Are we cutting the umbilical cord too soon after birth?

Are we cutting the umbilical cord too soon after birth?

Even after birth, the placenta continues to pulsate, transfusing blood into the newborn. Now, more and more evidence is being found to show that delaying umbilical cord clamping (between 2 minutes after birth and cessation of cord pulsations) affords the newborn a host of benefits. Yet in this world of medicalized hospital births where birth is a rushed chaotic experience for mothers, delayed cord clamping is seldom practiced, and there is little agreement among medical doctors about its optimal timing. Indeed, it seems to be common procedure to clamp and cut the umbilical cord within 10 seconds - 1 minute after birthing the baby. It makes sense - hospitals are busy places, obstetricians do not have time to spend the 2-3 minutes standing around holding a soaking wet newborn at vagina height, allowing placental transfusion to continue. So, age old wisdom is ignored in the rush to hand over the baby to the expectant mother; the cord is clamped and cut quickly after birth. Are we doing the newborn a disservice? Erasmus Darwin, British physician and grandfather to the famed Charles Darwin, once said:

"Very injurious to the child is the tying of the navel string too soon. It should be left till all pulsation in the cord ceases. Otherwise the child is much weaker than it ought to be, a portion of the blood being left in the placenta, which ought to have been in the child."

The placenta continues to pulsate, pumping blood to the baby for up to 5 minutes after birth. Some have even been known to continue for up to 30 minutes. Even so, in the majority of births, the cord is clamped and cut early. Enough evidence now exists to encourage a change in routine practice in major hospitals. In a study published in the BMJ, 400 full term infants born after a low risk pregnancy were randomised to delayed umbilical cord clamping (≥180 seconds after delivery) or early clamping (≤10 seconds after delivery). At 2 days of age, the delayed cord clamping group had a lower prevalence of neonatal anaemia. Furthermore, at 4 months of age, those subjected to delayed cord clamping had 45% higher mean ferritin concentration and a lower prevalence of iron deficiency. There were no demonstrable adverse effects associated with this practice.

Another research study published in The Lancet, randomizing 546 newborn babies into two groups (held at vagina height vs laid on the mother's abdomen after birth). The newborns were weight immediately after birth and after cord clamping, to determine the volume of placental blood transfusion that continues to occur between birth and cord clamping. The results were clear: the position of the newborn baby before cord clamping does not seem to affect the volume of placental transfusion. Mothers should safely be allowed to hold their baby on their abdomen or chest, allowing for delayed cord clamping (as the obstetrician does not need to hold the baby at vagina height). The result is enhanced maternal-infant bonding, and decreased risk of iron deficiency in infancy and childhood.

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