The birthing suite in any hospital is a place of miracles, a place of science, a place of medical expertise, hope, happiness, sorrow, joy, surprise, instinct and love. It is a place of tradition, best practice and also innovation. Those who choose to work in this field dedicate their lives to keeping women safe and delivering their babies carefully into the world. The experience they bring when helping a woman birth her baby is enhanced by the understanding that in the world of medicine, there is always more to learn. Such is the case at Mercy Hospital for Women, where a team of researchers, midwives, doctors and patients are participating in the Australian Placental Transfusion Study (APTS) ï¿½ a project that could change the way premature babies are cared for at birth.
Current medical practice dictates that when a baby is born, its umbilical cord is clamped and cut and the beloved bundle is quickly held up to show mum or placed on mumï¿½s chest so bonding can begin. For premature babies the process is fairly similar, though these fragile little lives can go on to develop a number of difficult conditions and health concerns. The APTS is exploring the theory of ï¿½the golden minuteï¿½, posing the question: If a premature baby born at 30 weeks or less is held at or below the level of the placenta for up to 60 seconds immediately after birth, without clamping the umbilical cord, can this final natural transfusion from the placenta negate health complications such as infection, anaemia and neurological impairment in early life?
Itï¿½s a question researchers such as Geraldine Wash, Research Nurse at Mercy Hospital for Women are excited to help answer. ï¿½This study is so important as it may improve health outcomes for our premature babies,ï¿½ says Geraldine. ï¿½A few small studies have been done on this topic in the past but this is the first time the long term effects of deferred cord clamping will be recorded.ï¿½
Geraldine Walsh, Research Nurse, and Jim Holberton, Neonatologist, are part of the Mercy Hospital for Women research team involved in the Australian Placental Transfusion Study.
The APTS is a randomised, multicentre study instigated by Australian academic Professor William Tarnow-Mordi. Collectively the goal is to recruit 1,600 babies across Australia and New Zealand, 50 per cent of whom will receive immediate cord clamping (standard practice), while 50 per cent will receive deferred cord clamping (holding the baby at or below the level of the placenta for up to 60 seconds before clamping the umbilical cord). Mercy Hospital for Women is one of eight centres in Australia âˆ’ two New Zealand centres are also involved âˆ’ participating in the study. Principal Investigators Dr Andrew Watkins and Professor Sue Walker are leading the hospitalï¿½s team of associate investigators, nurses, midwives, paediatricians and obstetricians who collect the data as each baby is born.
So far four babies have been recruited, two of whom were assigned deferred cord clamping and according to Geraldine, handled it perfectly. ï¿½They both came out breathing and crying and managed the full minute perfectly. We wrap the babies so they stay warm as theyï¿½re being held and a paediatrician is on standby. Midwives and obstetricians are there to monitor mum as well. The difficult part is remembering not to hold the baby up to show mum straight away, itï¿½s such a natural instinct in that moment of excitement.ï¿½
To date similar studies have shown improvements in short term complications such as infection, low blood pressure and anaemia, but the small number of participants involved meant changing standard medical practice based on results wasnï¿½t possible. The APTS has the potential to change the lives of severely premature babies and the families and medical staff who care for them. ï¿½As a tertiary centre and one of the largest Neonatal Intensive Care Units in Australia, it's essential that Mercy Hospital for Women is involved in such a study and is a collaborator in high quality research,ï¿½ says Geraldine. ï¿½Being involved in the first long term study of this kind which includes a two year follow up with these babies is not only exciting, but imperative to the ongoing learning and leadership of the hospital.ï¿½
Published in Our Voice Winter 2013