Delayed cord clamping

JVanRN · Mar 3, 2006

We usually just delay it. Unless it is a dire emergency, letting the cord finish pulsating only takes a few minutes.

The reasons I have heard are different. But one of the main one's is they want the baby to get all of their blood (or something to that effect).

CEG · Mar 3, 2006

I requested this with my babes, the theory being that the placenta is still doing something and it may benefit baby to receive the rest of that blood. The idea being that nature's design is probably not wrong.

On the flip side I have heard that delayed cord cutting increases the risk of jaundice as there are then more RBC's to be broken down.

In all honesty I don't think the cord cutting was delayed for my babies, but I was a little "in the moment" and have no idea. My MW said no problem but I didn't remind her when I was actually in labor so I don't know if she remembered.

tinyscrafts · Mar 4, 2006

I can probably assist with where they get their info...

The internet, magazines, WHO, Birth classes, friends with kids who have autism....

A great portion of the babies blood remains in the cord and placenta as you know.

Think about it, the baby comes out and must IMMEDIATELY start breathing air. A lot of parents want the backup system to remain intact to smooth the transition. That next ctx will force a bolus of warm oxygenated blood into the baby. I heard a lecture at a midwifery conference (by Anne Frye, you can google up the tape I think it was called physiologic cord closure, more important than you think - or something) about this that made perfect sense. There are valves in the cord so the baby can equilibrate its blood volume if need be. And new studies show that polycythemia is not increased when delaying. So Why not?

The WHO says:

"Late clamping (or not clamping at all) is the physiological way of treating

the cord, and early clamping is an intervention that needs justification.

The "transfusion" of blood from the placenta to the infant, if the cord is

clamped late, is physiological, and adverse effects of this transfusion are

improbable, at least in normal cases. After an abnormal pregnancy or labour,

for instance in rhesus sensitization or preterm birth, late clamping may

cause complications, but in normal birth there should be a valid reason to

interfere with the natural procedure."

http://www.who.int/reproductive-health/publications/MSM_96_24/MSM_96_24_Chap

ter5.en.html

This is about stem cell gathering but I think it still applies.

The AAP (American Academy of Pediatrics) says

it's unethical to *aggressively* practice immediate clamping:

"The importance of larger numbers of stem cells to the success of

engraftment could encourage the attendance at delivery by a physician or

other health care personnel to attempt to harvest more cord blood. It has

been shown that the timing of umbilical cord clamping has an important

effect on the neonatal blood volume and the subsequent hematologic status.

If cord clamping is done too soon after birth, the infant may be deprived of

a placental blood transfusion, resulting in lower blood volume and increased

risk for anemia in later life. Immediate cord clamping will, of course,

increase the volume of placental blood for harvesting for cord blood

banking. There may be a temptation to practice immediate cord clamping

aggressively to increase the volume of cord blood that can be harvested for

cord blood banking. This practice is unethical and should be discouraged."

http://pediatrics.aappublications.org/cgi/content/full/104/1/116

ACOG itself says not to immediately clamp anymore, but most don't know that yet....

"In the February 2002 edition of Obstetrics & Gynecology, ACOG quietly

announced, in very small print on a back page (361), that Bulletin 216

has been withdrawn from circulation. I

that is widely and naively performed by many practicing obstetricians.

It would be ethically and morally appropriate for ACOG

To Announce To Every Obstetrician In Very Large Print:

1. That immediate cord clamping is no longer officially sanctioned as

standard care.

2. That the person who clamps the cord before the lungs are oxygenating

the child should have sound, documented, clinical justification for

doing so and

3. That the person who clamps the cord immediately or prematurely is

individually responsible and liable for the resulting injuries."

Dr George Morley http://www.whale.to/a/cord.html

TrudyRN · Aug 21, 2007

I can probably assist with where they get their info...
The internet, magazines, WHO, Birth classes, friends with kids who have autism....
A great portion of the babies blood remains in the cord and placenta as you know.
Think about it, the baby comes out and must IMMEDIATELY start breathing air. A lot of parents want the backup system to remain intact to smooth the transition. That next ctx will force a bolus of warm oxygenated blood into the baby. I heard a lecture at a midwifery conference (by Anne Frye, you can google up the tape I think it was called physiologic cord closure, more important than you think - or something) about this that made perfect sense. There are valves in the cord so the baby can equilibrate its blood volume if need be. And new studies show that polycythemia is not increased when delaying. So Why not?
The WHO says:
"Late clamping (or not clamping at all) is the physiological way of treating
the cord, and early clamping is an intervention that needs justification.
The "transfusion" of blood from the placenta to the infant, if the cord is
clamped late, is physiological, and adverse effects of this transfusion are
improbable, at least in normal cases. After an abnormal pregnancy or labour,
for instance in rhesus sensitization or preterm birth, late clamping may
cause complications, but in normal birth there should be a valid reason to
interfere with the natural procedure."
http://www.who.int/reproductive-health/publications/MSM_96_24/MSM_96_24_Chap
ter5.en.html
This is about stem cell gathering but I think it still applies.
The AAP (American Academy of Pediatrics) says
it's unethical to *aggressively* practice immediate clamping:
"The importance of larger numbers of stem cells to the success of
engraftment could encourage the attendance at delivery by a physician or
other health care personnel to attempt to harvest more cord blood. It has
been shown that the timing of umbilical cord clamping has an important
effect on the neonatal blood volume and the subsequent hematologic status.
If cord clamping is done too soon after birth, the infant may be deprived of
a placental blood transfusion, resulting in lower blood volume and increased
risk for anemia in later life. Immediate cord clamping will, of course,
increase the volume of placental blood for harvesting for cord blood
banking. There may be a temptation to practice immediate cord clamping
aggressively to increase the volume of cord blood that can be harvested for
cord blood banking. This practice is unethical and should be discouraged."
http://pediatrics.aappublications.org/cgi/content/full/104/1/116
ACOG itself says not to immediately clamp anymore, but most don't know that yet....
"In the February 2002 edition of Obstetrics & Gynecology, ACOG quietly
announced, in very small print on a back page (361), that Bulletin 216
has been withdrawn from circulation. I
that is widely and naively performed by many practicing obstetricians.
It would be ethically and morally appropriate for ACOG
To Announce To Every Obstetrician In Very Large Print:
1. That immediate cord clamping is no longer officially sanctioned as
standard care.
2. That the person who clamps the cord before the lungs are oxygenating
the child should have sound, documented, clinical justification for
doing so and
3. That the person who clamps the cord immediately or prematurely is
individually responsible and liable for the resulting injuries."
Dr George Morley http://www.whale.to/a/cord.html

:yeahthat:

KellNY, RN · Aug 21, 2007

A big "Yeah, that" to tinys

When a pt requests that the MD delay cord clamping until after it has stopped pulsating, how do you respond?

I tell them "okay" and inform the MD. Technically, they can refuse any treatment/procedure for themselves or their babies, and that includes immediate cord clamping.

Elvish, BSN, DNP, RN, NP · Aug 21, 2007

I'm not into the lotus birth thing (OT, I know) though I don't mind if others are. But it was probably not designed for cords to be clamped immediately after the baby breathes his first. I think it's pretty cool to delay clamping, actually.

I get called a granola sort a lot at work.

beckinben, CNM · Aug 21, 2007

This was published in March in JAMA. I wish it had been published in a more OB-oriented journal, as most people I show this too never saw it.

Late vs Early Clamping of the Umbilical Cord in Full-term Neonates

Systematic Review and Meta-analysis of Controlled Trials

Eileen K. Hutton, PhD; Eman S. Hassan, MBBCh

JAMA. 2007;297:1241-1252.

Context With few exceptions, the umbilical cord of every newborn is clamped and cut at birth, yet the optimal timing for this intervention remains controversial.

Objective To compare the potential benefits and harms of late vs early cord clamping in term infants.

Data Sources Search of 6 electronic databases (on November 15, 2006, starting from the beginning of each): the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Neonatal Group trials register, the Cochrane library, MEDLINE, EMBASE, and CINHAL; hand search of secondary references in relevant studies; and contact of investigators about relevant published research.

Study Selection Controlled trials comparing late vs early cord clamping following birth in infants born at 37 or more weeks' gestation.

Data Extraction Two reviewers independently assessed eligibility and quality of trials and extracted data for outcomes of interest: infant hematologic status; iron status; and risk of adverse events such as jaundice, polycythemia, and respiratory distress.

Data Synthesis The meta-analysis included 15 controlled trials (1912 newborns). Late cord clamping was delayed for at least 2 minutes (n = 1001 newborns), while early clamping in most trials (n = 911 newborns) was performed immediately after birth. Benefits over ages 2 to 6 months associated with late cord clamping include improved hematologic status measured as hematocrit (weighted mean difference [WMD], 3.70%; 95% confidence interval [CI], 2.00%-5.40%); iron status as measured by ferritin concentration (WMD, 17.89; 95% CI, 16.58-19.21) and stored iron (WMD, 19.90; 95% CI, 7.67-32.13); and a clinically important reduction in the risk of anemia (relative risk (RR), 0.53; 95% CI, 0.40-0.70). Neonates with late clamping were at increased risk of experiencing asymptomatic polycythemia (7 studies [403 neonates]: RR, 3.82; 95% CI, 1.11-13.21; 2 high-quality studies only [281 infants]: RR, 3.91; 95% CI, 1.00-15.36).

Conclusions Delaying clamping of the umbilical cord in full-term neonates for a minimum of 2 minutes following birth is beneficial to the newborn, extending into infancy. Although there was an increase in polycythemia among infants in whom cord clamping was delayed, this condition appeared to be benign.