A recent scientific article has brought to our attention what most women innately knew was true - that is that delaying cord clamping can be good for the baby.
So lets go over some simple anatomy to remind ourselves of the 'mother- baby system'. The umbilical cord connects the baby to the placenta and transfers nutrients, oxygen, and other molecules that are not filtered out, between the two. The placenta is an organ that develops during pregnancy. It forms and attaches to the wall of the uterus and it is from here that the oxygen and nutrients is transferred to the baby through the umbilical cord. The placenta also removes waste from the baby's blood.
What is delayed cord clamping?
Cord clamping occurs when the blood flow between the placenta and baby is manually stopped with a clamp across the umbilical cord. Most of us are familiar with this concept, and once clamped, cutting of the cord soon follows.
In the context of the whole period of human existence, cord clamping is very new. It emerged as a part of modern society over the past century. In conjunction with the development of modern medicine, birth has been fashioned into being more efficient and expedient, so that it can fit neatly within our hospital systems and the demands on them, as a result the best practices do not always prevail. Cord clamping speeds up the process post birth and therefore was embraced, without much evidence for its positive effect on the baby's health.
What are the current practices for cord clamping?
The Royal Australian and NZ College of Obstetrics and Gynaecology states that 'there is no clear evidence to guide practitioners regarding delayed cord clamping in term infants' (link provided below).
The common practices in a hospital setting are usually as follows, but would vary between hospitals and individual practitioners -
In the case of a vaginal birth where the baby if vigorous, the cord is usually clamped in around 30 - 60 seconds.
In neonates needing resuscitation, the cord is clamped as soon as possible and usually transported to the warmer for resuscitation.
In the case of cesarean deliveries the cord is clamped as soon as possible.
So what is the most recent research showing?
A research paper published in the Journal of Clinics of Perinatology, by Anderson and Mercer (link below), demystifies many of the questions that had surrounded delayed cord clamping. They found that (in line with the innate knowledge and wisdom of many midwives) that:
"Keeping the umbilical cord intact by delaying cord clamping for at least 3 minutes improves iron stores during infancy and supports health and development for the growing child. In preterm infants, delayed cord clamping reduces mortality by approximately 30%...To warn for risk of jaundice and need for phototherapy after delayed cord clamping is not evidence based "
You can see in this diagram below the major benefits of delayed cord clamping. With delayed clamping you have the increased blood volume. Although the increased heamoglobin/haematocrit decreases after 2 days to 3 months, there is a higher level of iron stores for up to 8 months. This helps protect against anaeima later in infancy. Iron is vital for optimal neurodevelopment. There is rapid development of the baby's brain in the early years. We can clearly see from this flow chart the importance of ensuring that the baby receives their optimal blood volume from the placenta by delaying cord clamping for at least 3 minutes.
What can you do to ensure delayed cord clamping for your baby?
Communication with your healthcare provider is vital. You should check with your obstetrician or midwife about the cord clamping policy at the hospital you plan to birth in. In the case of a planned homebirth, you can discuss this with your midwife.In some circumstances where there is an emergency situation, delayed cord clamping may not be appropriate although intact cord resuscitation - the case where the baby is resuscitated with the cord intact - can be performed in some instances.
Placental transfusion is an essential part of the birth. When possible, keeping the umbilical cord intact for at least 3 minutes or until the cord is flat and white allows for the transfer of the infants blood volume from the placenta to the baby - nourishing the organs and improving long term outcomes.
References:
Ola Andersson, Judith S. Mercer, Cord Management of the Term Newborn, Clinics in Perinatology, Volume 48, Issue 3, 2021, Pages 447-470
Link to article:
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