Delayed Umbilical Cord Clamping

After seeing that gorgeous, pink slippery baby being placed on your chest, the last thing on your mind is what’s going on with the cord and placenta. But there are some really big, evidence-based reasons why you need to be clear about what happens to your baby’s cord and placenta. Delayed cord clamping (which really should be normal cord clamping, since immediate cutting is a premature act) offers some massive health benefits to your baby, but many doctors and hospitals are yet to implement delayed cord clamping as standard practice as they just don’t want to wait. Here’s why you should insist that your caregiver should wait before cutting your baby’s cord. Reason NOT To Cut The Cord #1: Your Baby Will Have Significantly More Blood Volume Thats right, around a third of a baby’s volume of blood will be where it belongs – in your baby and not discarded.
Many maternity care providers continue to clamp the umbilical cord immediately after an uncomplicated vaginal birth, even though the significant neonatal benefits of delayed cord clamping (usually defined as 2 to 3 minutes after birth) are now well known.
In some cases this continued practice is due to a misunderstanding of placental physiology in the first few minutes after birth.
Delayed Cord Clamping Umbilical cord blood is a baby’s life blood until birth. It contains many wonderfully precious cells, like stem cells, red blood cells and white blood cells (including cancer-fighting T-cells) to help fight disease and infection. It makes sense that delayed cord clamping is a great option for newly born babies.
Businesses have been set up to store this precious cord blood for you in case of future diseases. This all sounds great in theory, but why deprive a baby of those super cells at birth and then give them back on the very small chance that a problem will appear later in life? Could there be a link to not having those super cells at birth and those illnesses? Storing cord blood is not only extremely expensive, but it is also worth finding out exactly what cord blood has been successful in helping, and how common those conditions really are. How Likely Is It That My Baby Will Need Stored Stem Cells?
Image result for cutting the umbilical cord delayed
According to Dr Sarah Buckley, in her well researched book Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices by Dr. Sarah Buckley: The likelihood of low-risk children needing their own stored cells has been estimated at 1 in 20,000 Cord blood donations are likely to be ineffective for the treatment of adults, because the number of stem cells is too small Cord blood may contain pre-leukaemic changes and may increase the risk of relapse Autologous cord blood is only suitable for children who develop solid tumours, lymphomas or auto-immune disorders All other uses are speculative.
In a presentation to fellow medical professionals, delayed cord clamping advocate, Doctor Nicholas Fogelson says, “Delayed cord clamping clearly increases fetal haemoglobin, blood volume and iron stores. The evidence supports a clinical benefit of delayed clamping. There’s really no strong evidence against delaying the cord clamping. When we talk about interventions in medicine, really, the burden of evidence is on the intervention. People say, “Delayed cord clamping, you can’t prove that that’s an intervention that helps.” I’m like, “Oh, no, no, no, no! Delayed cord clamping is what we evolved to do. We evolved to get the blood that’s in the placenta. I don’t have to prove that that’s right. You need to prove to me that phlebotomizing the baby of forty percent of its blood volume is right.
Here’s two reasons in one to not cut the cord early! Intraventricular haemorrhage is bleeding into the fluid-filled areas of the brain (the ventricles), and is more common in premature babies. Late-onset sepsis usually develops at around 3-7 days post birth and is bacterial infection in the baby’s blood.
significant differences were found between the ICC [immediate cord clamping] and DCC [delayed cord clamping] groups in the rates of IVH [Intraventricular Hemorrhage] and LOS [Late-Onset Sepsis].While the umbilical cord is attached to the baby, he or she still receives oxygen, which helps to explain how water-birthed babies can breathe while under water. Its not until they hit the air that the breathing reflex is stimulated. Having a valuable source of oxygen is so important, especially for babies who need help breathing. It would be fabulous for someone to design resuscitation equipment for hospitals which allow for the baby to have the cord in tact and close to his mother, both of which can be extremely beneficial for babies with difficulties.There is no reason to separate the mother and her baby and there is no reason to cut that cord. The mother and baby should be enjoying beautiful skin to skin contact without any interference. Leave the cord alone and let mother and baby be, unless there is a medical emergency.So When Should The Cord Be Cut? Some of the studies quoted have based their findings on two minutes before clamping the cord, but most parents like to wait until the cord has stopped pulsating, meaning the placenta has done its job and is no longer sending blood to the baby. The very least amount of time you would want to wait is two minutes. A small percent of parents choose to have a lotus birth, where they leave the placenta attached and allow it to detach in its own time. They often make or purchase specialised placenta bags, sprinkling herbs and flowers (like lavender) on the placenta, so there is no smell.After baby is born we usually think of the umbilical cord as a relic – part a life support system that is no longer needed. But the reality is that the cord has one last job to do, and it’s a big one.You see, the cord and placenta are a sort of external circulation system: one vein carries oxygen and nutrient-rich blood from the placenta to the baby, and two arteries carry carbon dioxide rich blood and waste away from baby to the placenta for purification. When baby is born, about 1/3 of its blood is in the external part of the circulation system, but quickly makes it’s way to the baby via the umbilical cord. Unless of course, the cord is cut before the transfer is complete.There’s the perspective expressed by the International Childbirth Education Association, which is that “Delayed cord clamping (DCC) is a practice by which the umbilical cord is not clamped or cut until after it stops pulsating. It may also include not clamping or cutting the umbilical cord until after the placenta is delivered.”

“It’s incredible to see what a difference an extra three minutes and one-half cup of blood can have on the overall health of a child, especially four years later,” the lead author of this study, Dr. Ola Andersson, told CNN.

In the study, researchers found that “A couple of extra minutes attached to the umbilical cord at birth may translate into a small boost in neurodevelopment several years later . . . Children whose cords were cut more than three minutes after birth had slightly higher social skills and fine motor skills than those whose cords were cut within 10 seconds. The results showed no differences in IQ.”

There is one caveat to these findings: The benefits only applied to boys. “We don’t know exactly why, but speculate that girls receive extra protection through higher estrogen levels whilst being in the womb,” Dr. Heike Rabe, a neonatologist at Brighton & Sussex Medical School in the in the United Kingdom, told NPR.

Decreased Risk Of Anemia

Breast milk is naturally low in iron, which has led some to suggest that breast fed children need to be supplemented with iron to prevent anemia. “At first glance, this seems like an error, given that all living things need iron,” writes Nina Planck in Real Food For Mother And Baby.

She add that “we must suspect a deliberate strategy on nature’s part. Sure enough, there is logic to the missing iron. E. coli, the most common source of infant diarrhea in all species, depends on iron, as do other pathogens.”

Now here’s where things get really interesting. Though excess iron in the digestive tract may not be a good thing, iron stored elsewhere in the body is critical for healthy brain development. (source) The natural transfusion of blood via delayed cord clamping delivers a substantial amount of iron – one study found that waiting two minutes increased iron stores by 27-47 mg! (source)

According to the American College of Obstetricians and Gynecologists, waiting three minutes may prevent iron deficiency during the first year of life:

“Physiologic studies in term infants have shown that a transfer from the placenta of approximately 80 mL of blood occurs by 1 minute after birth, reaching approximately 100 mL at 3 minutes after birth (16, 31, 32). This additional blood can supply extra iron, amounting to 40–50 mg/kg of body weight. This extra iron, combined with body iron (approximately 75 mg/kg of body weight) present at birth in a full-term newborn, may help prevent iron deficiency during the first year of life (33).” (source)

Can I just say that I am blown away by the intrinsic wisdom of our bodies? For the past few decades, we’ve assumed that nature made a mistake and therefore started children on iron fortified foods early. Meanwhile, we left polysaccharides out of infant formula because they’re indigestible to baby and therefore useless. Only it turns out they’re not, they feed the beneficial bacteria in our digestive tracts, while excess iron may feed unwanted E. coli. So interesting!

Increased Blood Volume / Smoother Cardiopulmonary Transition

According to Mark Sloan, M.D., whether a baby “is premature or full term, approximately one-third of its total blood volume resides in the placenta. This is equal to the volume of blood that will be needed to fully perfuse the fetal lungs, liver, and kidneys at birth.

In addition to the benefits that come with adequate iron stores . . . babies whose cords are clamped at 2 to 3 minutes—and thus, who have an increased total blood volume compared with their immediately-clamped peers—have a smoother cardiopulmonary transition at birth.” (source)

According to this article, “Another potential benefit of delayed cord clamping is to ensure that the baby can receive the complete retinue of clotting factors.” In other words, the increased volume of blood will naturally increase blood platelet levels, which are needed for normal blood clotting.

Increased Levels Of Stem Cells

Delayed clamping also results in an infusion of “stem cells, which play an essential role in the development of the immune, respiratory, cardiovascular, and central nervous systems, among many other functions. The concentration of stem cells in fetal blood is higher than at any other time of life. ICC [immediate cord clamping] leaves nearly one-third of these critical cells in the placenta.” (source)

Stem cells may also “help to repair any brain damage the baby might have suffered during a difficult birth,” Dr. Rabe said.

 Better Outcomes For Pre-Term Infants

“Preemies who have delayed cord clamping tend to have better blood pressure in the days immediately after birth, need fewer drugs to support blood pressure, need fewer blood transfusions, have less bleeding into the brain and have a lower risk of necrotizing enterocolitis, a life-threatening bowel injury,” continued Dr. Rabe. (source)

Is Delayed Cord Clamping Possible For Cesarean Births?

In some cases, yes. According to The American College of Nurse-Midwives,

“The usual practice at cesarean delivery is immediate cord clamping; however, infants born by cesarean can benefit from placental transfusion resulting from delayed cord clamping or umbilical cord milking. Researchers initially reported that placental transfusion did not occur at the time of cesarean delivery, but this was most likely associated with uterine atony and the use of general anesthesia. In a small observational study, Farrar and colleagues recently demonstrated that a full placental transfusion does occur at cesarean delivery, but the optimal timing of delayed cord clamping remains unclear. Ogata et al. reported that a 40-second delay in clamping provided the infant with a partial placental transfusion.23 Concerns were raised that blood would flow back to the placenta if the cord was clamped after 40 seconds, but this reverse flow has not been demonstrated.

Another approach at the time of cesarean delivery is to milk the umbilical cord. This approach is ideal for cesarean birth when time and speed are important factors. In a small, randomized controlled trial, Erickson-Owens et al. compared immediate cord clamping with umbilical cord milking. They found less placental residual blood volume and higher newborn hematocrit levels at 48 hours of age in infants who received umbilical cord milking.  Delayed cord clamping and umbilical cord milking are approaches the clinician may consider at the time of cesarean delivery to facilitate placental blood transfer to the newborn.”

What About Babies Who Need Intervention?

According to several sources, resuscitation is less likely to be needed if cords are left intact. Many practitioners, such as neonatologist Anup Katheria, are actively looking for ways to resuscitate when needed without prematurely cutting the cord in order to move the baby.

“The practice of helping babies breathe while waiting to clamp the umbilical cord has been around for a long time; it makes sense for the sickest infants,” she told CNN. “We’re focused on producing evidence that shows the benefits. We think this could become the foundation for practice changing resuscitation techniques, transforming outcomes for the most critical of newborns nationwide.

Regarding this trend toward keeping the cord intact when resuscitation is needed, Midwifery Today writes:

“The requirements of medicalized neonatal resuscitation are warmth, a firm surface, suction and access to the umbilicus. Other priorities include comfortable position for staff and the ability to draw umbilical blood for cord gas analysis. A warm firm surface can be the bed or surface where baby is born. In this author’s 2011 poll of 34 midwives from around the world, most reported that they perform resuscitation with the cord intact using the bed, side of a pool designed for waterbirth, part of an adult human body (mother or midwife) or a portable board with a warm pack.

Suction can be from a main hospital line, resuscitation machine or a portable unit such as those used at homebirths. The umbilicus is accessed to provide drugs and fluids. If the cord is left intact, then fluids are already being provided. Drugs are rarely required for resuscitation, and it’s likely they would be required far less often if cords were intact. Since extensive resuscitation is rarely required, can we not be uncomfortable once in a while, bending over the baby rather than performing resuscitation at our standing height? Even if one requires cord gases for medical reasons rather than protection from litigation, they can wait. Cord gas results don’t change significantly if taken immediately after birth or after two minutes of delayed clamping (De Paco et al. 2011; Asfour and Bewley 2011).”

Are there times when providers need to cut the cord to initiate lifesaving interventions? Yes, says one of the most respected researchers on delayed cord clamping.

However, some care providers believe that the cord and placenta have innate “resuscitation equipment” qualities worth considering as well. You can read about some of them here.

Are There Any Risks Of Delayed Cord Clamping?

One analysis found a very slight (2%) increase in jaundice among babies who received delayed cord clamping. However, according to the Thinking Midwife, “The only studies available involve the administration of an artificial oxytocic (syntocinon or syntometrine) in the ‘delayed clamping’ group. IV syntocinon is associated with jaundice. Therefore, it could be the oxytocic making a difference here – not the clamping.”

What About Cord Blood Banking?

“Delayed cord clamping is not often compatible with cord blood donation or storage. The reason being is that in order for them to collect the amount of blood they want to store, some collectors will say that they need the cord cut immediately, and some (as confirmed by one of the biggest Australian cord blood collection companies, as recently as September 2013) will only allow up to 60 seconds before they want the cord clamped. This is not long enough for most of the benefits to reach your baby. If you would like your baby to have it’s full supply of cord blood, you may need to reconsider you plans to donate or store cord blood.

From the above recent study (2010) the following comments were made on cord collection:

‘There remains no consensus among scientists and clinicians on cord clamping and proper cord blood collection,’ concluded co-author and obstetrician Dr. Stephen Klasko, senior vice president of USF Health and dean of the USF College of Medicine. “The most important thing is to avoid losing valuable stems cells during and just after delivery.” So prevention is clearly better than cure – your baby will be better off keeping what is rightfully theirs.”

Adding Delayed Cord Clamping To Your Birth Plan

As birth advocate Diana Korte once wrote, “If you don’t know your options, you don’t have any.”

Here is a birth plan template that you can customize to fit your desires. Because cord clamping is often done automatically, care providers sometimes forget and cut the cord as a reflex despite previous conversations. It’s often a good idea to have an advocate such as a spouse or doula present to keep an eye on the cord just after the baby is born and remind the doctor if necessary.