What's the rush? The real reasons why delayed cord clamping is so important!

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"When I am asked, "Why don't you cut the babies' umbilical cord?" I say, "Isn't the real question: Why do you cut?" It's interesting that those of us on the path of nonviolence are being asked to justify our peaceful non-interventions by the perpetrators of intemperate protocols." - Ibu Robin Lim, CPM

What is delayed cord clamping?

According to 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.” 

Most midwives have been practicing delayed cord clamping as routine practice for decades. Midwife Amanda Burleigh has spent the last decade campaigning for babies to have more time attached to umbilical cords before they are cut and clamped. Recently, most mainstream health organizations have revised their guidelines regarding the practice of immediately clamping the cord. 

Each health organization has its own opinions on the exact length of time that is beneficial. The ACOG states "Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30–60 seconds after birth." The World Health Organization recommends 1-3 minutes. Ultimately, everyone seems to be in agreement that the more time attached to the placenta, the better the outcome for the infant. 

What are the benefits?

"There is growing evidence from a number of studies that all infants, those born at term and those born early, benefit from receiving extra blood from the placenta at birth," said Dr. Heike Rabe, a neonatologist at Brighton & Sussex Medical School in the United Kingdom. Rabe's editorial accompanied the study published  in the journal JAMA Pediatrics.

Delaying the clamping of the cord has allows more blood to transfer from placenta to the infant. Studies show that up a third of the infants blood still remains within the placenta and cord immediately after birth.

"The extra blood at birth helps the baby to cope better with the transition from life in the womb, where everything is provided for them by the placenta and the mother, to the outside world," Rabe said. "Their lungs get more blood so that the exchange of oxygen into the blood can take place smoothly."

In term infants, delayed cord clamping increased hemoglobin level and improves infant iron stores, as stated by the ACOG.

  • “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 (163132). 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).” 

Sufficient iron levels are important to healthy brain development in children. Iron deficiency in the first year of life have been linked to impaired cognitive, motor, and emotional development as found in a clinical trial published in the journal of JAMA pediatrics

The ACOG also revised their recomendations regarding preterm infants and delayed cord clamping, stating "In preterm infants, delayed umbilical cord clamping is associated with significant neonatal benefits, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage."

Even infants born via cesarean section can benefit from delayed cord clamping, as stated in a position statement made by 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. 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."

 

Are there any risks?

Some studies have demonstrated mildly higher levels of bilirubin (cause of jaundice) in delayed cord clamping babies.

"... but jaundice requiring phototherapy was less common among those newborns who had early umbilical cord clamping (2.74% of infants in the early cord clamping group compared with 4.36% in the late cord clamping group; RR, 0.62; 95% CI, 0.41–0.96). However, the authors concluded that given the benefit of delayed umbilical cord clamping in term infants, delayed cord clamping is beneficial overall, provided that the obstetrician–gynecologist or other obstetric care provider has the ability to monitor and treat jaundice." the ACOG states.

In the 2013 Cochrane review, the study found "that the difference between early and late cord clamping for clinical jaundice did not reach statistical significance.” 

Another concern is the risk of polycythemia, or blood that is too thick to oxygenate properly.  "Neonatal polycythemia has not been observed at higher frequencies among infants in the delayed cord clamping group in several systematic reviews, and in large randomized controlled studies" as published in a paper written by Tonse N. K. Raju, M.D, D.C.H.,and Nalini Singal, M.D., D.C.H.

its worth the wait!

Science has clearly proven the amazing benefits of delayed cord clamping. If you choose a hospital birth, be an advocate for your baby! You don't get a second chance once the cord has been cut, so be sure to express you desire to your health care provider before the day comes. Adding delayed cord clamping to your birth plan is a great way to make sure everyone is on the same page. The connection between baby and placenta is as sacred as birth itself. There is no better way to honor this connection than to leave the baby attached for as long as possible!

  Image courtesy of An Infinite Moment Photography

Image courtesy of An Infinite Moment Photography