Early cord clamping may harm baby

I'm a little sceptical. I don't think I've ever seen a term baby with anemia, unless it was an abruption. However I have seen term babies, mostly born at home, with polycythemia.
And unless that cord is 8 feet long and can reach a warmer bed,there is no way I'd feel comfortable with a preemie being attached to mom for 3 minutes or even one for that matter.

You mean you don't want to do compressions with baby on mom's chest?

I think the qualifier is the 'where it is safe to do so' bit. I can think of circumtances where it would and would not help.

Dr. Frederick LeBoyer and various midwives have always known that, where safe, when Mom and baby are not in distress that would supercede, it is best to let baby receive the cord blood. There is no need, in a normal birth, including a non-emergent, smooth CS, for the frenzy that accompanies hospital births.

Turn the lights down so as not to shock and horrify the new arrival, be calm and quiet and gentle and allow the newborn to unfold as his or her own pace, use the warm water bath sooner rather than later, gently swaddle, put the babe to breast ASAP, and otherwise be sane and sensible with Mom and babe, and you will see the happy results.

I am a licensed midwife and RN, board-certified in perinatal nursing. I have been attending homebirths for 31 years. In our practice we do routinely allow the cord to stop pulsating but have had only one case of polycythemia, an infant born at term this last July with pulmonary valve stenosis and a patent ductus. Here is an excerpt from an article on Medscape re: delayed cord clamping:

"Currently, no formal guidelines about the best timing for umbilical cord clamping exist. Clamping the cord immediately after birth results in a 20% reduction in blood volume for the neonate and up to a 50% reduction in red cell volume.[28] Several RCTs have indicated that more infants who experience immediate clamping have anemia of infancy compared to infants who had delayed clamping ( Table 1 ). A number of studies have related anemia of infancy, even when treated with iron, with less favorable neurodevelopmental and behavioral outcomes up to age 10.[29] There are no studies of immediate or delayed cord clamping that follow children beyond 6 months of age."

Here is the link to the article in its entirety:
http://www.medscape.com/viewarticle/558124_3

My own practice is to observe the cord for pulsation but also to observe for the usual s/s of placental separation, i.e., cord lengthening, separation gush, and uterine contraction. I clamp the cord near the introitus, provide controlled cord traction, deliver the placenta and then unclamp the cord. It typcially continues to pulsate in spite of the fact that we clamped the cord briefly and delivered the placenta. Once cord pulsation has stopped, the umbilical cord is cut (usually by the dad but sometimes by grandma or a sibling).

The fact that an intact cord will continue to pulsate even after the placenta is born suggests to me that it is important that the baby receive the cord blood.

When I was a new midwife I used expectant management of third stage, simply allowing the placenta to be born in its own time. Since implementing this modified version of active managment several years ago, postpartum hemorrhages are very rare in my practice. Like most homebirth midwives, I do not administer a prophylactic oxytocic routinely. We certainly do place the baby skin-to-skin and encourage privacy and early baby-to-breast contact (nuzzling, nippling, etc.), which keeps the oxytocin moving very nicely.

Here is a link on evidence-based practice re: active management of third stage.
http://www.aafp.org/afp/20030515/cochrane.html

Best,
Marla

It's interesting that there are no studies beyond 6 months of age. I've never known a baby with anemia (other than premies in the NICU or babies of abruption, etc).

Both of my girls were anemic at their 9 month check-ups, and were placed on iron-fortified formula and iron supplements at that time. My oldest was full-term, and jaundiced at birth, but didn't require phototherapy. My youngest was a preemie and required phototherapy for jaundice. Both were exclusively breastfed, and my pediatrician theorized that MY stores of iron were too diminished to provide them with good quality iron in the breast milk. Since I didn't supplement with formula, they weren't getting any iron to speak of.

Interesting to think that delaying cord clamping may have helped, but both of my deliveries "went south" in the last minutes, so I don't think either of my OBs had the luxury of delaying clamping the cord. Also, it may have worsened their jaundice.

Nine months down the line, it's hard to say why your children were anemic, I doubt it was from birth though.
Breast fed babies are more likely to be anemic. We send breast fed babies home on multi vites, never heard formula suggested.