Getting into pro and con camps

Before, during and after Apgar developed her scoring system, many papers pro and con appeared.  Evidence appeared to favor the tradition of waiting for pulsations of the umbilical cord to cease.  The following remarks pertain to a particularly loathsome article by Taylor et al. (1963), which opened with the following comment:

"Opinions vary as to the most beneficial time for clamping the umbilical cord." p893.

To their credit, they then noted the scholarly editorial on the subject in the June 9, 1962 issue of the Lancet, which introduced the articles in that issue by Bound (1962) and Secher & Karlberg (1962).

Taylor et al. then credited themselves with "the minority opinion," as follows:

"The minority opinion cautions that this rapid and relatively large transfusion might overload the infant's circulation."  p893.

They introduced their own investigation as being directed to the effects of early or late clamping of the cord on the clinical condition of the newborn, and expressed concerns over observations of temporary venous hypertension in infants following delayed clamping.  They then described their experimental protocol:

"The original plan was to study only infants born of ward mothers.   Ward patients were assigned in rotations to Service I or II when first seen at the hospital.  Service I infants were to have early and Service II late clamping of the umbilical cord." pp893-894

This plan was carried out for full-term infants, but --

"It became necessary to include private patients in the premature group to increase enrollment; the planned randomization of these infants as to time of cord clamping failed," p894.

What an outrageous statement.  Consent was apparently not easily obtained from private patients to be randomly assigned to one group or another.  Only clinic patients, those without means to pay for private care.

Childbirth was not covered by medical insurance in 1963.  That was the year my son was born, and I was a "ward patient" because my husband was a graduate student.  I agreed to be a participant in the "Collaborative Perinatal Study," which I understood was to follow children frequently during development.  My son needed to be resuscitated at birth, which was very worrisome and unsettling despite all the chiding that he was doing just fine.

Three years later he was diagnosed with autism, because of developmental language problems -- which fit Kanner's description of "irrelevant and metaphorical" use of phrase fragments.

I have no idea what "randomized" treatment group we were assigned to.  As for long-term developmental follow-up, that was left for me to deal with, as described at http://www.conradsimon.org/

Randomized-controlled studies should be reserved for experimentation with animals only, no matter how much the animal-rights advocates object.  "Ward patients" should have more rights than animals.