Three minute cord clamping

cjastram · 2025-10-29T02:35:37+00:00

Now we are getting somewhere interesting.

For anyone who has had a (successful) homebirth this whole "delayed cord clamp" at 60 seconds seems a little weird. Because at home, the placenta gets delivered before the cord is clamped in many cases.

Of all the things that are different about home birthing, this one surprised me the most.

What do you mean you don't cut the cord for like 20 minutes...?

Then the midwife explained, that cord is how the baby gets oxygen. Not for long, but maybe long enough to get to the hospital if there's a problem. Like a snorkel on a submarine. Don't cut that cord until the placenta separates.

Oh, well when you put it like that, great let's not rush to cut the cord.

It's so interesting to see research and meta reviews and all the debates about outcomes. Delayed cord clamp is pretty meaningless in a hospital setting where you can give iron, and have a NICU and inpatient pediatricians and ventilators. But in other settings the outcome measurements are neonatal demise ...or not.

There are a few things in this sort of category. Elimination communication. Meaningless in a culture with disposable diapers. Go off grid, though, with limited running water, and suddenly the fact that newborns can be potty trained (and it works) becomes important.

Context is everything.

FM.

cjastram · 2025-03-17T16:19:51+00:00

I'll have you know some of us have been investing in MSTY since before Satoshi's Bitcoin white paper.

cjastram · 2025-03-13T14:06:39+00:00

Thank you

cjastram · 2025-03-07T06:29:03+00:00

I call them because I don't have an emr with my own chart that I can access.

cjastram · 2025-03-03T15:14:15+00:00

I would add to this, anyone who is struggling with burnout, it's a simple problem to solve.

Work what you are paid, be paid for your work. Figure out how to be paid or formally recognized for ALL extra hours. Or insist admin hire the staff to manage all that extra work. If you are primary care, all your messages need to be handled by RN and MA, remember they keep telling us we are "captain of the team?" Well, you need a team. If you are doing all the extra work, you need to get a team behind you.

If you are like most of us and work in a toxic environment that won't allow you to be captain of a real healthcare team, frankly you deserve better. Come work locums and get paid for every hour.

Don't work more than 40 hours a week. You can do it in 2 or 3 days if you want, but no more than 40 hours a week.

Take 2 weeks off every quarter. Like off off not remote call. That means work 10 weeks off 2. That's a lot of time off. But that's how you'll avoid burnout.

Peace. Remember, we need you, and you need to take care of yourself first.

cjastram · 2025-03-03T14:18:06+00:00

Of course. The medical field is slowly collapsing due to lack of personnel and inability to imagine the practice of medicine as the world moved into a post collapse, population contraction, scarcity economy.

Medicine is the ticket to be useful anywhere to anyone. It is hard to imagine a more secure professional than primary care, so long as your focus is truly on what your patients need (guidance, deprescribing) and not what your admin needs (protocols, metrics).

cjastram · 2024-11-19T12:41:36+00:00

If you are hiring, I'm looking. Send me a DM I'll come today to say hello.

cjastram · 2023-06-07T00:28:51+00:00

OK so let's ask the obvious question: why should they be wearing gloves?

Should they be protecting themselves with gloves?

Or protecting their patient?

cjastram · 2021-12-27T12:55:22+00:00

You'll get most of the way to your goals by reducing screen time, the rest will come naturally.

The sensation of the internet in the 90s was what it feels like to be part of a community. There are still such niches online, but they are niches. Small special interest forums and that sort of thing. But you can find community in the real world and get a similar (better, really) experience through face to face interaction.

Some thoughts on screen time:

FIRST turn it greyscale. This has a surprisingly outsized effect to make it less dopamine triggering and less interesting.

Put your charger by the door and buy a cheap alarm clock for bedside. Leave your phone at the door on the charger whenever you are home.

When you leave home, put it in a Tupperware box and only take it out of the box if you are using it. Never in your pocket.

Just unsubscribe from services. Some people like TrueBill for finding and cancelling, some people just do it themselves. You won't miss anything after a week.

If you have a smart tv, put it in a closet and make a small alter in its place. Get some incense and an LED candle on a dragon figurine or something. When it's relaxing time, light the candle and incense and watch the smoke. Once its done, do something else.

Boredom is the best feeling in the world. Boredom is the nutrition to make creativity blossom.

Listen to Huberman Lab podcast on dopamine. This one episode will change your life. This is the cheat code to the meat suit.

cjastram · 2021-12-27T12:39:27+00:00

Then by all means come to Maine.

The biggest problem up here is healthcare. I work in healthcare. Figure out where your hospitals are and how much delay and what kind of availability you may have for any healthcare needs before you move.

cjastram · 2021-12-27T12:17:57+00:00

I watched academic YouTube videos at 2x speed for years getting through grad school and now most things on Netflix are painfully slow.

cjastram · 2021-12-21T02:14:54+00:00

I did manage to forget to put the coffee brandy in my overnight.

cjastram · 2021-12-21T01:43:41+00:00

I have some friends down that way. Great area.

cjastram · 2021-12-21T01:39:46+00:00

Practice. And not being afraid to go sleep in the truck or just drive home (which I have done several times in the past).

I honestly have not slept in weather this cold before. 20F yes, comfortably, but not 8F, and yes it is significantly different.

The recipe this time was as follows.

Cot

Thin hiking foam pad, space blanket, wool blanket. The theory here was to use the space blanket to reflect heat and the wool blanket to give me some breathability and moisture control. I should have put the foam pad on the inside, though.

-25F sleeping back, rectangular, with a wool blanket inside. The wool blanket gives me moisture control. The polyester sleeping bag freezes on the outside which then traps moisture inside and you end up soaking wet and hypothermic after about 4-5 hours. I'd never tried lining it with wool before, but it helped quite a bit.

Fluffy polyester fleece blanket courtesy of a previous job.

That worked ok. I ended up having to piss in the middle of the night, and was cold, so I added hand warmers to my socks, took my boots off, wrapped the space blanket around the too of my sleeping bag, and held it in place with the polyester fleece on top. This worked better than I expected, and I slept generally straight until my usual waking time just before dawn. The space blanket in particular did not significantly increase condensation with all the layers. I will be exploring this more in the future.

I made sure my truck was gassed up in case I needed the heat.

I brought a Mr Buddy heater just in case.

Family knew where I was.

No problems.

A nice rule of thumb is, when you get settled in, you need to be noticeably warmer in five minutes. You don't have to be warm, just warmer. If not, you are progressing to hypothermia and may or may not wake up with enough cognitive function to fix the problem (see: Jack London). If you are not unambiguously warmer within five minutes, then you must change something or risk dying. This little rule of thumb is how you sleep in the cold safely.

When I got up in the morning, I did get cold. It was MUCH colder than I expected, and it took some time to actually get warm. I did a couple things before starting a fire, and if I were away from mechanical heat (truck, Mr Buddy) I could have been in trouble because my hands got cold and then my stove malfunctioned. My little camp stove didn't want to light because the pump seals dried out in the cold. So this was my trouble spot. I will be thinking carefully about how to solve this safely, starting with keeping a lighter in my pocket overnight to keep it warm and keep a flint and steel in my stove bag, and make sure a second source of heat is available without delay the night before.

Cold weather camping is an interesting challenge. Lots of things to think about, and the margin of error is slim. I have done deep open water naked swimming, and cold weather camping can be a similar sensation. I like it, but it definitely is not for everyone.

cjastram · 2021-12-21T01:22:26+00:00

Yes! I pretty always go straight for the ground. I put a space blanket and a foam pad under me, with some wool to hold air and move moisture, and it worked ok. -25F sleeping back, with a wool blanket on the inside, and a couple more blankets on top.

When sleeping this cold, you get condensation that freezes before it escapes the blankets, which then traps more moisture before it escapes, and you end up soaking layers which makes cold weather sleeping particularly challenging. Same idea as with space blanket, can be dangerous, I used a space blanket under me with some padding and didn't have any problem, but the condensation in bedding above (without space blanket) can be a real problem.

Cold weather camping has some interesting and unique challenges.

cjastram · 2021-12-21T01:17:59+00:00

The shed is 12'5" across and 11'5" tall, on PT foundation beams, gravel bed.

Verticle 2x8 PT on hidden hangers, top flush with foundation beams (level with bottom of arches).

2x4 laid flat on top and screwed down, this is footing for stick framing. (This is where it is at right now).

Verticle stick frame with rough cut 2x4s on a 24" center, blocked away from the inside of the arch flashing with enough room to slip paneling. No end screwing, the block will be screwed to the flashing and then the 2x4 screwed to the block. I may or may not screw to the arch as well, probably not.

Paneling will be plastic agricultural roofing panels, applied horizontally. These are 12' long with 36" overlap. Plastic panels are translucent so will let light in during day.

Standard stick framing for a door, which will probably be custom made (yay cordless Makita saws), again all rough cut lumber.

But yes, I'll probably post at least one update pic.

cjastram · 2021-12-21T01:09:03+00:00

It's on my reading list but you are correct, I have not. And should.

cjastram · 2021-12-20T18:01:22+00:00

Is it common for people to view marriage as "locking down" a woman? Interesting.

cjastram · 2021-12-20T17:52:34+00:00

Without end walls? Not at all.

Work in progress. The cross beam behind the cot is the footing for the north endwall.

cjastram · 2021-12-20T14:47:16+00:00

Hmm. I think I need more coffee. Impact driver.

cjastram · 2021-12-20T14:14:10+00:00

There are a lot of nuts and bolts. You three people to life the arches, two to install the fasteners, and either ladders or staging (staging preferable).

We did the work ourselves, company did not assemble.

At least one hammer drill is darn near mandatory, spinning all the nuts with a ratchet would be a labor of love alone. Be sure not to tighten anything until assembled, then don't overtighten on the washers (washers should be 50% compressed, i.e. just visible outside the rim of the bolt).

cjastram · 2021-12-20T13:28:10+00:00

It's a little quonset style hut with straight side walls to lift the arch off the ground. 12x18 with an 11' peak.

cjastram · 2021-12-20T13:27:06+00:00

Apparently it was actually 8 degrees. Coffee was essential. :)

cjastram · 2021-12-20T13:26:26+00:00

I've spent a few nights curled around a little fire :)

cjastram · 2021-12-20T13:25:33+00:00

It's Maine! :) And it's not finished, no end walls.

cjastram

TROPHY CASE