umbilical
cord attachment site?
a. If yes, was your baby hospitalized or managed
outpatient?
b. If hospitalized, what hospital?
3. Did your baby have a granuloma?
a. If yes, was your baby hospitalized or managed
outpatient?
b. If hospitalized, what hospital?
4. How did you treat the placenta? For example, did you use
oils or salts?
5. What is the birth order of this baby?
6. Would you plan for a lotus birth again?
Figure 1. Phone survey questions.
90 Clinical Pediatrics 58(1)
and reviewed by our patient education librarian to
ensure that it met plain language guidelines. This hand-
out is publically available on the University of Michigan
patient education clearinghouse at http://pteducation.
med.umich.edu/. See Figure 3 (available in the online
version of the article).
Results
Four lotus births were identified as occurring at our
institution between April 2014 and June 2016. An addi-
tional two lotus births occurred between July 2016 and
January 2017 (see Table 1 and pictures). One infant was
delivered by unplanned cesarean section, one by vagi-
nal water birth, and the rest by non-water vaginal deliv-
ery. Only one family consented to administration of
hepatitis B vaccine (HBV) in the newborn nursery; the
other five families declined immunizations in the hospi-
tal. Vaccination records were able to be obtained
through MCIR on five of the six patients. Three showed
no immunizations ever being given, one patient received
only two polio vaccines, and the fifth showed a partially
vaccinated record. Erythromycin eye ointment was
administered 50% (3/6) of the time. Vitamin K supple-
mentation was given to 66.7% (4/6) patients with two
receiving IM vitamin K and two receiving PO (per os)
vitamin K. The hepatitis B vaccination rate in the lotus
birth group was 16.7% (1/6; 95% confidence interval of
[0-0.58]). Three of the families decided to cut the cord
before they left the hospital. No infections were noted.
Two patients received phototherapy. One received pho-
totherapy in the hospital for six hours and was cau-
tiously categorized as having a higher neurotoxicity
risk due to having a sibling with jaundice and being a
lotus birth. The patient otherwise had low neurotoxicity
risk and was 0.7 mg/dL below the medium-risk light
level when started on phototherapy. The other patient
was treated with home phototherapy via a bili-blanket
on day of life four. She was 0.4 mg/dL below the
medium-risk light level, but otherwise had low neuro-
toxicity risk. We were able to contact four of the six
mothers for the telephone interview. All four of these
mothers indicated that they would elect for a lotus birth
with a future delivery.
Discussion
This is a case series report on umbilical nonseverance or
lotus birth. This birth practice is generally not seen in
typical obstetric care, and pediatricians may not be famil-
iar with management of this situation, which leads to
inconsistent messaging to families and care teams. We
had six cases over the course of 33 months in an institu-
tion with approximately 4500 deliveries/year. Although
uncommon, it is important for medical providers to be
aware of this birth practice and its potential risks. As no
evidence-based research has been done on this topic our
study provides some insight into this practice.
Given the rarity of the request for a lotus birth deliv-
ery, medical providers may not have ready information
to use while providing care. We have found it helpful to
have patient education materials, which includes signs
and symptoms of infection as well as a protocol for med-
ical providers to reference. Medical providers should
aim to provide patient-centered care and accommodate
family desires around the delivery experience when it is
safe to do so. Unfortunately, rates of acceptance of stan-
dard, evidence-based newborn care were lower in this
patient population than on our typical newborn service,
with lower rates of HBV (16.7% vs 86.4%), erythromy-
cin eye ointment (50% vs 94.1%), and IM vitamin K
administration (33.3% vs 97.7%), suggesting a need for
focused communication around risk for families elect-
ing a lotus birth.
This study had some limitations. Our newborn nurs-
ery data on HBV vaccination rates, erythromycin and
IM vitamin K administration were obtained from
November 2015 to November 2016, while our study
dates were from April 2014 to January 2017. MCIR
records do not reflect vaccinations given in other states
unless entered by a medical provider. Therefore, it is
unknown if any patient(s) obtained vaccinations in
another state since birth.
Conclusion
As lotus births are rare occurrences with minimal aca-
demic literature available on the topic, it is important to
continue to gather case reports that will further inform
providers who care for infants in the newborn setting.
This will ultimately lead to better patient-centered care
for families electing this practice. In our lotus birth six-
patient case series, no infections were seen and the
majority of mothers expressed an interest in future lotus
births. Because these families may have an increased
rate of declining standard newborn care practices, care-
ful communication strategies should be developed for
discussing known risks for newborns.
91
Table 1. Patient Characteristics.
Patient 1 2 3 4 5 (Pictures) 6
Delivery characteristics
Gestational age 41 5/7 39 1/7 40 1/7 39 5/7 38 0/7 40 1/7
Birth order 3 1 3 5 1 4
Delivery method Vaginal C-section Vaginal Vaginal Vaginal Vaginal tub birth
GBS status Positive with adequate
IAP
Unknown with
adequate IAP
Negative Positive with adequate IAP Negative Unknown—inadequate
IAP
Neonatal clinical course
Erythromycin ointment Declined Declined Declined Given Given Given
Hepatitis B vaccine Declined Declined Declined Given Declined Declined
Vitamin K Given (IM) Given (PO) Declined Given (IM) Given (PO) Declined
Hemoglobin/hematocrit
(if drawn)
N/A N/A N/A 16.5/46.3 at 37 hoursa16.7/49.7 at DOL 20 N/A
Blood culture (if drawn) N/A N/A N/A N/A N/A N/A
Febrile during hospital
stay
No No No No No No
Infection at umbilical
site
No No No—per EMR,
unable to
confirm with
parent
No No Unknown—no follow-
up available by EMR
or parent
Granuloma
development
No No No—per EMR,
unable to
confirm with
parent
No No Unknown—no follow-
up available by EMR
or parent
Hyperbilirubinemia
requiring phototherapy
No (serum bilirubin never
ordered, Tcb 2.6 at 17
HOL)
No (serum bilirubin
never ordered, Tcb
8.8 at ~50 HOL)
No (serum
bilirubin never
ordered, Tcb
4.3 at 22 HOL)
Yes (overhead lights and a
bili-blanket for 6 hours.
Discharged on a bili-
blanket. TSB 8.5 at 20 HOL
[LRLL 10.8, MRLL 9.2],
started phototherapy and
9.0 at 30 HOL [LRLL 12.7]
when discontinued)
Yes (Tcb 4.5 at 18
HOL. TSB 15.7 at
81 HOL [LRLL 18.6,
MRLL 16.1], put on
bili-blanket in ED
after discharge from
birth hospitalization)
No (serum bilirubin
never ordered, Tcb
5.6 at 18 HOL)
Mother’s blood type
and baby’s blood type
(if known)
A+, DAT− O+, DAT− O+, DAT− B+, DAT−; B+, DAT− A+, DAT−; A+,
DAT−
O+, DAT−; unknown
(continued)
92
Patient 1 2 3 4 5 (Pictures) 6
Cord/placenta management
DOL for cord
separation
N/A N/A 7 10 5—assisted by parent N/A
DOL for cutting cord/
reason
2—parents decided to
have the umbilical cord
cut for safety reasons
3—parents decided
to cut the cord
“because it was dried
up”
N/A N/A N/A 2—parents did not feel
it was convenient
to take the placenta
home
Management of placenta Washed and patted dry
Placed in a strainer inside
of a bowl
Wrapped in cloth
with Himalayan salt,
dried lavender, dried
rosemary
Changed the dressing
periodically for the first
12 to 24 hours
Coated with a mixture
of salts, dried
lavender, and other
herbs that were
obtained from their
Doula
Wrapped in a
diaper and
swaddled in a
blanket—per
EMR
Coated with a mixture of
oil, salt, lavender, hibiscus,
rosemary, bay leaves, and
anise seeds
Cleaned
Coated with a
mixture of herbs—
rosemary, lavender,
and Himalayan salt
Wrapped in a silky
scarf and kept in
a lunch pail at the
same level as the
baby
Kept in a small
container at
bedside—per EMR
Maternal desire for a
lotus birth for future
children
Yes Yes Unknown Yes Yes Unknown
Maternal reason for
desiring a lotus birth
“Wanted the blood from
the placenta to go to the
baby”
“The placenta is like a
twin to the baby and
nurtures him”
“Cutting it is traumatic for
the baby”
Unknown Unknown It is a “DNA download”
“It helps the babies develop
better—walk at 8.5
months and talk earlier”
Lotus births were in her
family for years but
stopped during slavery
Unknown Unknown
Abbreviations: C-section, cesarean section; GBS, group B streptococcus; IAP, intrapartum antimicrobial prophylaxis; IM, intramuscular; PO, per os; NA, not applicable, DOL, day of life; EMR,
electronic medical record; Tcb, transcutaneous bilirubin; HOL, hour of life; TSB, total serum bilirubin; LRLL, low-risk light level; MRLL, medium-risk light level; ED, emergency department; DAT,
direct antiglobulin test.
aRounded up to nearest hour.
Table 1. (continued)
Monroe et al 93
Acknowledgments
The authors would like to thank Joanne Bailey, CNM, Carrie
Bell, MD, Anita Hernandez, MD, Michael Levy, MD, and
Linda Gobeski, RN.
Author Contributions
KKM assisted with study design and concept, creation of a
data collection plan, chart review, retrieval of data and analy-
sis, wrote the first version of the manuscript and executed all
manuscript revisions and approved the final manuscript. AR
assisted with study concept and design, data retrieval, per-
formed edits and approved the final manuscript. KPM
assisted with study design and concept, performed edits and
approved the final manuscript. MS assisted with study
design, executed all manuscript revisions and approved the
final manuscript. HLB assisted with study concept and
design, executed all manuscript revisions and approved the
final manuscript.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
Supplemental Material
Supplemental material for this article is available online.
ORCID iD
Kimberly Monroe https://orcid.org/0000-0002-0010-3486
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... Today, there is an increase in the number of women and families who want to practice lotus birth in the world and in Turkey. In the study results, it was reported that the mothers saw the placenta as a part of the infant rather than a medical product, and thus thinking that the placenta and umbilical cord should separate spontaneously when it is ready (Monroe et al., 2019). ...
... Contrary this situation, there has not been enough evidence on the possible benefits or harms of not clamping or cutting the cord (Hayes, 2019). Since there is no circulation in the placenta in the postpartum period, the tendency to infection increases and there is a risk of transmission of the developing infection to the newborn (Monroe et al., 2019). The relationship between lotus birth conditions such as neonatal hepatitis and hyperbilirubinemia supports this situation (Monroe et al., 2019). ...
... Since there is no circulation in the placenta in the postpartum period, the tendency to infection increases and there is a risk of transmission of the developing infection to the newborn (Monroe et al., 2019). The relationship between lotus birth conditions such as neonatal hepatitis and hyperbilirubinemia supports this situation (Monroe et al., 2019). In a study conducted with nine women in Turkey, the reasons for choosing the lotus birth were searched and it was found that they thought there was a spiritual relationship between the newborn and the placenta, however, cutting the umbilical cord was disrespectful to the placenta. ...
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... 8 At our institution, a limited 6-case series of UCNS was published in 2019, with no reported adverse outcomes. 9 However, shortly after publication, the first adverse event-associated case related to UCNS occurred. We report a case of omphalitis and Escherichia coli bacteremia and urinary tract infection associated with UCNS. ...
... deliveries per year. 9 Although there were no reported adverse outcomes in this primary analysis, we subsequently encountered this case associated with serious bacterial infection. In previous case reports, researchers have established omphalitis as an adverse outcome associated with UCNS. ...
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... In tutti i casi è stato effettuato un clampaggio ritardato del cordone. Inoltre, nonostante il dibattito sulla sicurezza del lotus birth sia ancora aperto [14,15], una discreta proporzione di donne (26,4%) ha optato per questa pratica, similmente a quanto riportato da Campiotti, et al. (28%-36%) [2]. La continuità assistenziale garantita dalle ostetriche fino al termine del puerperio assicura, tra le varie attività di care materno-infantile, anche un attento controllo del neonato per identificare tempestivamente i segni di una possibile infezione. ...
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The monograph with the title Lotus Birth Method against Iron Deficiency Anemia contains the effectiveness of the lotus birth method on the incidence of iron deficiency anemia in infants.
Article
The care of late preterm and term newborns delivered in hospital settings in the United States is largely standardized with many routine interventions and screenings that are evidence-based and serve to protect newborn's and the public's health. Refusals of various aspects of routine newborn care are uncommon but can be challenging for clinicians who care for newborns to navigate for many reasons. In this article, we describe the spectrum of refusal. We review suggested approaches that clinicians can take starting with increasing their own awareness of what specific components of newborn care are refused and why.
Article
Importance: Birth plans are an important part of childbirth preparation for many women. Objective: The aim of this review was to discuss some common requests, specifically home birth, water birth, placentophagy, lotus birth, vaccination refusal, and vaginal seeding, including evidence-based recommendations, perceived benefits, and potential maternal and neonatal consequences. Evidence acquisition: A literature search for each topic was undertaken using PubMed and Web of Science. For the home birth section, the MeSH terms home AND birth OR childbirth AND outcomes OR complications OR recommendations OR guidelines were used. For the vaccination section, birth OR childbirth OR maternal AND vaccination refusal were searched. For the remainder of the sections, umbilical cord AND nonseverance OR placentophagy OR vaginal seeding OR lotus birth were searched. A total of 523 articles were identified. The abstracts were reviewed by 2 authors (J.R.W. and J.A.R.); 60 of these articles were selected and used for this review. Results: Home birth is currently not recommended in the United States. Immersion in water for labor is acceptable, but delivery should not occur in water. Placentophagy and lotus birth should be discouraged because of risk of neonatal infection. Vaccines should be administered in accordance with national guidelines. Vaginal seeding should be discouraged until more is known about the practice. Conclusions and relevance: These evidence-based recommendations provide clear guidance for physicians so that the birthing experience can be enhanced for both mother and neonate without compromising safety. Relevance statement: This is an evidence-based literature review of alternative birth plans and recommendations for directive counseling.
Article
Lotus birth, or umbilical nonseverance, is the practice wherein the umbilical cord is not separated from the placenta after birth, but allowed instead to dry and fall off on its own. Lotus birth may result in neonatal omphalitis. This article describes the history and rationale for lotus birth as well as the etiology, incidence, clinical presentation, and management of neonatal omphalitis. Recommendations for educating families how to perform lotus birth safely are presented. Additionally, signs and symptoms that warrant newborn assessment and treatment are reviewed.
Article
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Lotus birth (LB) is a holistic practice, in which the umbilical cord is not cut after birth. The placenta becomes a necrotic tissue that lacks of blood circulation, particularly prone to infections. There is a total lack of studies concerning the benefits for newborns or the safety of LB practice. We present the first neonate with complicated LB delivery. The baby had persistent jaundice due to idiopathic neonatal hepatitis. The disease spontaneously recovered after the first months of life. The description of this case aims to provide a starting point for novel clinical researches concerning LB practice and its safety.
Article
Delayed umbilical cord clamping appears to be beneficial for term and preterm infants. In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes. There is a small increase in jaundice that requires phototherapy in this group of infants. Consequently, health care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor for and treat neonatal jaundice. In preterm infants, delayed umbilical cord clamping is associated with significant neonatal benefits, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage. Delayed umbilical cord clamping was not associated with an increased risk of postpartum hemorrhage or increased blood loss at delivery, nor was it associated with a difference in postpartum hemoglobin levels or the need for blood transfusion. Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30-60 seconds after birth. The ability to provide delayed umbilical cord clamping may vary among institutions and settings; decisions in those circumstances are best made by the team caring for the mother-infant dyad.
Article
Postpartum infections remain a leading cause of neonatal morbidity and mortality worldwide. A high percentage of these infections may stem from bacterial colonization of the umbilicus, because cord care practices vary in reflection of cultural traditions within communities and disparities in health care practices globally. After birth, the devitalized umbilical cord often proves to be an ideal substrate for bacterial growth and also provides direct access to the bloodstream of the neonate. Bacterial colonization of the cord not infrequently leads to omphalitis and associated thrombophlebitis, cellulitis, or necrotizing fasciitis. Various topical substances continue to be used for cord care around the world to mitigate the risk of serious infection. More recently, particularly in high-resource countries, the treatment paradigm has shifted toward dry umbilical cord care. This clinical report reviews the evidence underlying recommendations for care of the umbilical cord in different clinical settings.
Article
The discursive construction of the human placenta varies greatly between hospital and home-birthing contexts. The former, driven by medicolegal discourse, defines the placenta as clinical waste. Within this framework, the placenta is as much of an afterthought as it is considered the "afterbirth." In home-birth practices, the placenta is constructed as a "special" and meaningful element of the childbirth experience. I demonstrate this using 51 in-depth interviews with women who were pregnant and planning home births in Australia or had recently had home births in Australia. Analysis of these interviews indicates that the discursive shift taking place in home-birth practices from the medicalized model translates into a richer understanding and appreciation of the placenta as a spiritual component of the childbirth experience. The practices discussed in this article include the burial of the placenta beneath a specifically chosen plant, consuming the placenta, and having a lotus birth, which refers to not cutting the umbilical cord after the birth of the child but allowing it to dry naturally and break of its own accord. By shifting focus away from the medicalized frames of reference in relation to the third stage of labor, the home-birthing women in this study have used the placenta in various rituals and ceremonies to spiritualize an aspect of birth that is usually overlooked.