Increasingly desperate proponents of delayed cord clamping search for ever more arcane “benefits”

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Why are proponents of delayed cord clamping so sure that it has benefits for term infants despite all the scientific evidence to the contrary?

In part it’s because they have extrapolated inappropriately from existing science. It has been known for some time that delayed cord clamping is beneficial for premature infants. How? Many premature infants develop anemia known, not surprisingly, as anemia of prematurity. As this article on Medscape explains:

All infants experience a decrease in hemoglobin concentration after birth… For the term infant, a physiologic and usually asymptomatic anemia is observed 8-12 weeks after birth.

Anemia of prematurity (AOP) is an exaggerated, pathologic response of the preterm infant to this transition…

AOP spontaneously resolves in many premature infants within 3-6 months of birth. In others, however, medical intervention is required.

Delayed cord clamping provides an auto transfusion in the moments after birth, thereby decreasing the chance that a premature infant will need a blood transfusion for severe anemia.

But term infants don’t suffer from anemia of prematurity, so there’s really no reason to believe that delayed cord clamping is beneficial for them.

However, the real reason for believing that there are purported benefits is that proponents of cord delayed cord clamping come from a midwifery tradition of reflexive defiance. Simply put, many midwives operate on the premise that whatever obstetricians do is “unnatural” and therefore doing the opposite must be better. Not surprisingly, then, the “benefits” of delayed cord clamping were fabricated from whole cloth by a midwife. According to CNN:

What started as a grass-roots movement by UK midwife Amanda Burleigh nearly a decade ago, has recently grabbed the attention of medical doctors around the world. “I wanted to find answers to why so many children, including mine, my friends’ and my colleagues’ appeared to have additional learning and health needs, especially the boys,” said Burleigh. So she started reflecting on her own practice as a midwife.

“I began to question why we were trained to cut the umbilical cord immediately after a baby was born,” said Burleigh. “I then started to explore my theory that there must be a link to a child’s health based on when the cord is cut.” Her curiosity grew into a movement.

In other words, with absolutely no evidence, Burleigh spun a fantasy that her children’s learning and health needs were due to the evil acts of obstetricians, specifically immediate cord clamping.

In the intervening decade there have been numerous studies that were supposed to show the benefits of delayed cord clamping in term infants, but ended up showing nothing much at all.

Two years ago I wrote about the last study to receive substantial media attention in Delayed cord clamping: much ado about nothing, and I included a handy chart:

Benefits of delayed cord clamping

So the only “benefit”was slightly higher iron stores (a laboratory value), one that has no clinical effect and probably has no clinical significance.

But that hasn’t stopped proponents of delayed cord clamping from continuing their desperate search for benefits.

The latest effort comes from Sweden, and the scientists who conducted the study promoted it breathlessly … as nearly all scientists promote their work whether it is high quality or useless.

From the CNN article:

“It’s incredible to see what a difference an extra three minutes and one-half cup of blood can have on the overall health of a child, especially four years later,” said Dr. Ola Andersson, lead author of the study and a pediatrician at the department of women and children’s health at Uppsala University in Sweden. “This is very promising, but larger studies are necessary,” said Andersson.”

Not exactly.

What was the study, Effect of Delayed Cord Clamping on Neurodevelopment at 4 Years of Age; A Randomized Clinical Trial, looking for?

The main outcome was full-scale IQ as assessed by the WPPSI-III.

What did the author find?

As the chart below demonstrates, they found that delayed cord clamping had no benefit on IQ. Specifically, there was no benefit on full scale IQ, no benefit on verbal IQ, no benefit on performance, no benefit on processing speed and no benefit on general language composition.

delayed cord clamping Sweden 5-14

But wait!

Fine-motor skills were assessed by the manual dexterity area from the Movement Assessment Battery for Children, Second Edition (Movement ABC), which includes 3 subtests: time for posting coins into a slot (both hands), time for bead threading, and drawing within a bicycle trail…

Delayed cord clamping had no benefit on any of these tests of manual dexterity.

So delayed cord clamping had no benefit on IQ and no benefit on manual dexterity.

But wait! All was not lost:

Parents reported their child’s development using the Ages and Stages Questionnaire, Third Edition (ASQ) 48-month questionnaire, which was translated into Swedish … The ASQ contains 5 subdomains: communication, gross motor, fine motor, problem solving, and personal-social …

On 2 of those 5 parent assessments of their child, fine motor and personal-social, the delayed cord clamping group had statistically significantly better scores.

What does that mean? Absolutely nothing!

In reality, this study demonstrates that delayed cord clamping in term infants has NO appreciable benefits.

The study was conducted to determine if delayed cord clamping has an effect on IQ and found that it doesn’t. The the authors looked at objective tests of manual dexterity and also found no difference. Then they looked at parental assessments of child performance and found a statistically significant difference between in two subsets, but at no point have the authors demonstrated that the small sample of 263 children (which represented only 2/3 of the children originally enrolled) has enough statistical power to be valid.

In other words, the authors failed to find any meaningful benefit in neurodevelopmental outcomes caused by delayed cord clamping.

Contrary to Dr. Andersson’s assertion, the only thing incredible about this study is how brazen the authors are in claiming that their findings are incredible when, in fact, they merely highlight the increasingly desperate efforts to find some benefit, no matter how arcane, from delayed cord clamping in term infants.

  • SweetBabyJesus

    Read the new studies Dr. Amy?

  • Rachel

    My hospitals policy is to delay cord clamping. This is my first pregnancy. Should I ask them to clamp immediately?

    • SweetBabyJesus

      Maybe the reason that is their policy is because new evidence is showing that it produces some good outcomes for baby. Dr. Amy is just slow on the uptake for some of the emerging evidence, probably because of her inflamed ego. Seek other opinions! Ask your OBs and don’t base everything you are deciding on this woman’s extremely interventive practice style!

  • Adjective

    I did delayed cord clamping with both my kids. There may be benefits, and there are no detriments for a healthy baby. This isn’t a topic to wage war on, it’s not in the same ballpark as topics like home birth or anti-vax that can cause real harm.

  • MaryJBullock

    nowRead this skepticalob… Here’s a Blog

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  • namaste863

    Okay, to this layman (er-girl) worrying about chord clamping timing seems about as stupid and pointless as worrying about which way the toilet paper goes on the spinner. As long as my ass gets clean I really couldn’t care less. So can anyone tell me, are there risks to NOT clamping the chord right away? Does it really make any actual difference either way?

    • Nick Sanders

      I will fight you to the death about the toilet paper thing.

      • Allie

        I shall be by your side in the trenches, Nick, provided we agree on the correct direction, of course : )

        • LibrarianSarah

          All right thinking folk know that the toilet paper is supposed to go over and only terrorists, communists, and Disney villains put the paper under.

          • Who?

            A really awful snobby boy told me when we were at uni that you could ascertain a person’s social class, and therefore know whether or not you wanted to have anything to do with them, by simply going to their house and noting which way the paper was hung.

            All of which raised a lot of questions I didn’t care about the answers to, so that was the end of that.

          • Roadstergal

            It rolls so smoothly and in such a controllable fashion if draped over the top. Pulling from the bottom is all hurky. Clamp what? _This_ is important!

            (As is the proper use of ‘couldn’t care less’ by namaste.)

          • Cartwheel

            If your cat is allowed in the bathroom, having the tp roll from under can keep the cat from unrolling the whole thing in unholy glee.

            Or you can just keep the cat out of the bathroom.

          • Roadstergal

            My main pet concern in the bathroom was getting a trash can with a snug enough lid to prevent the dogs from getting at the tampons.

          • Direction doesn’t matter to Honor. We also solved seat up/down by keeping the lid down. Honor and Macavity put paw prints in the bowl at times because they like to bat the water.

          • KeeperOfTheBooks

            Double-bonus points for the cat name. 😉
            Macavity, Macavity, there’s no one like Macavity…
            I do love TS Eliot’s “Book of Practical Cats!”

          • Comrade X

            You are an enemy of society and I will hunt you down, you over-the-top-hanging deviant! (I’m not a terrorist or a Disney villain, but I am a communist, so I guess you may have a point in there somewhere…)

  • araikwao

    Is it my quick skim of the results table or is there a glaring lack of adjustment for multiple comparisons? That would leave only one (I think) statistically significant finding in a subgroup.
    Science of Mom posted about this too, but with fewer details. I brought up the subgroup thing, as it seemed to be a standout thing that only boys in certain domains benefitted, but she stated it was the same with the prem boys, and used that to suggest some sort of difference between boys and girls, and as further evidence to support the Swedish paper’s conclusions. After seeing this, I am less inclined to accept her explanation.

    However, like CanDoc below, it seems to me there is little to lose by delayed cord clamping when nothing else precludes it. I wonder if there would be any increased costs from need for phototherapy? The RR was not that high..

  • Before even reading this article, my first thought upon seeing the title was that many of them must roll with that belief because it jives with their contrary nature.

  • CanDoc

    Academic Ob/Gyn here, I do 200+ deliveries per year at a tertiary centre.
    Sorry, I respectfully disagree. There is absolutely no benefit to immediate cord clamping (former “active management of 3rd stage” claims having been debunked), and possible benefit to delayed cord clamping, especially in the prems. Delayed cord clamping for well babies without contraindications (IUGR, GDM, needing resuscitation, etc) has been standard in our centre for 7 or 8 years now, so there’s no “sowing seeds of discord” between women and their OB/Gyns. So although the evidence of benefit is subtle (at best), except in prems, where there is clear benefit with less transfusions and intraventricular hemorrhages (your cherry picked medscape reference notwithstanding) , there is also no longer any urgency to “get that cord clamped right away!!!” Like moving away from routine episiotomy and delayed pushing in the second stage, I think the default of DCC has simply become a new normal as part of routine perinatal care.

    • Susan

      Maybe I am confused are you responding to Dr. Amy’s article? I don’t really see the disagreement?

      • CanDoc

        I think Dr. Amy has cherry-picked the literature a little bit to downplay the admittedly small *but definite* benefits of delayed cord clamping, especially as they apply to early prems, and to excessively criticize those, even those with scientific credentials, who are proponents of the practice. Also, DCC isn’t some new fangled idea proposed by midwives a decade ago – it was always standard care until the 70s when immediate clamping as part of “active management of the 3rd stage” was introduced – without evidence – in an effort to minimize post partum hemorrhage.

    • yentavegan

      THe NCB industry preaches the value of waiting until the placenta is delivered before clamping the cord…is that part of your accepted standard procedure?

      • Monkey Professor for a Head

        There seems to be a huge variation in practices regarding delayed cord clamping. As far as I see the above study defines it as anything from 3 mins after birth onwards. I think at my antenatal classes they said hospital policy was to wait until it stops pulsing. And then there’s waiting until the placenta is delivered. Does anyone smarter than me know if there’s been any research on when the optimal time would be. Because at the moment the huge range in what constitutes DCC seems like it would make it incredibly difficult to draw any accurate conclusions about it.

        • araikwao

          IIRC, it’s >/= 1min..

        • Cobalt

          The table in the article defines early cord clamping as 10 seconds or less, delayed as 3 minutes or more.

          10 seconds sounds really fast. My kids were still getting faces cleared, breathing verified, and the general look over in that time. I can’t imagine shorting any of that to get a clamp on without an unusually urgent situation.

          • Medwife

            Sometimes we cut the cord “on the perineum”- the baby’s head is out with a very tight nuchal cord that must be cut to birth the body. It’s not hugely unusual.

          • Cobalt

            But certainly urgent, and a situation where there is a definite need. Do people complain about not getting delayed clamping when it needs to be done in order for the rest of the baby to deliver safely?

          • Medwife

            I have certainly never had anyone complain about it!

      • CanDoc

        No, if a uterotonic (e.g. oxytocin) is administered with delivery of the fetal shoulders, about 80% of total blood transfer is completed within 45 seconds, about 90% within 60 seconds. So we usually clamp at 45+ seconds at CS, and at our leisure at vaginal delivery. (Unless there are contraindications, of course). Our NICU has run our neonatal numbers internally: since the transition to delayed clamping, we have seen significantly fewer transfusions in all of our prems, slightly more jaundice requiring outpatient phototherapy in our term patients (but no adverse outcomes like kernicterus or exchange transfusion), and slightly fewer intraventricular hemorrhages (not statistically significant yet because of small numbers) in our early prems. We haven’t looked at long term follow up like anemia and motor skills but assume our outcomes would be consistent with the literature.

        • MIKE

          So, you are practicing in a way that is detrimental to some of your term babies, with no benefits seen in your centre at all in this group. Perhaps you should stop DCC in term babies? You’ve really been sucked in by the hippies.

    • areawomanpdx

      I agree. At both the large academic center and the huge HMO where I trained, we cut the cord when it stops pulsing, both OB/GYNs and CNMs, unless there was some other reason not to wait.

    • Guest

      I did “early” cord clamping with both my last two kids because I donated their cord blood to public banks. Out of curiosity, what is your tertiary center’s stance on cord blood donation since it appears the two practices are mutually exclusive?

      • TsuDhoNimh

        Guest … There’s plenty of cord blood left after the umbilical artery stops pulsing.

        Early clamping would get you a few CCs more, but as soon as the placenta is no longer needed, and separated from mom and baby, you can suck quite a bit out with a syringe.

    • nomofear

      The issue is that many in the natural birthing community believe that the cord should not be clamped for any reason until every drop is drained – to the extent that they preach that resuscitation should be done on the mother’s chest. Anyone who actually knows anything about resuscitation knows that it must be done on a flat surface, and that getting the baby oxygen ASAP is far more important than cord blood, as you state above. She’s not fighting delayed clamping per se, but instead, the idea that it is absolutely crucial to a child’s development that is pushed by the natural crowd, arguably to sow distrust between a woman and her medical team.

  • yentavegan

    The real advantage to preaching the benefits of delayed cord clamping is to deliberately plant the seeds of distrust between a woman and her ob/gyn….and then build on that distrust to market your homebirth, essential oils or CST business…..

    • Maya Markova

      Anyway, if there is little or no difference in term infants and clear advantage of DCC in premature infants, and if the patient – for whatever reason – prefers DCC, why not do it?

      • The Bofa on the Sofa

        And if there is little or no difference, why does the patient prefer it?

        This can go in circles.

        Actually, it’s not really a circle. Because if we are being honest, the reason the patient prefers it is because they have been deceived into believing it DOES make a difference. You can’t hide that by calling it “for whatever reason.”

        • Maya Markova

          A participant in this discussion claiming to be an OB said that immediate cord clamping was introduced and made a standard despite being backed with no evidence, in a (vain) effort to manage postpartum hemorrhage in the mother. My quick PubMed search produced results that were in agreement with this.
          The burden of evidence is on those who introduce a new procedure; in this case, the procedure was ICC.
          Dr. Amy’s post says that DCC helps premature infants and that, in term infants, it improves iron levels at 3-6 months. I disagree with the rest of the post. She says that a procedure that takes away blood from a newborn should be continued indefinitely until evidence accumulates that it causes statistically significant and lasting harm to the patients. I disagree. Medicine updates its recommendations all the time, often reverting to old ones (as with infants’ sleeping position). Having done a thing for decades is not a good enough reason to continue it, if it is pointless.
          I think that patient’s autonomy includes “for whatever reason”. And when neither Dr. Amy nor anyone else can list a single benefit of ICC, why insist on it just to be at odds with the natural childbirth crowd?
          The NCB crowd is also obsessed with breastfeeding – is this a reason to discourage breastfeeding? If a mother, for whatever reason, wants to breastfeed, I think the job of hospital staff is to facilitate her, not to explain her that she has been deceived into believing that breastfeeding makes more difference than it actually does.

          • Roadstergal

            “And when neither Dr. Amy nor anyone else can list a single benefit of ICC”

            Preventing jaundice? Not delaying administration of uterotonics?

          • Maya Markova

            I correct myself: not “cannot give”, just “didn’t give”. Though I hate commenters telling the blog author what to write, I think Dr. Amy should have written of this.

          • Amy Tuteur, MD

            Immediate cord clamping is hardly a new procedure. It’s been around for generations at least. So the burden of proof should be on those who wish to change it, especially because they are touting the “benefits” of DCC.

            DCC was originally promoted by a midwife who claimed that it prevented childhood illnesses and learning disabilities. That’s obviously untrue. Moreover, claiming DCC is “natural” isn’t a reason for doing it either.

          • Maya Markova

            Thank you for this clarification. The references I found are these:

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

            Timing of umbilical cord clamping: new thoughts on an old discussion. Arca G, Botet F, Palacio M, Carbonell-Estrany X.J Matern Fetal Neonatal Med. 2010 Nov;23(11):1274-85.

            Immediate or early cord clamping vs delayed clamping. Hutchon DJ.J Obstet Gynaecol. 2012 Nov;32(8):724-9.

            Committee Opinion No.543: Timing of umbilical cord clamping after birth. Committee on Obstetric Practice, American College of Obstetricians and Gynecologists.Obstet Gynecol. 2012 Dec;120(6):1522-6.

            Time to implement delayed cord clamping. McAdams RM.Obstet Gynecol. 2014 Mar;123(3):549-52.

            Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trial. Vain NE, Satragno DS, Gorenstein AN, Gordillo JE, Berazategui JP, Alda MG, Prudent LM.Lancet. 2014 Jul 19;384(9939):235-40.

            Cardiovascular transition at birth: a physiological sequence. Hooper SB, Te Pas AB, Lang J, van Vonderen JJ, Roehr CC, Kluckow M, Gill AW, Wallace EM, Polglase GR.Pediatr Res. 2015 May;77(5):608-614.

            I left aside studies focused on premature infants, those published in midwifery or nutrition journals, and one or two relying heavily on models. I failed to find any articles recommending ICC.

  • anotheramy

    I’m an occupational therapist who regularly uses one of the tools mentioned in this “study”, the ASQ-3. I can’t believe they would claim “higher scores on the AsQ-3” as a benefit of delayed cord clamping,! First, it is a screening tool, which means it just identifies kids who need further evaluation. So, the results of the other evaluations would “trump” results from a screening tool. Second, the ASQ-3, doesn’t give percentile rankings. Kids scores are classified as “area of concern” (1.5 SD below the mean, IIRC), an “area to watch” (1SD below the mean), and “no concern.” As long as the child falls in the no concern group, a higher score really is meaningless.

    • anotheramy

      Just want to add: The ASQ-3 can be used by professionals (or parent’s reporting) and can measure task performance objectively. I did not read the full study, just what Dr Amy wrote.

  • Renee Martin

    And if your kid has HDN its a bad thing. But no one thinks about that.

  • Allie P

    OT: My friend gave me “Birthing from Within” (Quoth my husband: Can you birth from another place???) and it’s driving me up a freaking WALL. I’m only on page 20. My last induced, epiduraled, hospital birth was quite pleasant, NOTHING like the nightmares they are describing. Half the time I want to tell these ladies to either get a life (like the one whining that her baby shower was more about giving her presents and being happy for her than “honoring her as a mother”), or get better care (the one whining that all their doctors did at their prenatal appt was scare them with stories of what could go wrong). But it is making me feel like there’s something wrong with me for having less than zero desire for my baby’s birth to be some kind of spiritual experience. Get it out, give me the kid, and then we can have spiritual experiences for the rest of our lives.

    • DelphiniumFalcon

      I’m totally in agreement with you. Kind of like how my husband and I don’t consider our wedding day the happiest day of our lives because we have many days ahead together to be even happier. You have your child’s entire childhood for spiritual whatevers.

      And if someone at a baby shower gives me a massage gift certificate, I most certainly will not complain that it’s “more about giving me presents.” It can honor me as a mother by recognizing building a new human being is hard work! There! Honored!

      • Chi

        I’m SURE there’s something spiritual about having chewed-up, soggy biscuit stuck in your hair, something totally unidentifiable crushed into a seam on your pants, and the living room looking like a category five hurricane hit it.

        Haven’t figured out what that is, but I’m sure it’s there.

        • DelphiniumFalcon

          Patience. Teaches patience. XD That’s one of the holy virtures, right? Lol

    • Gatita

      the one whining that all their doctors did at their prenatal appt was scare them with stories of what could go wrong

      To be fair, I had one of these and yes, it’s really unpleasant. But I switched to another OB (not a wackjob midwife) halfway through the pregnancy and had a much better experience in the end. OB #2 was still a MFM specialist but somehow managed to convey calm reassurance when discussing the possible negative outcomes and why she wanted us to get certain tests, unlike OB #1 who scared the shit out of us yet was maddeningly resistant to giving us real info and talking through our options.

    • fiftyfifty1

      ” But it is making me feel like there’s something wrong with me for having less than zero desire for my baby’s birth to be some kind of spiritual experience.”

      There’s not a thing wrong with you. There seems to be no end to people in this world who are ever so certain that they know exactly when and how you ought to be having spiritual experiences. Busy bodies.

    • FrequentFlyer

      Upvotes for your husband too. Did the woman say how she should have been honored as a mother? I was honored that my family, friends, and coworkers went out of their way to show me how happy they were for me by giving me cake and lots of useful and adorable baby things. About the one who was upset because of her doctor telling her what could go wrong, umm, I think that’s called treating the patient like an adult who should be informed and prepared for all possibilities. I’m in favor of that. Spiritual experience? I think I had one once I had my baby in my arms. I know I have never felt anything else like it. I think you’re the normal one, not them.

  • First Time Mama

    Thanks for this analysis. I heard of this study last week, but hadn’t had a chance to look at the original paper. My first thought was to wonder if they controlled for other factors that might also influence fine motor skills, but now that I see the large loss to follow up, and the fact the differences were based on subjective reports from the parents, I won’t be asking my OB about this during my appointment this week.

    • yentavegan

      Good for you ! Don’t let yourself fall victim to the deliberate planting ideas of distrust between you and your Ob/gyn. Delayed cord clamping propaganda is a marketing tool of the NCB industry.

  • moto_librarian

    I think that this is simply an extension of the magical thinking that midwives have about the placenta and umbilical cord. How many times have we heard midwives claim that a baby born flat isn’t really in trouble because said baby is still getting oxygen from the cord? These are the same idiots who think that it’s no big deal to delay resus efforts because the cord hasn’t been cut yet.

    Newsflash: the umbilical cord doesn’t work like scuba gear. Once the baby is out, the placenta starts to detach and the baby isn’t getting oxygen that way. Babies need to start breathing immediately, and delaying resuscitation in the name of delayed clamping is negligent.

    • Allie P

      SCUBA EQUIPMENT. I LOVE IT.

  • NoLongerCrunching

    OT, but this article is outrageous. Not once did they mention that the parents should have supplemented with formula rather than diluting the breast milk. The article was all about how breast milk contained the proper electrolyte balance. Well these parents did not have enough breastmilk. The article should have been clearer that the only safe solution is to combination feed. http://www.sheknows.com/parenting/articles/1082950/the-dangers-of-diluting-breast-milk

    • Sarah

      That’s absolutely, devastatingly tragic. And honestly I think we may see more such cases if the demonisation of formula continues.

    • Ash

      Look at the comments–a mother said she has been mixing her breastmilk with “Similac Mom” for her baby. Similac Mom is a beverage for adults, not babies. Hopefully she has gotten in touch with someone and stopped using Similac Mom to feed her baby.

      • Azuran

        Many of the comments are just plain stupid and hilarious. One of them even said that boiling water was bad because it causes bacteria to grow.

        • DelphiniumFalcon

          Ow…my brain…

  • Mel

    “I wanted to find answers to why so many children, including mine, my friends’ and my colleagues’ appeared to have additional learning and health needs, especially the boys,” said Burleigh.

    This is the most interesting quote of the whole article to me because she never clarifies the control group OR the experimental group. “Additional learning and health needs” compared to whom? What are these additional learning and health needs?

    My assumption is that the control group is the imaginary children Burleigh and her friends had in their minds before they actually had children. Children who were perfectly healthy, hit developmental milestones months before everyone else and who behaved like happy little angels.

    Instead, she got children. Actual, honest-to-God children. The kind who are ear-infection prone or croupy or refuse to learn how to walk before 16 months. Who spend most of kindergarten hiding under a table in their “play fort” guarding the classroom from dragons. Who refuse to open their eyes for photos for 18 months because the red-eyes scare them. Who refuse to go outside in 90+ degree weather without jeans, socks and long-sleeve shirts because of fear of ticks. Who spend time tied to trees and tying siblings to trees. Who tell their brothers they are breathing too loud at breakfast.

    You know, kids. Kids like the kids my husband and I used to be.

    • MegaMechaMeg

      Well I don’t know what is wrong with your imaginary children but mine in addition to your list have impeccable fashion sense and are fluent in french, chinese and italian due to the light opera that they were instinctually drawn to.

      • guest

        My imaginary children just didn’t cause me so much physical pain with the stepping on my feet, biting hard enough to draw blood, hitting and kicking to protest a diaper change, yanking on my arms for attention, stepping on all my tender spots trying to sit on my lap, poking me right in the eye with an errant arm movement, etc. Even though the majority of it is unintentional, I sometimes have flashbacks to an old, abusive relationship.

        • MegaMechaMeg

          It is amazing how remorselessly children are after causing you injury. My friends kid gave me a black eye once during a diaper change and then told me that I should have been more careful. I almost punted them on the spot.

          • baileylamb

            The child said that or the friend?

          • MegaMechaMeg

            The child, which I think makes it better? I think she was repeating what her parents tell her when she hurts herself 🙂

          • guest

            Diapers changes do require the utmost of being careful.

      • Mel

        I hope I can find the picture of 7-year old Mel dressed in a flannel shirt, jeans with socks over the top and eyes serenely closed – while surrounded by cousins wearing swimsuits in 90 degree heat.

        What the picture misses is me freaking out because my “crazy” parents wouldn’t make my 3 year-old brother dress in my tick-free clothing in 90 degree heat. Nor would they join me in tick-free safety.

        Did I mention the way I would freak out when – after swimming which is a fairly tick-free activity – I’d find a bit of magnetite sand on my leg?

        Or that my beloved, massively intelligent elderly bachelor great uncle would leave information about ticks and Lyme disease lying around at the cabin we rented? Mom swore each of those pamphlets/scientific papers set me back at least a week in terms of dressing in shorts when it was 90+ out.

        As MegaMechaMeg et al., pointed out – be careful what you wish for. Being smart enough to understand what Lyme disease was and how it was transmitted at age 7 doesn’t mean I had the emotional or general developmental skill to handle the information.

        • DelphiniumFalcon

          Or learning about killer bees and not understanding biomes yet and thinking they’re out to get you.

          Yay smart children! We’re so neurotic. XD

          • Mishimoo

            Having paedophiles explained in detail at 6 and devouring the Sunday newspaper (the only regular source of new reading material) destroyed any hope of faith in the justice system.

            On the upside, having a Home Doctor book and a lot of National Geographics to read made me very firmly pro-vax even when my parents were getting into the woo (thanks, ‘Dr’ Rebecca Brown)

    • DelphiniumFalcon

      Everybody wants the super smart child until they have one. Then they want to tie them to a chair and keep cameras on them at all times. Intelligence untempered by morals is a terrifying thing.

      This isn’t bragging, I was legitimately in the higher intelligence end of the milestone markers. And it made me an unholy terror.

      Let’s see… I was nigh unpunishable. Take away toys? Find new ones to play with. Go to my room? Play with toys. Take away toys and go to room? Jump on the bed and kick the walls. Put in the corner? Make hand puppets out of my hair. Pull my hair back? Hand puppets without hair. Forced to sit on the church pew until I could sit nicely and not kick the pew in front of me or talk at the top of my lungs? Even at two I understood the concept of time and that Dad’s was limited. Mine wasn’t. I outlasted him because eventually we’d have to leave the church building.

      They figured out early on the positive reinforcement worked better but I found ways around that too. Be good and I got rewarded. But what were they going to do to me when I didn’t feel like the reward was worth it? I’d already outlasted the rest of their punishments. Logic when logic could be applied actually worked best. Explain why it was important and the resulting consequences of not following what mom and dad were and I usually found it wasn’t interesting anymore.

      That’s when mom and dad went to their last resort and with huge reservation after all else failed had to spank me. They only had to do it a few times and it was a quick swat that hurt my feelings more than anything. I only remember getting spanked like three times at most. And it was for important things like when I wouldn’t stop trying to run into a busy street. That’s why I’m not 100% against spanking. Sometimes it’s the only tool left in the box.

      I was a little Houndi too. Got outside completely naked and rode my trike to the park when I was two when we were living on Dugway Proving Grounds. Mom put me down for a nap in the middle of the day because she needed one too. She’d just had a late miscarriage and lost a lot of blood. I was usually a good napper. During that time I’d escaped my crib, gotten through two regular door locks, the deadbolt, the chain, and disabled the alarm system Mom had put up just in case I got that far. Thank goodness we were living on an army base as I was gone only a few minutes and brought back by the base law enforcement. Mom wanted to die of embarrassment. I was also a master of escaping the car seat while the car was in motion. I’d find a way to trip a mechanism eventually no matter the model.

      I don’t know how my parents didn’t outright murder me… Tell me again why people want the super intelligent children? Mom doesn’t tell me she hopes she has a child like me. It’s too cruel a wish and I agree! But she said I was fun and most of the time she just laughed because what else can you do at that point?

      For other examples we have my husband where in the time it took his mom to go get the mail while she was feeding him in his high chair, he’d gotten out of the chair, pushed it to the door, climbed up and locked his mom out. He was quite proud of himself. Gotta give his mom props. She just stayed calm and said “That’s very good, Joey! Can you show me how you did that?” He was so impressed with himself naturally he wanted to show his mom how smart he was and unlocked the door.

      My cousin did the same thing to my grandpa. And then raided the fridge for yogurt and set up a chair to watch my Grandpa try and figure out how to get back inside.

      I’m hiding keys everywhere outside my house when I have kids. Maybe some wire cutters just in case.

      Wishing for overly intelligent children is like drawing a demon summoning circle!

      • MegaMechaMeg

        People don’t mean that they want and intellegent child when they say things like that, they mean that they want a sweet and bidable angel who will cutely recite their ABCs on demand and say socially appropriate precocious statements when applicable and give the parents bragging rights when they achieve all of their milestones first. In my experience the smartest kids in my aquaintance are the least bidable because they know that they can get their way eventually :-).

        • DelphiniumFalcon

          So not the toddler that stood up on the church pew and yelled “SHIT!” at the top of her lungs. Got it.

          • MegaMechaMeg

            Probably not, but I think we would for sure get along. I was a fairly tame toddler according to my mother and I could have used the pointers.

          • DelphiniumFalcon

            Your mother would have killed me and my parents for giving you ideas. XD Oh my gosh I was awful.

          • baileylamb

            That does beat asking for Santa Claus at the mystical part of Christmas mass. Sounds cute until you realize he doesn’t believe in Santa (his choice) and he was laughing as he was doing it.

          • DelphiniumFalcon

            Oh my gosh that is hilarious! I wasn’t as much of a clever child with things like that so I applaud his reasoning abilities.

            Yeah I learned that word from my dad’s mom. That mouth of hers… She dropped things and said “shit!” so I thought this was appropriate protocol when displeased or dropping something. I’d dropped by bottle at church.

            She swore in the temple once while in one of the dressing rooms. “I can’t find my damn socks!” Next thing you know socks come raining down into her stall from her daughters hissing “Mom! We’re in the temple!!!”

          • baileylamb

            Mr. Hasn’t said any of the bad words, perhaps he is too posh for that. He did call his dad a racist when his dad was changing little sis. Then Mr. stormed off muttering about racism under his breath. I told him that the baby needed to be changed, so Mr (my 3 year old) called me a racist. I didn’t want to totally invalidate his feelings, so I told him I’m sorry he feels that way, but to use the words bigot and bigotry instead. I told him “racist/ racism” was over used, that there are no races (social construct) and that bigot could work for,more situations. He smiled, repeated the words a and filed it away somewhere.

          • Who?

            I hope you get to see and hear when he decides to pull the words out and use them again!

          • Ah, 2nd of 9’s first word, when Grandma’s cookie drawer wasn’t filled yet: “Thit!” Mom was mortified.

          • EmbraceYourInnerCrone

            Possibly this child is related to me…I liked to stand on the pew and sing On top of Spaghetti at full volume.Channeling my inner atheist early apparently. I was 3..the priest was not amused sadly

          • rachel

            So, also not the 4 year old sitting forlornly on the garage step telling me “Mommy, I’m really sorry to have to tell you this, but, I feel like shit”? At least he used it in proper context. I have at least one moment daily that makes me want to call his pre-K teacher and ask if she’s sure my kid is really “the most advanced in class and definitely needs to move on to kindergarten”.

      • baileylamb

        All of this, minus the spanking, spanking makes him laugh. I did lock him (and myself) out of his room. Had to wait for dad to unscrew the door knob. That worked, ;).

        • DelphiniumFalcon

          Screw drivers! That’s the other thing I need to hide around the yard and house!

          Spanking makes him laugh? May God have mercy on your soul, you poor woman.

      • FEDUP MD

        Yeah, I have a very smart 3.5 year old. I am always exhausted.

        • Mishimoo

          *nods* I can relate. My youngest is nearly two, and his sisters were so much easier. He breastfed longer, so I’m going to start blaming that for his mischief.

          (Seriously, who decides that sticking one’s head into the fishtank to practice breathholding is a good idea? My kid!)

      • I was the really smart one. Mom had my number: books. I read everything I could get my hands on, and it kept me quiet. When stepdad entered the picture, he got me hooked on SF&F, and that had me reading even more! At least Mommy was into Star Trek…

    • PrimaryCareDoc

      My imaginary children were adventurous foodies. They went out to restaurants with us and were perfectly behaved angels who sampled sushi.

      My real children subsist on chicken nuggets and Goldfish crackers.

      • MegaMechaMeg

        Hey, my imaginary children come to brunch with me all the time! I smugly sip my mimosa and engage in adult conversation with my husband while they sit quietly by my side eating their organic mixed greens and reverantly taking in the local art pieces surrounding the seating area. Occasionally they will play with a handcrafted and ethically sourced wooden toy. It is the best part of our week as a family.

        • PrimaryCareDoc

          Our imaginary families should totally hang out together!

          • MegaMechaMeg

            I will bring the kale chips and the unsweetened carob-veggie “brownie” bars!

          • PrimaryCareDoc

            I’ll bring the organic sulfite-free wine and the cloth diapers! Hugs, mama! See you soon!

          • Mad Hatter

            My imaginary children don’t need diapers at all because they communicate to me when they need to go and I can take them to the potty!

          • Azuran

            Mine go to the potty on their own.

          • MegaMechaMeg

            Mine don’t poop. We bred that out of them. I’m sure you are doing your best though.

        • baileylamb

          My real child told us to climb the property ladder (real words used dang you hgtv). He’d dropped not so subtly hit in the past weeks about how his grandparents house was “his house”. Actually, “Mr.—” house, he gave himself a formal tittle and talks in the third person. Mr. will say, “thank you so very much” if you please him. He also will call his beloved sister “that”.

      • baileylamb

        My hellion is a foodies…Who currently loves to scream at a high pitch (only indoors). I think he broke the nurse during his annual checkup. He knew she was new and refused the vision portion. She love how he pointed out letters on his kindle, after claiming he didn’t know his ABC’s. He won’t say sorry (once for a whole day), but if pressed he will spell it. He is awesome an awesomely frustrating. I feel like I’m raising my grandpa bc he’s so old school. All of my sons biggest strengths are his weakness as well. So be glad you don’t have a kid who ask for white chocolate ganache on one tier of his bday cake (with strawberry apricot filling and buttercream for the top). I had to make my son a mini wedding cake for him to eat it, and then then he said the wc was too sweet, now the top portion he climbed on the table and tried to run off with it before his friends came over.

        • DelphiniumFalcon

          This is amazing. I mean it must drive you up the wall but this is still amazing.

          Incidental plus, imagine how much you can embarrass him in front of his friends as a teenager!

        • Mel

          One of our neighbors has an awesome little boy who is the poster child for ADHD. He’s sweet, loving and completely unpredictable because he lives nearly entirely in the moment. A few years ago, his dad and mom did a quick hand-off of E. (who was about 3) at my bridal shower. Since everyone knows E. – and his amazing powers of chaos – there were at least 10 women keeping an eye on him. His mom rounds him up to go to the car and notices a bulge in his pocket. She asks him “E. What is in your pocket?” His face goes completely blank as in “What pocket? I don’t have a pocket.” as he remains silent. She reaches into his pocket and removes the full-sized, aluminum wrapped baked potato that he had gotten from the buffet line and placed in his pocket for later.

          The amazing thing is no one remembers seeing him by the buffet let alone grabbing the massive Russet potato and maneuvering it into his little overall side pocket….

          It’s become an running joke for my husband and I. “I mean, you NEVER know when you are going to need a baked potato. You could get hungry. You could need to throw it at a bear. Plus, you get at least 6 square inches of aluminum foil. That’s great for preventing aliens from reading your mind. Seriously, why don’t we carry these in our pockets?”

          • Mishimoo

            That is beautiful!

          • Brix

            He sounds awesome (both the potato thief and your husband, actually).

        • Mishimoo

          Pretty sure this will be my youngest when he decides to start speaking more. He hates fastfood and prefers to eat whatever I’m having regardless of whether he’s tried it before or not. He’d also run off with the whole cake if I took my eyes off him for a second. I’m not looking forward to him being tall enough to open his bedroom door.

  • Gah

    Oh wow. Delayed cord clamping was the only thing on my birth plan when my son was born a few months ago. I didn’t actually even have a birth plan–I just told the OB that I wanted to delay clamping. It was my only request and the only woo thing I did during pregnancy or birth. And it turns out I didn’t even need to do it! Oh well…at least it doesn’t hurt anything. Or does it?

    • Helen

      AFAIK, the only danger of delayed cord clamping is a delay of medical treatment for either the mother or the child. If that had been the case, that either of you were in need of such treatment, the OB would likely have overruled the birth plan. That she didn’t tells me that there was no problem in going along with this. Things were fine and the OB allowed you a more relaxed post-birth experience.

    • Cobalt

      There’s an increased risk of jaundice that balances out the reduced risk of anemia. Delayed clamping during an otherwise uncomplicated delivery isn’t bad, it’s just not good, either. It really doesn’t matter except in specific circumstances (like preemies or if mother and baby need to be separated quickly to treat complications or if the cord blood is being collected).

      • Renee Martin

        Also babies that have issues with their mothers blood attacking their red cells. In that case, doing that can make it worse. My kid had to have an exchange transfusion to stop the damage- took all the blood out and replaced it because mine was so damaging.

        Its like RH disease, but with other factors. It can even happen with simple blood factors when they don’t match, you don’t need the extra ones (hell, C, c, E,e, Kell, etc).

        And we didn’t know with my first until later on when he turned daffodil yellow!

  • TsuDhoNimh

    Here’s the discussion from the chocolate sting article:

    We knew our chances of getting at least one “statistically significant” result were pretty good.

    Whenever you hear that phrase, it means that some result has a small p value. The letter p seems to have totemic power, but it’s just a way to gauge the signal-to-noise ratio in the data. The conventional cutoff for being
    “significant” is 0.05, which means that there is just a 5 percent chance
    that your result is a random fluctuation. The more lottery tickets, the
    better your chances of getting a false positive. So how many tickets do
    you need to buy?

    P(winning) = 1 – (1 – p)n

    It’s called p-hacking—fiddling with your experimental design and data to push p under 0.05—and it’s a big problem.”

    http://theness.com/neurologicablog/index.php/p-hacking-and-other-statistical-sins/

    Or data dredging …

    http://en.wikipedia.org/wiki/Data_dredging

  • TsuDhoNimh

    And in other news, chocolate promotes weight loss. 🙂

    It looks like they surveyed a whole bunch of stuff in a small sample and kept looking until they found a positive correlation. I don’t know how many subjects you need to measure 15 variables, but I think it’s more than they had.

    Chance alone would put one or more of them into “significant” statistical territory.

    • Amy M

      Yeah, they probably could have attempted to correlate amount of caffeine the mother drank while pregnant, how many fluorescent lights were on in the delivery room or if the hats on the babies were made of synthetic fibers or natural fibers to the kids’ physical abilities and gotten a similar answer.

      • demodocus

        Only 100% qiviut wool for my snowflake! (That’s from the muskox and, if memory serves, is collected from either combing or picking up loose bits from bushes and stuff. It’s also crazy expensive; 1oz of lace weight from one company is $108 US.)

      • Mishimoo

        There was one study that I found when I was pregnant with my eldest, which I have not been able to find since, which suggested that moderate intake of caffeine (under the 200mg limit) during pregnancy may increase the size of the hippocampus leading to a higher IQ. Being as friends and family were commenting on my moderate coffee intake, it was very satisfying to mention that and shut them up. Even if it was a crappy study, it still made life much easier for me. (Plus, drinking coffee helps me avoid blacking out while going from sitting to standing, or laying down to sitting. Giving that up while pregnant is probably a bad idea.)

  • DelphiniumFalcon

    Hmmm… Decisions decisions…

    Do I delay cord clamping and have some hazy non-proven benefit? Or do I clamp when the doc recommends and then donate the blood to a public cord blood bank?

    Yeah, I’ll do the second. It might get thrown out for not meeting standards or never be used but it also might be what gives someone with a genetic disease or a blood cancer another chance they didn’t have before. I’d rather it have the potential to be used to help someone else.

  • Roadstergal

    That’s a lot of outcomes. Did they correct for multiplicity? That would make the results look like even less of a difference between the two.

  • Gatita

    Here’s an analysis that Health News Review did on this story: Waiting to clamp the umbilical cord — NPR carefully balances discussion of benefits and harms

  • MHAM

    During my most recent pregnancy, I read somewhere about there being an increased risk of jaundice associated with delayed cord clamping in term infants. For the life of me, I can’t remember where I came across that and I have no idea if there’s any merit to it. My oldest had jaundice, so I decided not to fool with delayed clamping for this baby and donated the cord blood instead. (And this baby ended up with jaundice anyway, too, so…)

    • Poogles

      There’s been a few studies showing that a higher percentage of babies who have delayed cord clamping end up needing phototherapy for jaundice compared to babies who had their cord cut “immediately”. The WHO discusses them here:

      http://apps.who.int/rhl/pregnancy_childbirth/childbirth/3rd_stage/cd004074_abalose_com/en/

      “significantly more infants (relative risk 0.59; 95% CI 0.38–0.92) in the late cord clamping and cutting group required phototherapy for jaundice than in the early cord clamping and cutting group (five trials, 1762 infants).”

      • Roadstergal

        Wait, am I reading that report right? It sounded like the only significant outcome difference they found was just that result – increased incidence of jaundice requiring phototherapy with DCC – and they then jump right into how to implement DCC?? (Including delaying active management in favor of DCC?)

        • Poogles

          Yeah, that’s pretty much how I’m reading it too. Makes little sense to me….

  • Jacqueline

    Does “No Benefit” also imply “No Detriment”? I.e. can I just stop concerning myself with the umbilical cord entirely now?

    • TsuDhoNimh

      Clamping it prevents the newborn from bleeding out through the umbilical vein and artery if the blood vessels don’t close off quickly enough.

      So clamping before cutting, and remembering to cut on the placenta side of the clamp, not the baby side. (we had two clamps, not because clamp # 2 was needed, but cutting between the clamps ensured that you never cut on the baby’s side of the cord).

      • Deborah

        Clamp #2 is needed so the placenta side of the cord doesn’t spout off like a fire hose and get blood on the ceiling. But, yes, medically not needed.

        • Anj Fabian

          Thank you for the visual. I may never be able to go into another L&D room without checking the ceiling now.

          • demodocus

            I had a pretty good view of my L&D room, no visible blood. Maybe they sent vampires in?

      • Jacqueline

        Yikes. I’m going to go ahead and assume I don’t need to remind the OB of that ;). The hospital I delivered my first baby at routinely did “delayed” cord clamping, I guess ’cause it’s the cool thing these days? I put the delayed in quotes because I think they only waited a minute or so rather than “until it stopped pulsing” or whatever the NCB crowd deems essential today.

  • Daleth

    Thank you so much for cutting through the BS. You’re helping enormously–how many of us feel guilty about not insisting on crap like this, when we read studies about How Important (TM) it is?

  • PrimaryCareDoc

    That’s a great study. The correct title of it should be, “Some parents think their kids are awesomely gifted, all evidence to the contrary.”

    • Guestahoy

      My friends believe their son is going to be a gifted engineer. They are searching for an appropriate engineering magnet school to foster his talent. This child is six, can’t read, doesn’t like building type toys, hates doing math. Great kid, very sweet, quite possibly would make a fine engineer some day, but it is a little bit hilarious to see them twist every action into a tiny miracle of engineering genius. “he giggles at explosions! he has a natural love and instinctive grasp of chemistry!”

      • DelphiniumFalcon

        Maybe he just wants to be a special effects artist? 😀

        • Azuran

          Or a terrorist :p

        • Guestahoy

          As far as I can tell his life goal is to be Commander Cody which is a noble life path that I support in full. 🙂

          • DelphiniumFalcon

            As long as he understands that Order 66 is not be be enacted at any time.

      • Monkey Professor for a Head

        When we went to see the Avengers, my unborn son kicked like crazy anytime there were explosions. He must have a natural instinctive grasp of chemistry. Or be the Hulk….

      • KarenJJ

        Geez, poor kid. Engineering can be a great career choice but it needs some internal motivation and stamina to get there and stay there.

    • Renee Martin

      Everyone thinks they have a genius. Then you meet an actual genius kid, like Kumquat writers son, and you realize how very average your kid is.
      I am glad I didn’t labor under the illusion my kids were brilliant because watching him would have ben a huge come down. He is amazing, and too smart to discipline. She is lucky he is good natured to begin with! Because he is NOT doing anything he doesn’t wanna do. Like other kids, plus the smarts!

      • KarenJJ

        One of my kid’s friends is like this. Her mum’s a single mum with few resources and she’s been butting heads with her kid’s teachers since kindy because they were sure there’s something “wrong” with her daughter. She’s taken her to the paediatrician for screenings and doing her head in trying to find out what the matter is meant to be. At home her kid seemed happy, friendly and was reading very well and very early. At school she was acting out and the normal discipline (thinking chair etc) wasn’t working and she wasn’t doing the work…

        She ended up getting an IQ test done and the poor girl scored very very highly and has probably been bored out of her mind. Thankfully the result has convinced the teachers that she is perfectly capable and her new teacher has been finding some great ways to get her engaged with her schoolwork.