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Dr. Jones: When should you cut the cord? I'm not talking about making your adolescents independent, but that's a good topic. But when should you cut the umbilical cord after the birth of a baby? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health, and this is The Seven Domains of Women's Health on The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: When a baby is just born it is attached by the umbilical to the placenta which is still attached to the mother's uterus. Of course after the birth of a baby we want to get the baby dried off, and warm, and in the arms of the mom, skin to skin if possible. But when do you cut the cord? This has actually been of some debate over the years, cut immediately, cut in a minute, cut in five minutes, why does it matter? And what's best for the baby?

First of all, the placenta is two pools of blood in it, pumped by two hearts. The reason of placenta is there for all of us mammals is to provide oxygen and nutrients from the mom to the baby. The mom pumps her blood through her side of the placenta and the baby's hearts pumps blood through its side of the placenta. The blood isn't directly mixed but goodies are exchanged.

Immediately after the baby is born, before its starts to take its first breath and really get his lungs going, the blood is still pumping on the baby's side of the placenta. Eventually, some of the blood on the baby's side comes back to the baby about 80 to 100 cc or three ounces. Then the umbilical cord stops pulsing and clamps down. This happens to babies born all over the world without a birth attendant, without a clamp and some scissors, and it happens in other mammals, in dogs and cats.

That extra blood that goes back to the baby does makes the baby's blood a little thicker, a little higher count than is found in babies a month later, but that blood also serves as extra iron stores for the baby to make its red blood cells while it's nursing, as breast milk is low in iron. So most OBs were trained to deliver the baby and clamp and cut the cord right away. This was as much habit as anything, but there was some data that babies that had delayed cord cutting might be at higher risks of bilirubin problems -- having a little jaundice after birth as a result of the extra blood.

So until a couple years ago, it was habit to clamp and cut the cord right away. However, moms and midwives we're fighting back from what they saw as a more natural approach to cutting the cord, wait a minute or two, or three, or at least until the cord stops pulsing. So there were some randomized trials, healthy term babies were randomized to having the cord cut right away versus waiting a minute or so. And although there was a slight increase in the rate of jaundice in the baby's with later clamping, the babies had less anemia several months later.

They also did the same study with babies that were somewhat premature and these babies did better also. The preemie babies who were stable enough to delay cord clamping a little while had less needs for transfusion in the intensive care unit and a lower risk of some of the serious problems of prematurity.

For term babies the concern is iron deficiency anemia which isn't common but can happen in more than 5% of term newborns. Iron deficiency and anemia in young babies may also be associated with some developmental and cognitive problems later. It's important to know that the vast majority of babies with early cord clamping did not get anemic but there was slightly less of chance of anemia in babies with later cord clamping.

Many babies in the U.S. get vitamins and minerals, but this certainly isn't true of all babies in the U.S. and definitely isn't true for babies around the world. So, in January of 2017, the American College of Obstetrics and Gynecology along with the American Academy of Pediatrics and the American College of Nurse Midwives put out a practice bulletin that recommends waiting 30 seconds to a minute before clamping the cord after the birth of the baby. Incidentally the British Royal College of OB/GYN recommends at least two minutes and the American College of Nurse Midwives recommends two to five.

Originally it will thought that the baby had to held below the mom's abdomen to let the blood rundown to the baby, but a study -- all that science -- comparing having the baby held below the uterus made no difference compared to a baby place on mom's tummy or chest to be dried and warm. In healthy babies, the extra couple of minutes don't make a difference one way or the other, but OB's are often delivering babies in trouble. Very premature babies or babies with low heart rates or distress, for those babies no more than 30 seconds, which can feel like an eternity for an OB delivering a baby in trouble, would be advised. And in some cases is very important to hand the baby off to a pediatrician for immediate care.

Some conditions affecting the mom would be if the mom has hemorrhaging and the placenta needs to be removed immediately or if the placenta has prematurely separated during delivery. Sometimes the cord is wrapped very tightly around the baby's neck and needs to be cut to allow the baby to be delivered. These are not so common in general, it's a reasonable thing the wait a little bit if the baby and the mom are not in danger.

Another reason to consider immediate cord clamping is the case where the parents have planned umbilical cord banking either for this child or to help another child. Delayed cord clamping means more blood goes to the newborn and less is available for collecting for the cord blood bank. If the cord blood banking is a critical issue for this baby or another child, then the cord might best be clamped immediately.

Now in the case of adolescents, I don't know when the time is right to cut the cord. But I think we now have some really good evidence and guidance for delaying cord clamping newborns. And this is what we have been doing at the University Hospital for some time now. Good luck with your newborn and with your adolescents and thank you for joining us on The Scope.

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Dr. Gellner: It's a disturbing trend, teens cutting themselves. Why? And how can you help your child, if they are a cutter. I'm Dr. Cindy Gellner and we'll discuss this on today's Scope.

Announcer: Keep your kids healthy and happy. You are now entering The Healthy Kid Zone, with Dr. Cindy Gellner, on The Scope.

Dr. Gellner: Cutting isn't new. But, this form of self injury has been more openly discussed lately. If you haven't heard about cutting, chances are pretty good, that your teen has and might even know someone who does it. It can be hard to understand why a teen would deliberately cut themselves. But parents who are aware of this problem, can really help. That's why we're talking about it today.

Many parents don't really understand what cutting is. It's when a person uses a sharp object to make marks, cuts, or scratches on their body, on purpose. Teens usually cut themselves on their forearms, thighs, or belly. Somewhere they can hide with clothing. They might use a razor blade, knife, scissors, a metal tab from a soda can, the end of a paperclip, anything that can injure the skin. And there is a sense of shame and secrecy that often goes along with cutting. So most teens make up excuses on how they were hurt if someone sees the marks.

Most people who cut are girls. But guys do it too. And it usually starts during the teen years. The bottom line is that cutting is a sign of a deeper, emotional issue. And if you want to help your teen, you'll need to figure out, what those issues are. The cutting often begins as an impulse. "So and so mentioned it feels good, so maybe I should try it." A teen might give in to peer pressure to try cutting as a way to seem cool, popular, or avoid being bullied by other teens.

Regardless of the reasons, cutting isn't a healthy way to deal with the extreme emotions, or pressures, that come with the teenage years. For some, cutting helps them deal with feelings that seem too intense to endure. From the normal teenage heartbreaks, to rejections from friends, dramatic situations, or even the pressure to be perfect. Deep grief can be overwhelming for some.

Cutting can be a way of testing whether they can still feel physical pain. Others describe cutting, as a way of waking up from emotional numbness. Many teens discover that once they start, they can't stop. There is a sense of control and relief to see and know where this specific pain is coming from. And a sense of soothing when it stops. It seems to give them a sort of stress relief, from deep painful emotions, or even a high. Endorphins are feel good hormones released during intense physical exertion. But, they can be released during an injury.

Unfortunately, cutting is a behavior that tends to reinforce itself. Many teens say they feel addicted to the behavior. Whenever tension builds, the brain craves relief and drives the self injuring teen to seek relief by cutting again. Some would like to stop but don't know how, or feel they can't. Other teens don't want to stop the cutting, it just feels that good.

Cutting is often linked to other mental health conditions. Like obsessive compulsive disorder, depression, or bipolar. Other teens struggle with personality traits that attract them to dangerous excitement of risky behavior, or self destructive acts. Some are prone to dramatic ways of getting reassurance that they are loved and cared about. Many teens cut for a long time before anyone else knows. It can take courage and trust, to reach out.

If confronted by the cutting, teens can respond in different ways depending partly on the teen, and partly how they are approached by it. Some might deny the cutting, while others might admit to it. But say it's not really a problem. Some might get angry and reject any help. But many teens are relieved that someone knows, cares, and wants to help.

Like quitting any habit, cutting can be difficult to stop. And a teen might not succeed at first. It takes determination, courage, strength, as well as support from others, who understand and care, to break this powerful desire to harm themselves. If you find that your child is cutting, please talk to your pediatrician or other mental health provider. Getting to the bottom of the cause of the cutting may take some time. But your child is worth it.

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Interviewer: Common ways that people cut themselves that lands them in the ER. That's next on The Scope.

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Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health Care. What are some of the ways that you see that people come into the ER that they've cut themselves that lands them in the ER? The whole point of this is to maybe make us all a little bit aware.

Dr. Madsen: Sure.

Interviewer: When we're doing one of these things that, you know, this is a common way that somebody could cut themselves.

Dr. Madsen: Yeah, it is, and we do see lots of lacerations. Probably when you think of the ER, you think of going there because you were cut at some point and maybe had to have stitches. One of the common ways I often see people cutting themselves is cooking. This is something where I oftentimes see people who work in restaurants, who cook on a regular basis and are slicing and cutting things up and they'll catch a finger.

That's the most common site. They'll sometimes cut off the end of the finger, just the tip of it, not through the bone but slice off a piece there or cut down through the fingernail and then it seems to stop once it hits the bone. That's not an uncommon thing I see just from rapid cutting and just getting their finger in the wrong spot and getting that knife right through it.

Interviewer: Yeah, restaurant workers. What about just regular people? Not quite as much?

Dr. Madsen: Oh, sure. We see it with regular people, too.

Interviewer: Yeah, sure.

Dr. Madsen: But I guess for me it's always a surprise when you see the restaurant worker where they're doing this all the time and then they cut themselves and they always say they feel stupid, but it happens quite often.

Interviewer: Okay, so kitchen accidents. Watch those kitchen knives.

Dr. Madsen: For sure.

Interviewer: Be careful.

Dr. Madsen: Watch the kitchen knives and watch your fingers when they're near the kitchen knives.

Interviewer: Because that's the common kitchen cut, is a bit of finger.

Dr. Madsen: Exactly.

Interviewer: More so than a [makes cutting noise].

Dr. Madsen: Oh, yeah, for sure. I usually don't see someone who sliced down through their hand. It's almost always on the finger.

Interviewer: Okay. All right, what's the second kind of most common cut that you might see?

Dr. Madsen: The next common cut I see is someone who falls. They either land on their elbow and that will split the elbow open causing a laceration there, or they hit their knee and slice their knee open, or sometimes they'll fall and hit their head.

These head injuries, when it hits the scalp, that's where you really see a lot of bleeding. A lot of times they'll just come in with all sorts of bandages or holding towels on their head and just saying, "I must have a huge laceration on my scalp because it's bleeding like crazy." We'll pull these towels off and it's maybe only an inch long.

Interviewer: Oh, no.

Dr. Madsen: But scalp lacerations bleed like crazy. That's the bottom line. That is probably the next most common thing I see.

Interviewer: So they look much worse than they really are?

Dr. Madsen: They really do.

Interviewer: Generally?

Dr. Madsen: I think they really scare people and it's something you've got to go to the ER for typically, or maybe an urgent care because you do have to have it repaired, but a lot of times it looks much worse than it actually is.

Interviewer: All right. So I guess I didn't even consider a cut caused by blunt trauma.

Dr. Madsen: Sure.

Interviewer: That's interesting.

Dr. Madsen: Not an uncommon thing.

Interviewer: What are some other common ways that you see people with cuts?

Dr. Madsen: So another common thing we see is power tools. I've got to throw this one in here because probably the biggest surprise for me when I started working in the ER was all of the table saw injuries I saw. It's funny because at the time I had this old table saw in my garage. I'm not an experienced woodworker, but I thought I'm going to pull that saw to make some stuff with it.

Within the first month I probably saw four people who came in who had had their fingers amputated, cut off, from table saws. So I immediately got rid of the table saw. These were experienced carpenters and woodworkers that just said, "You know, it just happened." As they were pushing the wood through this table saw it just jumped or whatever, it hit a knot and their finger jumped forward, just cut right through the finger. So household equipment, power tools, table saw injuries, we do see a lot of those.

Interviewer: Watch those sorts of things. You've got experienced people that are cutting their fingers. Is there anything you can do to avoid that?

Dr. Madsen: Well, there are certain techniques you can use. I know there actually are some power tools and table saws that, I don't know how they're designed to do it, but somehow it's able to sense if that saw hits flesh. I don't know how it knows this. It's pretty remarkable.

Interviewer: I know, I took a woodworking class and the guy said you could take a hot dog and go to run it through this blade and it would stop it without cutting that hot dog.

Dr. Madsen: Yeah, it's amazing, but apparently you don't want to try the hot dog because if you do that, the way the mechanism works it just throws some steel right up into the blade and pretty much destroys the tool. Apparently, that's an option. I think there are other techniques where you're just not getting your hand close to . . . like, using a piece of wood or something to push that wood through rather than getting your hands right in there.

Interviewer: So three ways that people tend to cut themselves. Is there kind of a fourth category that you could lump in, two or three of the more minor ways?

Dr. Madsen: Yeah there are always knives. People who have pocket knives or maybe something where they're using their knife or some kind of tool to try and use it in a way maybe it shouldn't be used. Something slips or . . . you know I've got to tell you a personal story. I once made the mistake of trying to separate several frozen hamburgers using a butter knife. The butter knife slipped and went right into my hand.

Interviewer: A butter knife?

Dr. Madsen: Yeah, a butter knife. It was not good. I threw a little suture in that and tried to sew it up myself. It actually worked okay, but that's the kind of stuff we see, too. People with different household items, maybe screwdrivers, things like that, trying to use them in certain ways and something slips and cuts themselves.

Interviewer: Using them in a way that they weren't intended.

Dr. Madsen: Exactly.

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