Manipulations with the cord clamp
Given any novel instrument, it seems to be part of
human nature to experiment with variations in its use.
Fortier (1945) stated:
"Recent literature has emphasized the importanc
of delayed clamping of the cord [i, ii], one writer's
work suggesting that there is even an increase in
the infant's blood volume during the period of
placenatal expulsion [ii].
During the past several months I have been
attempting to improve on the above-mentioned
method of delayed clamping of the cord by an
immediate clamping of the umbilical arteries…"
"… In most cases the umbilical arteries are easy
to define and clamp. In large cords a single
blade of the hemostat is made to pierce the cord
adjacent to the vein, and all tissues except the
vein are clamped." [1, p305]
Fortier explained that this procedure disrupts the
blood flow to the placenta, and results in
exsanguination of the placenta into the body of the
infant, via the umbilical vein. The explanation
continues with the thought that this blood would
otherwise remain in the placenta, or be spilled in the
practice of bleeding the placenta to facilitate its
separation and expulsion.
Fortier's article provides evidence that clamping the
cord had already become standard procedure in
obstetric practice, and that other manipulations had
also been adopted to hurry the third stage of labor,
and get the placenta delivered as quickly as possible.
Fortier, on the other hand, commented that he had
frequently observed that in cases of asphyxia
administration of oxygen tothe mother improves the
color of the infant, and that for this reason he never
clamped the umbilical arteries until the newborn infant
cries. He therefore followed what most people would
consider to be common sense, unlike academicians of
today who describe experiments in which the cord is
clamped before the first breath.
- Fortier GMA. Benefit from early clamping of umbilical arteries. Am J Obstet
Gynecol 1945 Feb; 49(2):304-5.
- Fortier GMA (1945) Benefit
from early clamping of
umbilical arteries.