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Birth Balance Blog

A series of topics related to preconception, pregnancy, labor, birth, bonding, and post partum issues. Feel free to make suggestions for future topics.

Archive for December, 2009

Lotus Birth: Trend or Risk

Thursday, December 17th, 2009

This is an interesting article about not cutting the cord after the baby’s birth. This is called, a ‘lotus birth’. When I broach the topic to some people they are disgusted. Others are fascinated and still others ask many questions. Read on and enjoy the information.


DEC 03, 2009


Named for the lotus flower, lotus birthing is becoming a trend in home birthing circles where parents opt to keep the baby attached to the placenta.

It raises questions about the practice of cord clamping right after birth and raises eyebrows in the medical community where many doctors contend this birthing practice poses unnecessary risks of infection.

Lotus birthing means the baby’s cord is not immediately clamped or cut. The parents and their midwife instead opt to have the placenta remain attached to nourish the baby and let it fall off naturally.

During this period before it does fall off, parents clean, salt and  wrap the placenta, usually in a cloth diaper. This option is not  offered in hospitals and some hospitals don’t even allow the  parents to take the placenta home.

People who have chosen lotus birthing said they believe that the placenta is providing the baby with nutrients and oxygen even after it separates from the uterus.

At the very least, they contend the clamping and cutting of the cord should only be done after the cord stops pulsating.

The immediate clamping and cutting of the cord as soon as the baby is delivered, the standard at hospitals, may deprive the baby of the ability to transition from a liquid-based environment to an oxygen-based environment, according to supporters of delayed clamping.

American obstetrician Dr. George M. Morley is considered a champion of delayed cord clamping. Morley’s argument for the delay is that cutting before the umbilical cord has stopped pulsating could mean that the baby is being deprived of oxygen and nutrients. If a child becomes hypoxic (it lacks oxygen) and ischemic (lacks blood flow), Morley believed the child could be placed at greater risk of brain damage.

The argument for delayed cord clamping is often used as a springboard for those who believe in lotusbirthing, a more extreme version of delayed cord clamping.

Some doctors are becoming more accepting of delayed cord clamping, but they criticize the idea of lotus birthing methods.

High risk obstetrician Dr. Mara Dinsmoor questions the safety of both delayed cord clamping and lotus birthing. “The concerns are that, because there is quite a bit of blood in the placenta, you may end up with a baby whose blood count is too high from doing that,” she said.

She said that too much blood in the baby’s system due to the delayed clamping has been known to cause blood clots and sludging in the baby’s organs, which could result in damage to those organs. She also said that carrying the placenta around could be a “potential infectious risk.”

Dinsmoor also said that she believes lotus birthing may not really be of any use. “Fairly soon after the baby is born those umbilical vessels…basically are obliterated. So you are not getting anything really good from the placenta through those umbilical vessels,” she said.

But, lotus birthing is gaining popularity because women choosing to take more control of their pregnancy are asking questions and turning to the Internet for answers.

Chicago attorney Leonard Hudson and his wife Gayle  Hudson, a stay-at-home-mother, said they discovered lotus  birthing on a Web site.

Gayle Hudson said she had only one priority: “What is going  to give [my baby] the best start in her life? And I thought –  the least amount of drugs, the least amount of stress.”

Hudson’s said her fear of having a birth in an environment  where she felt doctors and nurses see birth as surgery,  made her choose home birth. After making this decision,  her mind turned to more alternative birthing methods and  she found and researched lotus birthing.

After about three days of carrying around their baby with the placenta attached, the Hudson’s decided it was time to cut the cord. Gayle Hudson said the placenta had become unwieldy and the couple feared their child would get tangled up in it.

The Hudson’s urge other parents to take control of their birthing experience by educating themselves.

“Part of the organizing principle of our birth plan was the timing of it should be set by Gayle and the child,” letting nature take its course, said Leonard Hudson. “So having the lotus birth was sort of a continuation of that.”

To see video of LOTUS BIRTHS: THE DEBATE By Monica Orbe with Medill Reports to to:


©2001 – 2009 Medill Reports – Chicago, Northwestern University.  A publication of the Medill School.

Lotus Birth in Turin

Thursday, December 17th, 2009

Living on the east coast of the United States, NYC precisely, one will not find so many women opting for leaving the umbilical cord attached until it falls off the baby naturally.  I find it fascinating, and there are parts of the U.S. as well as around the world where it is a natural custom or personal choice.  Here is a story of a progressive Hospital that is ‘waking up’ to the idea that MAYBE it might actually be a good thing.

PREGNANCY – PART – Paediatrics    21/4/2009

pixel.gifLotus Birth: born naturally. In Turin

In Turin, the first major hospital that gave birth to a baby … with the placenta. The opinion of the expert and the testimony of mothers


Birth in water, painless childbirth, epidural anesthesia are all terms that expectant mothers feel appoint at least once. Instead of a period which speak little or no thirst and “second nature.” And it is likely that almost none has ever been asked how it wishes to happen, the second, or the final phase of childbirth, which consists in the expulsion of the placenta.

But there’s something new and, although not yet become a routine practice, many parents are already experiencing the second natural birth or the placenta or the “Lotus birth.

According to experts, is the most gentle and less traumatic to bring to light a child.

The method is very simple and is to leave the placenta attached to the baby for a few days (on average 3 or 4) until natural detachment. This gradual separation could provide the child, even a small amount of placental blood useful for the formation of the immune system.

“We know that the placenta is formed from the division of the same cells that form the fetus, then baby and placenta have the same DNA. Lotus Birth is the birth that deeply respects the importance of this union’s biological child with her placenta, “explains Susanna Swapana Hinnawi, Breathworker and Counselor ICC (Inner Child Codependency). Referee for Italy’s birth Lotus Birth.

“In the Lotus Birth, in fact, the umbilical cord is cut, but expects that detaches itself from the navel when the child is ready for separation.” Susanna Hinnawi Continue “on average, the wait is three to four days . When the cord comes off spontaneously, the umbilicus does not need medication or special care, it is tightly closed and healed, in times less than when severed the umbilical cord. ”

What are the benefits of this mode of delivery? We ask Susanna

“It’s hard to have to summarize in a few words … Speaking from a physiological point of view, the connection to the placenta causes the baby receives all the rich oxygenated blood, important for the proper development of organs still immature at this delicate stage of adjustment. When the cord is cut in the opening minutes, the placenta remains to be third to 50% of the blood that should go to the baby! Another aspect to consider is that of breathing, being under the pulmonary system a perfect autonomy, continues to be from two sources in parallel: the placenta and lungs. Then, if the cord is cut, we avoid separating the child from his birth mother, a union which must absolutely be preserved! But what struck me most is the emotional and psychological. Training for staff believe that birth is the cornerstone on which to build their lives. Born without trauma, in a respectful and friendly is definitely a good start on which is easier to develop aspects of character of completeness and integrity. Keeping together the biological unit formed by the baby and placenta, avoiding any kind of injury, both physical and emotional. If we are not “wounded,” we are at peace. There are no scientific studies demonstrating the benefits of Lotus Birth, but from what I started to notice, children born without cutting the cord, show generally a strong immune system, a pronounced tendency to socialization and autonomy . Someone called them “beings complete. Moreover there are many studies showing how important it is to delay cutting the cord until the end of the pulse, well, the Lotus Birth is merely an extension of this delay that is safe, but, rather, brings additional benefits.

So the Lothus Birth should not be seen as a particular technique to be used during  childbirth, but a conscious and responsible choice that guarantees health and  wealth to the unborn.

“I would point out that this mode must be understood as a piece in the mosaic that  makes up a responsible choice of birth ‘points Suanna Hinnawi” A birth in which the  woman picks up herself, is in contact with your body, with its emotions and fears,  has chosen to be with his child, the only protagonist. An event that should not be  delegated to anyone except her ability to procreate mammal: so from spectator to player, from lamb to lioness! After this introduction, the Lotus Birth may also occur after a cesarean section, in all those conditions in which the placenta is healthy and there are no other impediments. Indeed, after a caesarean, as well as a premature baby, it would be more desirable because it provides an excellent support to the respiratory system that in both cases is greater compromise. ”

We understand that in Italy is a technique almost unknown, there are other countries where it is practiced more often?

“In Italy the Lotus Birth was introduced in 2004, when it was translated and published the book in Australia” Lotus Birth: the integral, born with the placenta. ” In recent years, our association has been working to publicize this way of coming into the world maybe a little ‘unusual, but certainly natural, and above all no contraindications. Children are born in our homes, maternity homes and even in those hospitals where doctors “enlightened” or maybe even just curious, have allowed to happen. In Australia and Canada is a very common mode since the end of the ’70s.

Lotus Birth may be required in an Italian hospital?

“The hospitals have their protocol from which hardly differ. However, as I said above, some doctors areparticularly sensitive, especially in structures of the province, have accepted the Lotus Birth, into the protocol in a hospital official.

The paradox is that although there are no scientific studies that demonstrate the need to cut the umbilical cord, the failure to cut it often needs to be proven scientifically! I welcome the availability of wanting to start a search, unfortunately, are funds that fall outside our capabilities. ”

It is true that one of the first hospitals to test the technique Lotus Birth was the Sant’Anna di Torino?

“Not really. The Sant’Anna di Torino was perhaps the largest hospital in which both happened. Moreover, thanks to a very tenacious and determined mother, the first Lotus Birth was in 2006 in a hospital in the province of Mantua. Despite initial resistance imaginable, now this is one of the public in which it can take birth.

To make us even more aware of what is the Lotus Birth. We ask those who have experienced directly and that Eusebius Prabhat and Monica Farinella, parents of small Deva was born December 16, 2008 right in the Sant’Anna di Torino.

Before you try this new experience, you had a little ‘fear or any doubt?

“The first time we heard about the Lotus Birth was during the course of our pre-  natal eldest Munay, midwives have referred to this technique, namely the ability to  not sever the umbilical cord and leaving the child attached to the placenta, until  natural detachment. For us it was immediately clear that the party had done with  this mode, bought and read the book I had no doubt or fear in wanting to run the  integral part. ”

What sensations did you feel with the Lotus Birth?

“Around the baby in those days is a feeling of sacredness, all emotions are amplified, the strongest feeling is to assist the mystery of creation in a way that reflects and respects the time of life and nature, since in last 100 years, the event of birth was completely “industrialized” to the paradox of planned caesarean. The two cases are differentiated by Lotus in the duration of the days when the cord is still attached to the placenta, Munay let go of her placenta between the 6th and 7th days, Deva between the 3rd and 4th. ”

And the Sant’Anna hospital staff? There was skepticism on the part of doctors?

“Rather than skepticism, we would say ostracism. The new, if it is not known scares. Our civilization isfounded on dogmas at all levels, suffice it to say that the hospital protocol the placenta is considered a refusal and not an organ, where there is not sold (but that’s another story). The amazing thing is that the medical director of a company as the S. Anna, talking in terms of ownership of the placenta, to my question, but you can not deny the biological origin of the placenta, as a result of insemination sperm / ovum has not been able to answer, the answer is that the logic can shatter any dogma, then we realize the opening of minds and accept new truths.

Eventually, after more than two hours of discussion, we came out tonight with Girls and placenta, and a historic declaration by a hospital, a certificate stating that a health worker can not sever the umbilical cord without parental consent, statement written that actually opens a new way to natural childbirth. Thanks S. Anna.

The birth occurred even without the aid of oxytocin, monitoring, epidural, episiotomy, antibiotics, the delivery room couch, pushed manuals, etc.. because a choice like this?

“The party, as for the first child has been without outside intervention. The woman does not feel and no longer knows his body, or rather, knows only through the models of media, lifting and correction in a meaningless race against time. For generations, childbirth is seen as an agonizing suffering, when the best thing would be to be able to experience together with operators who know the rhythms of nature, women are able to help a pregnant woman to be aware that childbirth is not a ‘ operation, and that all women, with a working knowledge about themselves, and a proper preparation (mental and physical) can have a natural birth without medical intervention. Should allow time to the woman and the child to feel and communicate with each other, and having close of discreet … the rest takes place naturally. ”

After your experience, is there anything you feel to inform readers of “”

“What our experience is told in a free book download from The greatest contribution we can make to humanity and the best gift we can do for our children is closer to the pregnancy with a deep sense of respect for the mystery that is, knowing that only our ability to inform and to choose the path fewer artifacts, and our courage, can make a difference. What we as humanity is the result of what we have tried so far, let’s try something new and waiting … waiting for the results read, informiamoci, seeking new ways to be born and to live accordingly. ”

For more information:



“Laboratory of birth – meetings and stories”

1 to 3 May 2009, at Officinale, in the park of Castle Belgioioso (Pavia), on the topic of birth with the experts.

Every story of birth is unique and special and teaches us something. For this association CHILDBIRTH, Lotus Birth Italy along with the National Association of midwives for childbirth at home and BambiGioi organized three days to deepen various topical issues in the world of birth.


“Lothus Birth: the integral, born with the placenta” – by Shivam Rachana – Amrita Editions



Breast-feeding to the Breast but… also INTEGRAL BIRTH, with the Placenta – “LOTUS BIRTH” – Part 6  ( In Italian)

(Allattamento al Seno ma… anche NASCITA INTEGRALE, con la Placenta – “LOTUS BIRTH” – Parte 6)

PHOTOS Lotus Birth: born naturally (7 Photographs)

Delayed Cord Clamping

Thursday, December 17th, 2009

I have always believed the delayed cord clamping would be beneficial for the baby as well as the mother. The paper below presents control studies indicating the BENEFITS of delayed cord clamping for the baby.  IF you are going to proceed with cord blood storage, you will NEED to cut the cord IMMEDIATELY in order to preserve the precious stem cells into the vial for potential future use.  It is ONLY as a result of this preservation that the cord be cut immediately.  We have YET to see controlled studies about the benefits for the mother as well. Enjoy!

Academic OB/GYN December 3, 2009      Nicholas Fogelson

Delayed Cord Clamping Should Be Standard Practice in Obstetrics

There are times in our medical careers where we see a shift in thought that leads to a completely different way of doing things.   This happened with episiotomy in the last few decades.  Most recently trained physicians cannot imagine doing routine episiotomy with every delivery, yet it was not so long ago that this was common practice.

Episiotomy was supported in Medline indexed publications as early as the 1920s(1), and many publications followed in support of this procedure.  But by as early as the 1940s, publications began to appear that argued that episiotomy was not such a good thing(2).  Over the years the mix of publications changed, now the vast majority of recent publications on episiotomy focus on the problems with the procedure, and lament why older physicians are still doing them (3) (4).  And over all this time, practice began to change.

It took a long time for this change to occur, and a lot of data had to accumulate and be absorbed by young inquisitive minds before we got to where we are today, with the majority of recently trained OBs and midwives now reserving episiotomy only for rare indicated situations.

Though this change in episiotomy seems behind us, there are many changes that are ahead of us.   One of these changes, I believe, is in the way obstetricians handle the timing of cord clamping.

For the majority of my career, I routinely clamped and cut the umbilical cord as soon as it was reasonable.   Occasionally a patient would want me to wait to clamp and cut for some arbitrary amount of time, and I would wait, but in my mind this was just humoring the patient and keeping good relations.  After all, I had seen all my attendings and upper level residents clamp and cut right away, so it must be the right thing, right?

Later in my career I was exposed to enough other-thinking minds to consider that maybe this practice was not right.   And after some research I found that there was some pretty compelling evidence that indeed, early clamping is harmful for the baby.  So much evidence in fact, that I am a bit surprised that as a community, OBs in the US have not developed a culture of delayed routine cord clamping for neonatal benefit.

I think that this is a part of our culture that should change.  This evidence is compelling enough that I feel like a real effort should be made in this regard.   So to do my part in this, I am blogging about it.

As this is Academic OB/GYN, of course I am going to lay out this evidence I speak of.  But before I do that, I want to present some logical ideas under which this evidence ought to be considered.

Prior to the advent of medical delivery, and for all time in animals, it has been the natural way of things for a baby to stay on the umbilical cord for a significant period of time after delivery.  Depending on culture and situation, the delay in cord separation could be a few minutes or even a few hours.  In some cultures the placenta is left on for days, which of course I find excessive and gross (5).  But whatever the culture and time on cord, the absence of immediate cord clamping allows fetal blood that was previously in the placenta to transfuse back into the baby.  Studies have demonstrated that a delay of as little as thirty seconds between delivery and cord clamping can result in 20-40 ml*kg-1 of blood entering the fetus from the placenta (6).

Considering this data, I have to think about evolution and  function.  I am a strong believer in evolution, but even  under creationist thinking I have to believe that if the  system meant for babies to have been phlebotomized of  50-100 cc of blood at birth, we would have been born with  higher hemoglobins.  Clearly the natural way of things is for  this not to happen.

So does this mean that early cord clamping is necessarily  harmful?  Absolutely not.   But what it means is that the  burden of proof is on us to prove that early cord clamping,  which amounts to planned fetal phlebotomy, is a beneficial  thing.  Otherwise, all things being equal we ought to give the tykes a few minutes to soak up what blood they can from the placenta before we cut’em off.

Check out this video by Dr. Stuart Fischbein: Delayed Cord Clamping:

So the question is whether or not there is strong data either way.

It is easy to imagine a randomized study of immediate vs. delayed cord clamping, with quantitative analysis of fetal lab values and clinical outcomes.  So easy in fact, that it has been done many times – and in just about every study, there is a clear benefit to delaying cord clamping, even if it is just for 30 seconds after delivery.  These benefits include important outcomes such as decreased rates of intraventricular hemorrhage and necrotizing enterocolitis in preterm neonates.  Furthermore, aside from some intermittent reports of clinically insignificant polycythemia and hyperbilirubinemia in term infants, there appears to be no harm that can be linked to delayed cord clamping. It feels like being a doctor 10-15 years ago looking to see if there is any data about episiotomy, and finding that there’s a lot, and it says we’ve been doing it wrong for awhile now.

So here’s the data:

Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial(7)

Randomized 72 VLBW infants (< 1500 grams) to immediate or delayed cord clamping (5-10 vs. 30-45 seconds).  Delayed cord clamp infants had significantly less IVH (5/36 in delayed group vs. 13/36 in immediate group, p = 0.03) and less late onset sepsis (1/36 vs. 8/36, p = 0.03).

The Influence of the Timing of Cord Clamping on Postnatal Cerebral Oxygenation in Preterm Neonates: A Randomized, Controlled Trial (8)

Randomized 39 preterm infants to immediate clamping vs. 60-90 second delay, and examined fetal brain blood flow and tissue oxygenation.  Results showed similar blood flow between groups, but increased tissue oxygenation in the delayed group and 4 and 24 hours after birth.

Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomized controlled trial(9)

Randomized 476 infants to immediate or 2 minute delayed clamping and followed them for 6 months.  Delayed clamped babies had higher MCVs (81 vs. 79.5), higher ferritins (50.7 vs. 34.4), and higher total body iron.  Effects were greater in infants born to iron deficient mothers.  Delayed clamping increased total iron stores by 27-47mg.  A follow up study showed that lead exposed infants with delayed clamping also had lower serum lead levels than immediate clamped infants, likely due to iron mediates changes in lead absorption.

A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short-term clinical and laboratory endpoints(10)

Infants delivering at 30 to 36 weeks gestation randomized to immediate vs. 1 minute delay.  Delayed group had higher RBC volumes (p = 0.04) and hematocrits (p < 0.005), though there was no difference in RBC transfusions.  There was a small increase in babies requiring phototherapy in the delayed group (p = 0.03) but no difference in bilirubin levels between groups.

Immediate versus delayed umbilical cord clamping in premature neonates born < 35 weeks: a prospective, randomized, controlled study (11)

Randomized 60 infants to clamping at 5-10 seconds vs. 30-45 seconds.  Delayed clamping infants had higher BPs and hematocrits.  Infants < 1500 grams with delayed clamping needed less mechanical ventilation and surfactant.  Trend towards more polycythemia in delayed group, but not statistically significant.

And that’s just some of it.  I’ll be happy to send you an Endnote file with a pile more of you’d like it.  If the burden of proof is on us to prove that immediate clamping is good, that burden is clearly not met.  And furthermore, there is strong evidence that delaying clamping as little as 30 seconds has measurable benefits for the infant, especially in premature babies and babies born to iron deficient mothers.

So basically, we should be doing this.  I’m going to try to effect some change in my department, but there are a lot of things that need to happen for us to change as a general culture.  It can’t just be the OBs.  L and D nurses and pediatricians need to buy in as well.

Some people will argue that premature babies need to be brought to the warmer right away for resucitation.  I don’t know the answer to this, but it’s worth study.  One might think that it is important to intubate a very premature baby right away, but I have to wonder if that intact cord will be better at delivering oxygen to the baby for 30-60 seconds than the premature lungs.  Particularly in cases of fetal respiratory acidosis, there is strong logical argument that a baby might be better resuscitated by unwrapping the cord and letting it flow a bit than trying to oxygenate it through its lungs.  Until that placenta is detached, you have a natural ECMO system.  Why not use it?  Certainly there are exceptions to this logical argument, abruption being the biggest one, and perhaps even severe pre-eclampsia and other poor feto-maternal circulation states.

I wonder at times why delayed cord clamping has not become the standard already; why by and large we have not heeded the literature.  It is sad to say that I believe it is because the champions of this practice have not been doctors, but midwives, and sometimes we are influenced by prejudice.  Clearly, midwives and doctors tend to have some different ideas about how labor should be managed, but in the end data is data.  We championed evidence based medicine, but tend to ignore evidence when it comes from the wrong source, which is unfair.  It is fair to critique the research and the methods used to write it, but it shouldn’t matter who the author is.  In this case, Mercer and other midwives have done the world a favor by scientifically addressing this issue, and their data deserves serious consideration.

To quote Levy et al (12) “Although a tailored approach is  required in the case of cord clamping, the balance of  available data suggests that delayed cord clamping should  be the method of choice.”  We ought to heed this advice  better.   Like episiotomy, this change in practice may take  awhile, but we should get it started.   I’m going to work on  it myself.  How about you?

1.            Martin DL. The Protection of the Perineum by Episiotomy in Delivery at Term. Cal State J Med 1921 Jun;19(6):229-31.

2.            Barrett CW. Errors and evils of episiotomy. Am J Surg 1948 Sep;76(3):284.

3.            Rodriguez A, Arenas EA, Osorio AL, Mendez O, Zuleta JJ. Selective vs routine midline episiotomy for the prevention of third- or fourth-degree lacerations in nulliparous women. Am J Obstet Gynecol 2008 Mar;198(3):285 e1-4.

4.            Gossett DR, Su RD. Episiotomy practice in a community hospital setting. J Reprod Med 2008 Oct;53(10):803-8.

5.            Westfall R. An ethnographic account of lotus birth. Midwifery Today Int Midwife 2003 Summer(66):34-6.

6.            Weeks A. Umbilical cord clamping after birth. Bmj 2007 Aug 18;335(7615):312-3.

7.            Mercer JS, Vohr BR, McGrath MM, Padbury JF, Wallach M, Oh W. Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial. Pediatrics 2006 Apr;117(4):1235-42.

8.            Baenziger O, Stolkin F, Keel M, von Siebenthal K, Fauchere JC, Das Kundu S, et al. The influence of the timing of cord clamping on postnatal cerebral oxygenation in preterm neonates: a randomized, controlled trial. Pediatrics 2007 Mar;119(3):455-9.

9.            Chaparro CM, Neufeld LM, Tena Alavez G, Eguia-Liz Cedillo R, Dewey KG. Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. Lancet 2006 Jun 17;367(9527):1997-2004.

10.            Strauss RG, Mock DM, Johnson KJ, Cress GA, Burmeister LF, Zimmerman MB, et al. A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short-term clinical and laboratory endpoints. Transfusion 2008 Apr;48(4):658-65.

11.            Kugelman A, Borenstein-Levin L, Riskin A, Chistyakov I, Ohel G, Gonen R, et al. Immediate versus delayed umbilical cord clamping in premature neonates born < 35 weeks: a prospective, randomized, controlled study. Am J Perinatol 2007 May;24(5):307-15.

12.            Levy T, Blickstein I. Timing of cord clamping revisited. J Perinat Med 2006;34(4):293-7.

Possibly related posts: (automatically generated)

Grassroots Network: Delayed Cord Clamping

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