“A strong healthy child, as soon as it is born, will begin to breathe freely, and in
most cases cry vigorously. As soon as it has thus given satisfactory proof of its
respiratory power, you may at once proceed to separate it from its mother by
tying and dividing the umbilical cord.” – Swayne 1856, p 20.
Swayne JG (1856) Obstetric Aphorisms: For the use of students commencing midwifery
practice. London: John Churchill.
"The cord should not be tied until the child has breathed vigorously a few times.
When there is no occasion for haste, it is safer to wait until the pulsations of the
cord have ceased altogether." – Lusk 1882, pp214-215.
Lusk WT (1882) The Science and Art of Midwifery. New York: D Appleton and Company.
"In cases of suspended animation, the cord should not be tied until it has
ceased to pulsate, as there is a possibility in such circumstances, of a certain
amount of placental respiration…" – Leishman 1888, p 320.
Leishman W (1888) A System of Midwifery Glasgow James MacLehose & Sons.
"Q: When an infant is born what is the proper treatment to adopt to severing the
A: You must first assure yourself that the child is alive and breathing …" –
Corney 1899, p 5.
Corney, BG (1899) Instructions with reference to the treatment of the umbilical cord.
"When respiration is established, let the infant rest on the bed between the
thighs of the mother, preferably on its right side or back, avoiding contact with
the discharges, while the navel string is attended to. No haste is necessary in
tying and cutting the cord, unless relaxation of the uterus, flooding, or some
other condition of the mother, requires immediate attention from the physician."
– King 1907, pp260-261.
King AFA (1907) A Manual of Obstetrics, Tenth Edition. Lea Brothers & Co.,
"As soon as the child is born, its eyes are wiped, any mucus in the air passages
is removed, and it is placed in a convenient position between the patient's legs.
The cord is tied as soon as it has stopped pulsating, and the infant is then
removed." – Jellett 1910, p 350.
Jellett, H (1910) A Manual of Midwifery for Students and Practitioners. New York:
"Normally the cord should not be ligated until it has ceased to pulsate…" –
Williams 1917, pp 342-343.
Williams JW (1917) Obstetrics: A Text-Book for the Use of Students and Practitioners,
"… A compromise is usually adopted, in that the cord is not tied immediately
after birth, nor does one wait till the expression of the placenta, but only until the
cessation of pulsation in the cord, an average of five to ten minutes." –
vonReuss 1921, p 419.
von Reuss, AR (1921) The Diseases of the Newborn. New York William Wood & Co,
MCMXXI (Vienna, January 1914)
"After waiting until the pulsation in the exposed umbilical cord has perceptibly
weakened or disappeared, the child is severed from its mother." – DeLee 1930,
DeLee JB (1930) The Principles and Practice of Obstetrics. Philadelphia and London:
WB Saunders Company.
"In most clinics the cord is not tied until pulsation has ceased." – Curtis 1933, p
Curtis AH, ed (1933) Obstetrics and Gynecology (3 vols). Philadelphia & London: WB
"…If the infant has cried and has respired well for about five minutes, there is no
advantage in leaving it attached any longer to the placenta." – FitzGibbon 1937,
Fitzgibbon, G (1937) Obstetrics. Browne and Nolan Limited,
"As soon as respiration is well established, lay the child on the bed on its side.
Wait for a few minutes until the cord shows signs of ceasing to pulsate…" –
Johnstone 1949, p 190.
Johnstone RW (1949) A Text-Book of Midwifery, for Students and Practitioners,
Fourteenth Edition. London: Adam and Charles Black.
" The cord is cut after about three minutes or after it collapses." – Greenhill 1955,
Greenhill, JP (1955) Obstetrics Eleventh Edition WB Saunders Company, Philadelphia
"After pulsation in the exposed cord has ceased, using dull scissors, the child is
separated from its mother." – Greenhill 1965, p 376.
Greenhill JP (1965) Obstetrics: From the original text of Joseph B. DeLee, MD.
Thirteenth Edition. W.B. Saunders Company, Philadelphia & London.
"The cord is clamped and divided as soon as pulsations have ceased." – Garrey
et al. 1974, p359.
Garrey MM, Govan ADT, Hodge C, Callander R (1974) Obstetrics Illusrated, Second
Edition, Churchill Livingstgone: Edinburgh and London.
"The umbilical cord should be tied up after its vessels stop pulsating, which
occurs in 2-3 min following the delivery of the infant." – Bodyazhina 1983, p 156.
Bodyazhina V (1983) Textbook of Obstetrics: Translated from the Russian by Alexander
Rosinkin (revised from the 1980 edition). Mir Publishers, Moscow.
"Q: What is the significance of continued pulsation of the arteries in
the umbilical cord at birth?
A: It means that respiration has not commenced. The physiological
stimulus causing closure of umbilical arteries (and ductus arteriosus)
is an increase in oxygen saturation of the blood which occurs when
the lungs expand with air." – Beischer et al. 1986, p 710.
Beischer, NA, MacKay EV (1986) Obstetrics and the Newborn: An illustrated textbook,
Second Edition. WB Saunders Company, Sydney, Philadelphia, London, Toronto, Tokyo,
“Another thing very injurious to the child, is the tying and cutting of the navel string
too soon; which should always be left till the child has not only repeatedly breathed
but till all pulsation in the cord ceases. As otherwise the child is much weaker than it
ought to be, a portion of the blood being left in the placenta, which ought to have
been in the child.” – Erasmus Darwin, (Charles Darwin’s grandfather) 1801, p 321
Erasmus Darwin E (1801) Zoonomia, 1801; Vol. III
“The head is born: perhaps the cord is turned once, or even more than once around
the child’s neck, which it encircles so closely as to strangulate it. Let the loop be
loosened to enable it to be cast off over the head. … [or] by slipping it down over the
shoulders. … If this seems impossible, it should be left alone; and in the great majority
of cases, it will not prevent the birth from taking place, after which the cord may be
cast off. … Should the child be detained by the tightness of the cord, as does rarely
happen, … the funis may be cut … Under such a necessity as this, a due respect for
one’s own reputation should induce him to explain, to the bystanders, the reasons
which rendered so considerable a departure from the ordinary practice so
indispensable. I have known an accoucheur’s capability called harshly into question
upon this very point of practice. I have never felt it necessary to do it but once. …
The cord should not be cut until the pulsations have ceased.” – Meigs, 1842
Meigs C. Professor of Obstetrics and Diseases of Women and Children, Jefferson Medical College. A
Philadelphia Practice of Midwifery, 1842.
“If the child be healthy, and not have suffered from pressure, &c. it will cry as
soon as it is born, and when respiration is established, it may be separated from
its mother…” – Churchill 1850, p 132.
Churchill F (1850) On the Theory and Practice of Midwifery. London: Henry Renshaw.
TRADITION (quotes from textbooks 1801-1986):
After Queen Victoria gave birth to Prince Leopold in 1853, anesthesia in childbirth
became more and more widely promoted and accepted. During the following
century, as childbirth became increasingly medicalized, clamping of the umbilical
cord within the first minute of birth was employed to preserve the "sterile field"
for suturing. Virginia Apgar, in 1953, attributed respiratory depression at birth to
use of anesthesia, apparently without consideration of whether or not the
umbilical cord was clamped before the first breath.
Anesthesia was first used in 1846, and a year later in childbirth.