Wait a few minutes after birth before clamping the umbilical cord

Why delay clamping the umbilical cord?

Advantages of delaying clamping the umbilical cord

Should delayed clamping be routine medical procedure?

References

Why delay clamping the umbilical cord?

The standard medical procedure is to clamp and cut the umbilical cord immediately after birth. However, a number of studies have shown that delaying the clamping for as little as two minutes, or as long as ten minutes or the cord takes to stop pulsing, has a number of advantages for the newborn baby. These advantages start immediately and continue for years.

The studies suggest that delayed clamping, for as little as two minutes, should be implemented as standard practice. However this is yet to happen at many hospitals.

The studies found no significant differences in the mothers health either way.

Advantages of delaying clamping the umbilical cord

• Delaying the clamping of the cord lets blood flow from the placenta to the infant, who has just been squeezed through a tight birth canal. The delay can increase the infant's blood volume by up to a third.
• The placental blood contains iron, nutrients, hormones, stem cells and many other valuable components. Several studies have focused on the increased blood iron, and found that delayed clamping increases the infants' iron storage, which favourably affects brain development. Haemoglobin deficiency in infants at 24 to 48 hours was significantly less likely in delayed cord clamping babies, and at three to six months iron deficiency was still less than half as likely. (1)
• Another study (2) randomly assigned sixty term infants delivered vaginally to one of the two groups - early cord clamping (ECC) or delayed cord clamping (DCC). Six months after delivery a variety of metrics relating to iron were measured. All metrics were better in the DCC group than the ECC group. (2)
• The authors of study (1) concluded that a more liberal approach to delaying clamping of the umbilical cord in healthy term infants appears to be warranted, particularly in light of evidence that delayed cord clamping increases early haemoglobin concentrations and iron stores in infants.
• Birthweight was significantly higher in delayed cord clamping babies. (1)
• Study (1) found that delayed cord clamping slightly raised the risk of jaundice and the need for phototherapy. However, the risk of side effects such as polycythaemia and jaundice are low and in study (2) they were not seen.
• A study (3) of 263 infants found that those whose cords were cut more than three minutes after birth had better social skills and fine motor skills than those whose cords were cut within ten seconds. However, there were no differences measured in a childrens IQ test. (3)
• Another study (4) of 358 mother-infant pairs found that at six months of age, infants who had delayed clamping had significantly higher mean corpuscular volume and total body iron. The effect of delayed clamping was significantly greater for infants born to mothers with low ferritin at delivery, breastfed infants, and infants born with birthweight between 2.5 and 3.0 kg. The conclusion was that a two-minute delay in cord clamping could help prevent iron deficiency from developing before 6 months of age. (4)

Should delayed clamping be routine medical procedure?

So why is delayed umbilical cord clamping not routinely used in hospitals? A study (5) published in 2009 found that "difficulty in implementation" was the main reason obstetricians in the UK, EU, USA, Canada, Australia and other countries have not adopted the practice. The truth might be more that the delivery team simply wants to clean up and sign off without further delay. (5)

References

1. 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 Syst Rev. 2013 Jul 11;(7):CD004074. doi: 10.1002/14651858.CD004074.pub3.

2. Nesheli HM, Esmailzadeh S, Haghshenas M, Bijani A, Moghaddams TG. Effect of late vs early clamping of the umbilical cord (on haemoglobin level) in full-term neonates. J Pak Med Assoc. 2014 Nov;64(11):1303-5.

3. Ola Andersson, Barbro Lindquist, Magnus Lindgren. Effect of Delayed Cord Clamping on Neurodevelopment at 4 Years of Age: A Randomized Clinical Trial. JAMA Pediatr. 2015;169(7):631-638. doi:10.1001/jamapediatrics.2015.0358.

4. Camila M Chaparro, Lynnette M Neufeld, Gilberto Tena Alavez, Raul Eguia-Liz Cedillo, Kathryn G Dewey. Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. The Lancet. Volume 367, No. 9527, p1997-2004, 17 June 2006.

5. A. B. O. Ononeze, D. J. R. Hutchon. Attitude of obstetricians towards delayed cord clamping: A questionnaire-based study. Journal Of Obstetrics And Gynaecology Vol. 29, Iss. 3, 223-224. 2009.