There have been a lot of articles out there recently
discussing the benefits of delayed cord clamping versus early cord clamping.
What exactly is the difference? In most
research papers, early cord clamping is the clamping and cutting of the
umbilical cord within 60 seconds of birth. While delayed clamping, involves
waiting at least 60 seconds or until pulsation ceases before clamping the cord.
After birth, the placenta continues to function,
providing oxygen to baby and filtering off waste until the baby has
transitioned to extrauterine life. As this transition occurs, the cord ceases
to pulsate. Eventually, the hormones of the mother’s body kick in again, and the
placenta detaches from the uterine wall and comes out the vagina. This natural
process ensures the baby is assisted as much a possible into their transition
into extrauterine life. It also ensures that baby received their entire required
blood volume, and thus their iron stores. This also means that the placenta is
less bulky so therefore easier for the uterus to contract and expel.
The intervention of clamping and cutting the cord
before these processes happen has become mainstream (particularly in the
Western World). It is part of most hospital policies for ‘active management of
the third stage’ and ‘getting accurate cord blood gasses’ is not a good enough
reason in my mind. In my experience, it is done with more haste and urgency
when a baby has been compromised during the birthing process (for example the
use of forceps or a non-reassuring foetal heart rate). To me, this is completely
illogical. In these cases, it seems even more urgent to leave the cord intact
so the mother’s body can assist in restoring acid-base balance and ease the
transition into extrauterine life. Most resuscitation measures can be performed
on the mothers abdomen (or at the very least in-between her legs at the foot of
a bed) and it seems logical for health care professionals to work with the life
support system nature made rather than against it.
There are stories of midwives in isolated areas
leaving pulsating cords of very premature babies intact until help arrives some
hours later. There are also stories of Doctors hanging the connected placenta
above babies like an IV bag following a haemorrhage. So the physiology
obviously makes sense to some.
The research tells us that babies who have ‘delayed
cord clamping’ have higher haemoglobin levels between
one and two days after birth and were less likely to be iron-deficient three to
six months after birth. There is a
slight increase in hyperbilirubinemia (also known as jaundice) however some
studies show this increase is not associated with an increase in treatment,
while others show a slight increase. These babies also had a statically higher
birth weight. These babies’ mothers did not show any difference in postpartum
blood loss or haemoglobin levels.
So, the research backs up what nature and physiology
have been telling us – not intervening and leaving the cord to cease pulsating
naturally gives the best possible outcomes for babies.
If you are choosing to have active management of
your third stage of labour, you are completely able to decline early cord
clamping and cutting in favour of evidence-based delayed cord clamping. You are
of course able to decline cord blood gasses also.
It’s your baby, your body and your birth.
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| Shows how much blood transfers to baby over time if the cord is left intact. This took about 15 minutes! Thanks to Birth Dance for the image. |
~Bec
The most recent study (2013) has been published by
the Cochrane Collaboration.
McDonald SJ, Middleton
P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term
infants on maternal and neonatal outcomes. Cochrane Database of Systematic
Reviews 2013, Issue 7. Art. No.: CD004074. DOI: 10.1002/14651858.CD004074.pub3.
