Judith Mercer,
Please would I be able to have an e-mail contact for you. I just want to
check with you about forwarding your message re. nuchal cord to an NZ
midwifery group, and possible other use.
Thank,
Jo Davis
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----- Original Message -----
From: "Rose Mlay" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, February 04, 2003 3:44 PM
Subject: Re: palpation for nuchal cords
> Than you for this information Judith.
> Rose
> ----- Original Message -----
> From: Judith Mercer <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Monday, February 03, 2003 5:43 AM
> Subject: Re: palpation for nuchal cords
>
>
> > All new midwives in the US are not taught to cut and clamp a nuchal
cord!
> > The preferred method is to 1) reduce the cord over the baby's head if it
> will
> > go easily or 2) reduce the cord back over the shoulders as the baby is
> born
> > and deliver the body thru the cord, or 3) if it is tight, a somersault
> > maneuver can be used as described in an article by Schorn (Schorn MN,
> Blanco
> > JD. Management of the nuchal cord. J Nurse Midwifery 1991;36:131.).
> >
> > In 1998, we completed a questionnaire of American nurse-midwives and
cord
> > clamping practices. (Mercer, J., Nelson, C., Skovgaard R (2000).
> "Practices
> > and Beliefs about Umbilical Cord Clamping of American Nurse-Midwives"
> Journal
> > of Midwifery and Women's Health, 45(1), 58.) Some notes -- "When
> questioned
> > about management of nuchal cord, fifty-seven percent of the respondents
> chose
> > the option "Clamp and cut only when very tight." The somersault
maneuver
> > (Schorn, 1991) was selected by 40% of the participants as their best
> option
> > for managing nuchal cord and only 3.2% stated that they clamp and cut in
> most
> > cases of nuchal cord.
> >
> > When confronted with a nuchal cord, 96% of the CNMs avoid immediate
> clamping
> > and cutting of the cord. This practice is well supported in the
> literature.
> > The umbilical vein walls lack the muscular layer found in arteries and
is
> > more easily compressed. Blood is pumped by the driver of the system,
the
> > fetal heart, to the placenta from the fetus via the arteries, but
> compression
> > of the vein prevents the oxygenated blood from returning to the fetus.
> Thus
> > a nuchal cord may result in a fetus to placenta transfusion. With
> immediate
> > clamping, a neonate having a nuchal cord is at risk of hypovolemia and
> anemia
> > (Cashore WJ, Usher R. Hypovolemia resulting from a tight nuchal cord at
> > birth (Abstract). Pediatr Res 1973;7:399).
> >
> > Another issue related to the management of a nuchal cord is the risk of
> > shoulder dystocia following the cutting and clamping of a nuchal cord.
> Iffy
> > (Iffy L, Varadi V. Cerebral palsy following cutting of the nuchal cord
> > before delivery. Medicine & Law 1994, 13:323-30) reported 5 cases of
> cerebral
> > palsy after nuchal cords were cut and shoulder dystocia delayed the
birth
> by
> > as little as three minutes. These facts make it highly advisable to
avoid
> > cutting the nuchal cord before delivery whenever possible. Schorn
> describes
> > the somersault maneuver which keeps the neonate's head close to the
> perineum
> > to decrease tension and allow the cord to be unwrapped after birth. It
is
> > preferable to allow these babies to reperfuse and to be resuscitated if
> > needed at the perineum. Those at risk of hypovolemia present with
white,
> > "drained" bodies (or mottled blue and white), no tone, and no reflexes.
> > However, they usually have heart rates above 100 and will reperfuse,
> > correcting any acid-base imbalance that exists as evidenced by the
return
> of
> > tone about the same time that the baby begins breathing (Mercer, cases
in
> > progress). If the heart rate is not above 100, resuscitation can be
done
> at
> > the perineum without clamping the umbilical cord of the obviously
> hypovolemic
> > infant. The infant can be dried and put on clean pads at the perineum
or
> > skin to skin on the mother's abdomen to keep warm. Theoretically, the
> only
> > time that this process would not work is if the placenta separates
> > immediately.
> >
> > Two other articles that shed light on this whole issue are: 1) Mercer,
J.
> > Skovgaard R. "Neonatal transitional physiology: A new paradigm."
> Journal
> > of Neonatal and Perinatal Nursing, 2002;15(4):56-75.
> >
> > 2) Mercer, J. (2001). "Best evidence: A review of the literature on
> > umbilical cord clamping." Journal of Midwifery and Women's Health,
> invited,
> > November/December 2001;46(6):402-414. This article was reprinted in
> MIDIRS
> > in Summer of 2002.
> >
> > This is my area of research and would be happy to share more info with
> > interested parties. Have just been funded by NIH (starting 3/1/03) to
> begin
> > a research project on this issue and will have more time to participate
in
> > this sharing once I get started!
> >
> > Judith Mercer, CNM
> > Director, University of Rhode Island Nurse-Midwifery Program.
> >
>
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