Childbirth in the 1950s
By the time Apgar was developing her newborn
score, Colozzi (1954) remarked:
"It is difficult to assay the various methods of
umbilical cord clamping. Every physician
employs a different technic and usually
establishes a pattern that he carries out
routinely in his obstetric work. At times this
pattern is influenced by the equipment, the
nursing situation, hospital policy in care of the
newborn and various emergencies arising in the
mother or the infant...
... It has been observed that the cord is often
clamped immediately, either as a routine
procedure or so that the infant can be handed
toa nurse for resuscitation and aspiration." [1,
p629]
On the other hand some practitioners viewed so
strongly in the need for full placental transfusion,
that they would strip the cord three or four times to
squeeze all residual blood into the child [2]. A
survey in 1949 of 1900 members of the American
Board of Obstetrics and Gynecology found two thirds
regarded placental transfusion as a matter of minor
importance, but nearly one quarter (455) used the
stripping procedure [3].
A year later, Landau et al. (1950) determined that
immediate clamping of the cord after Cesarean
section was leaving the newborn in a state of
hypovolemic shock, which they were able to
counteract by holding the placenta above the infant
to obtain drainage through the still intact pulsating
umbilical cord [4].
Colozzi (1954) investigated red cell and hemoglobin
values in infants with immediate cord clamping,
delayed cord clamping with infant above or below
the level of the uterus during the period of postnatal
transfusion, and stripping [1]. In the group subjected
to immediate clamping, some of the red-cell and
hemoglobin levels were thought to be alarmingly
low. Postnatal transfusion with the infant held above
the level of the uterus appeared comparable to that
with the infant below the uterus, the reason
apparently due to uterine contractions - though the
infant heart may have a lot to do with regulating
blood flow back to the placenta. Stripping the cord
led to the highest red-cell and hemoglobin values.
Although stripping the cord is not totally natural,
Colozzi's concluding comments may be worth
keeping in mind:
"Too often, after a traumatic delivery or
intrapartum bleeding episode, the physician is
in great hast to clamp the cord and give a pale,
listless infant to a nurse for aspiration and
resuscitation. Usually, these infants are
described as having asphyxia pallida, and their
prognosis is grave. They respond poorly to
oxygen administration, and worse to other
heroic measures of resuscitation. Their main
difficulty is shock and blood loss, which are
inadequately corrected by oxygen and are not
improved by rough handling. I have see several
infants with asphyxia pallida who were very pale
and listless, with a rapid pulse and a very weak
cry; with gentile, slow, methodical cord stripping,
they were transformed within a few minutes to
ruddy, lustily-crying infants." [1, p632]
Colozzi also provided advice on finding the cord
around an infant's neck during delivery:
"Another situation commonly encountered is the
infant with a loop or two of cord around its
neck. Usually, the most expeditious measure is
to clamp and cut the cord in situ. This actually
amounts to immediate clamping in an already
depressed baby. Every effort within reason
should be made to slip the loops over the
infant's head and allow it the benefit of its own
blood." [1, p632]
Colozzi's (1954) research was among many that can
be called "randomized controlled trials." These
continue to the present day, for what reason it is
hard to fathom. If only heed were paid to the non-
invasive research data that awaits rediscovery in
medical journals going back over 130 years ago.
Even then, research was carried out assigning
groups of infants to early and some to delayed cord
clamping. The major difference from such research
today is the difference in what was considered early
or delayed.
Hormann & Lemtis (1954), in the tradition of
Schucking (1877 & 1879), Hofmeier (1878 & 1879),
Ribemont (1879 -1881), vonEngel (1885), Kostlin
(1898), Haselhorst (1929), and Allmeling (1930),
measured weight-gain in newborn infants during
the period of continuing umbilical cord pulsation.
They collected data on 100 babies. They found that
during the first minute after birth infants received on
average 78 percent of the total transfusion, with loss
and gain fluctuations in the succeeding minutes,
diminishing up to 12 minutes after birth.
- Colozzi AE (1954) Clamping of the umbilical cord; its effect on the
placental transfusion. N Engl J Med. 1954 Apr 15;250(15):629-32.
- Siddall RS, Crissey RR, Knapp WL. Effect on cesarean section babies of
stripping or milking of the umbilical cords. Am J Obstet Gynecol. 1952
May;63(5):1059-64.
- McCausland AM, Homes F, Schumann WR (1949) Management of cord
and placental blood and its effect upon the newborn; part I. California
Medicine 71(3):190-196.
- Landau DB, Goodrich HB, Francka WF, Burns FR (1950) Death of
cesarean infants: a theory as to its cause and a method of prevention.
Journal of Pediatrics 36:421-426.
- Hormann G, Lemtis I (1954) Untersuchungen uber den fetalen
Plazentakreislauf warhrend der Nachgeburtsperiode. Zentralblatt fur
Gynakologie 76(9):329-341.
- Colozzi AE (1954) Clamping
of the umbilical cord; its effect
on the placental transfusion.
- Siddall RS et al. (1952) Effect
on cesarean section babies
of stripping or milking of the
umbilical cords.
- McCausland AM et al (1949)
Management of cord and
placental blood and its effect
upon the newborn; part I.
- Landau DB et al. (1950)
Death of cesarean infants: a
theory as to its cause and a
method of prevention.
- Hormann G, Lemtis I (1954)
Untersuchungen uber den
fetalen Plazentakreislauf
warhrend der
Nachgeburtsperiode.