Being Pregnant
World Health Org Supports Delayed Cord Clamping
photo : flickr.com/nagobe
The term “delayed cord clamping” is probably something most readers here have never heard of, but as someone deeply involved with the childbirth community, it is something I have been hearing for years.
The basic explanation of delayed cord clamping includes leaving the umbilical cord intact until it stops pulsating, or passing blood from the placenta to the newborn baby. Pregnancy.about.com explains the process as:
“Definition: The severance of the umbilical cord from the placenta after a period of time. While there is no standard definition of time, some suggest that as little as 30-94 seconds could be beneficial, while other practitioners have personal definitions, including waiting until the cord has stopped pulsing.
The benefit is that anemia in the baby could potentially be eliminated or reduced by allowing the baby to receive more cord blood. It also increases the risk of jaundice which may require phototherapy in full term infants.”
In fact, back in March, I sat down with OB/GYN Nicholas Fogelson MD, also known as The Academic OB/GYN from his online blog, and spoke about delayed cord clamping for nearly an hour on my internet radio show. I thought I knew a little about it when we started, but I almost felt like an expert by the time the show ended. He is an outspoken advocate in the obstetric community for delayed cord clamping and believes it should be a common practice by obstetricians and birth professionals — as do I after learning more about it. The benefits clearly outweigh the convenience factor which drives immediate clamping and cutting.
Some of the benefits of delayed cord clamping include:
- Increases the level of iron in your infant
- Decreases the instance of intraventricular hemorrhage
- Less need for blood transfusions
While most studies show that delayed cord clamping benefits babies across the board, studies of preemies and infants with low birth weight have shown a greater benefit following delayed cord clamping. The same studies concluded delaying cord clamping for at least two minutes should be the standard practice across the board, of course excluding emergency situations.
The World Health Organization (WHO) has had the same policy in place that really hasn’t come into light until recently with all the debate over the practice. The International Federation of Gynecology and Obstetrics, a section of WHO, has advised against early umbilical cord clamping. Dr. Mercola posted a great quote from The British Medical Journal yesterday I really enjoyed:
Dr. David Hutchon argues:
“Clamping the functioning umbilical cord at birth is an unproved intervention. Lack of awareness of current evidence, pragmatism, and conflicting guidelines are all preventing change. To prevent further injury to babies we would be better to rush to change.”
I know for my upcoming birth, I am going to discuss with the providers who will be in the operating room about delaying clamping, and cutting the cord. C-sections are rough enough on newborns, and I don’t want it to be any rougher than it needs to be.
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0 Comments
laura commented on Dec 03 10 at 12:23 pmI’m confused at the top it said that: “It also increases the risk of jaundice which may require phototherapy in full term infants.”
but in the middle it says: “Some of the benefits of delayed cord clamping include :
•Lower risk of anemia and jaundice”
Was one of these a typo? Does it increase or decrease the risk of jaundice? As a non-medical professional, I’d imagine that more blood means more bilirubin (broken down blood cells) and thus more jaundice. not less.
David Hutchon commented on Dec 03 10 at 2:47 pmYou are quite right and I expect the “Lower risk of anaemia and jaundice” is a typo. There are two major metanalysis, one by Hutton and Hasson, and the other by Cochrane. They both included the same trials but with one additional trial in the Cochrane review. There was no increase in clinical jaundice in the Hutton and Hasson review but there was in the Cochrane review so it is expected this difference must have come largely from the additional trial which was by one of the Cochrane authors Susan Mcdonald. Although this trial is included in the review it has never been published so checking the data is not easy. However we do know that the physicians making the decision regarding phototherapy for the jaundice knew whether or not the babies had had early or delayed cord clamping. We do not know if they were influenced by this knowledge or not. However the increase wes very slight (1% to 2%) so this needs to be balanced against the aneamia risk.
However none of these studies could have shown the real danger of early cord clamping. A recent study from Bradford in England showed that, by weighing the babies on computerised scales (to get rid of the effect of movements) babies gained up to 165mls of blood. Two out of the 26 babies gained over 160mls of blood so if this is typical then it is about 8% of all babies will get this much blood if you wait 5 minutes. If you do not wait 5 minutes then it will be less and if you clamp the cord within seconds of birth the baby will have 165mls less blood than it “should” have. You can check yourselves what proportion 165mls is of the normal blood volume but even in a big baby I think it is 25%. Would you be happy to donate 25% of your blood volume over a few minutes and then go out and do a days work? If you were also a bit short of oxygen, exhausted (fetal distress) and you were an average sized baby that just failed to get the 165mls of blood you needed you may not be able to cope with everything. Remember you have to change over to lung breathing, keep your diaphragm muscles moving etc etc. If you cannot keep a good enough blood circulating to your brain, and hypovolaemia will eventually have this effect, your brain will become damaged.
So it seems quite logical and possible that some babies who die soon after birth do so as a result of severe hypovolaemia. It is virtually impossible to determine what is the blood volume of a baby at birth and it is certainly not something which can be measured at PM. So it is just missed. You may question the doctor if immdeiate cord clamping, to get the baby over to the resucitaire, could have made the baby hypovolaemic and he/she will tell you no. After all they say I did this to 24 babies in the last month and they were all fine. So maybe this baby was one of the two that would make up the 2 out of 26 losing 165 mls of blood?
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