Delayed cord clamping
Delayed cord clamping is the practice of postponing the clamping and cutting of the umbilical cord for several minutes after the birth of an infant. Traditionally, medical professionals have clamped the cord within seconds of birth, primarily to prevent maternal hemorrhage. However, emerging research suggests that delaying this process may offer significant health benefits for the newborn. By waiting until the cord has stopped pulsing, which usually occurs about five minutes after birth, it is believed that the baby can receive additional blood, oxygen, and nutrients that may be retained in the placenta—potentially reducing the risk of anemia and supporting brain development.
Studies have indicated that even a brief delay of one to three minutes can improve iron levels and overall health in infants. Some findings also suggest benefits such as enhanced fine motor and social skills in children who experienced delayed clamping. Health organizations, including the World Health Organization, advocate for this practice, recommending a delay of at least one to three minutes, unless immediate medical intervention is required. Overall, delayed cord clamping is gaining traction as a practice that may promote healthier outcomes for newborns, while still being respectful of individual birth circumstances and needs.
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Delayed cord clamping
Delayed cord clamping refers to waiting a few minutes after the birth of an infant before clamping and severing the umbilical cord, which is attached to the child at the navel and connected to the placenta of the mother. Physicians and midwives frequently clamp the cord within seconds of a child's birth. Now some experts are citing potential health benefits to the child that might result from waiting to clamp and sever the cord for several minutes. Some birth professionals are encouraging the adoption of a widespread practice of delayed cord clamping.
Background
Before a baby is born, it receives its nutrition from the mother through the umbilical cord. The umbilical cord is a lifeline, much like the line that connects astronauts to an orbiter during space walks. The umbilical cord is a tube about twenty to twenty-three inches in length. It contains a vein that brings fresh blood to the baby and two arteries that carry deoxygenated blood and waste products away from the developing fetus. The blood vessels are surrounded by a substance called Wharton's jelly, and the whole cord is covered in a membrane known as the amnion.
The cord connects to the baby at its navel, or belly button. The other end of the cord connects to the placenta inside the mother's uterus. The placenta is an organ that grows inside the womb during pregnancy to help support the growing child. Blood carrying oxygen and nutrients passes through the placenta before going through the umbilical cord to the baby, and spent blood and waste from the baby returns through the placenta before going into the mother's system. The placenta also produces hormones that help protect the baby from illness.
When a child is born, the baby generally emerges first with the cord attached, followed a short time later by the placenta. In most births in a medical setting, the cord will be clamped with specially designed plastic clamps about one and a half to two inches away from the child's body. A second clamp is placed on the cord near the placenta. The cord is then cut with scissors in between the two clamps but usually closer to the child.
Often this is done within seconds of the birth; this practice originated to protect the baby from the effects of a hormone given to the mother to help prevent excessive bleeding after the birth and has been the usual practice for more than sixty years even after safer anti-hemorrhage drugs became available. However, if the cord is not clamped or cut, the opening where the blood enters and leaves the child will seal naturally about an hour after birth; the cord and attached placenta will fall off on their own within ten days.
Overview
A growing number of birth professionals and researchers are encouraging a delay of at least several minutes before the umbilical cord is clamped after birth. The first person to raise the issue publicly was Amanda Burleigh, a British midwife. In the early 2000s, Burleigh began to question the practice. She wondered if the baby might be missing out on some health benefits from the maternal blood still in the placenta.
When experts looked into the question, they discovered that up to a third of the baby's blood supply is retained in the placenta. The researchers found a connection between this and an increased risk of anemia in the infant from lack of iron in the blood. This in turn is thought to be connected to possible learning delays later in life.
Burleigh and others began to encourage a practice of waiting longer after birth before clamping and cutting the cord. Waiting at least until the umbilical cord stops pulsing about five minutes after birth allows the remainder of the infant's blood to be transferred to the infant. However, it was thought that delaying even as little as one to three minutes could help blood and the iron and nutrients it carried reach the baby and provide several benefits to the infant. The additional blood supply is in itself helpful, as is the oxygen and iron that it carries. This is believed to help in the development of the infant's brain as well as to ease the transition from being in the womb to being outside and breathing oxygen.
In the early days of the campaign to delay cord clamping, most of the studies conducted focused on infants shortly after birth. These studies showed an increase in the oxygen and iron in the infants' systems along with correlating health benefits, such as a reduction in the number of iron deficiencies in babies up to six months of age. It was not until around 2010 that studies were conducted that followed children who had later cord clamping to see if there were any benefits in later years.
The study, published in the July 2015 edition of JAMA Pediatrics (Journal of the American Medical Association Pediatrics) examined 263 Swedish children at four years of age and looked for differences between those who experienced delayed cord clamping and those who did not. The study found little difference in some areas of development but identified a higher level of fine motor skills and some social skills in children whose cords were not cut until at least three minutes after birth. This was especially noticeable in boys. There were no negative findings associated with delaying the cord clamping in either the children or their mothers.
Other studies found that the practice was beneficial for preterm infants, where it appears to reduce the likelihood of hemorrhaging in the heart of the infant. Some research found a slight increase in the number of children who developed jaundice, a condition where the blood has too much bilirubin. This is treated by placing the child under special lights and is generally not serious.
A number of health organizations recommend delaying cord clamping for several minutes after birth. The World Health Organization (WHO) recommends waiting at least one to three minutes, unless the child is in danger and needs additional care or resuscitation. Other organizations that have endorsed the practice include the British National Institute for Health and Care Excellence (NICE) and the Royal College of Midwives, which recommend waiting at least a minute and as long as five minutes or longer after birth to clamp and cut the umbilical cord.
Bibliography
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Andersson, Ola, et al. "Effect of Delayed Cord Clamping on Neurodevelopment at 4 Years of Age: A Randomized Clinical Trial." JAMA Pediatrics, vol. 169, no. 7, 2015, 631–38, jamanetwork.com/journals/jamapediatrics/fullarticle/2296145. Accessed 8 Dec. 2016.
Ansari, Azadeh. "The Great Umbilical Cord-Cutting Debate." CNN, 30 May 2015, www.cnn.com/2015/05/29/health/cut-the-cord/. Accessed 8 Dec. 2016.
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Haelle, Tara. "Delayed Umbilical Cord Clamping May Benefit Children Years Later." NPR, 26 May 2015, www.npr.org/sections/health-shots/2015/05/26/409697568/delayed-umbilical-cord-clamping-may-benefit-children-years-later. Accessed 8 Dec. 2016.
Mohney, Gillian. "New Birthing Trend: Don't Cut the Cord." ABC News, 11 Apr. 2013, abcnews.go.com/blogs/health/2013/04/11/new-birthing-trend-dont-cut-the-cord/. Accessed 8 Dec. 2016.
"Optimal Timing of Cord Clamping for the Prevention of Iron Deficiency Anaemia in Infants." World Health Organization, www.who.int/elena/titles/full‗recommendations/cord‗clamping/en/. Accessed 8 Dec. 2016.
"What Is the Placenta?" NHS Choices, www.nhs.uk/chq/Pages/2309.aspx. Accessed 8 Dec. 2016.
"What Is the Umbilical Cord?" NHS Choices, www.nhs.uk/chq/pages/2299.aspx?categoryid=54. Accessed 8 Dec. 2016.