Delayed Cord Clamping

Approximately 50 years ago, hospitals instituted the procedure of clamping and cutting the baby’s umbilical cord moments after birth. New research is calling this practice into question, and delayed cord clamping is becoming a component of the birth plan requested by more and more parents choosing a natural birth.

With delayed cord clamping, the family and their midwife or care provider will at least wait until the cord stops pulsating before clamping and cutting the cord. Some parents choose to keep the cord and placenta connected to the baby until the cord naturally dries and falls away (Full Lotus Birth.) While some families choose something somewhere in between.

Newborns (usually weighing only between 4.4 to 11 lbs  (2 and 5 kilos) are being denied up to 1/3 of their blood volume! This happens when the umbilical cord is immediately clamped and cut, by the doctor or midwife, moments after the baby is born. Calling this blood “cord blood” is doublespeak; ambiguous language that masks the fact that the blood present in the umbilical cord at the time of birth is truly the BABY’S blood.

How much blood is in the baby’s cord?

At the time of birth up to 1/3 of each baby’s blood supply is traveling from the placenta via the umbilical cord to the baby.

At the moment of birth, newborn infants have a blood volume of approximately 78 ml per kilogram, or a total of about 273 ml for an average weight baby of 3.5 kg (7.7 lbs.). This is the diminished amount of blood that almost all newborns are left with when their umbilical cords are immediately clamped and cut.

Research has shown that when umbilical cord clamping is delayed for 5 minutes, a newborn’s blood volume increases by 61% to 126 ml/kg, for an average total of 441 ml. This placental transfusion amounts to 168 ml for an average  3.5 kg (7.7 lb.) infant.  One-quarter of this transfusion occurs in the first 15 seconds, and one-half within 60 seconds of birth.

New research shows that by simply delaying the clamping and cutting of babies’ umbilical cords, our newborn children suffer less trauma, fewer inner cranial hemorrhages and have higher stores of iron at 4 months of age, and even up to 8 months after birth. ^[1],[2],[3]

The nutrients, oxygen and stem cells present in the blood transfused into babies by the placenta, when cord severance is delayed, ensures that the body’s tissues and organs are properly vitalized, supplied with energy and nourished. This translates into improved health, heightened immunity, increased intelligence and potential longevity.

A randomized clinical trial conducted in Sweden and published by JAMA Pediatrics showed improved scores in fine-motor and social skills of children who had delayed umbilical cord clamping and cutting at 4 years of age.[4] This means that the timing of each baby’s cord clamping and cutting at birth is significant far into each baby’s future.

What are the benefits for the baby?

• Less anemia due to increased iron stores
• Less respiratory distress in the first hours and days of life because  the lungs have adequate blood supply to help keep the aveoli open
• Fewer cases of brain hemorrhage, especially in premature infants
• Possibly fewer cases of blood clotting problems in the newborn because the baby will have more blooding factors present when not deigned 1/3 of their blood volume
• Mother and baby are not separated

When did cord clamping immediately after birth became standard procedure?

The habitual practice of immediate umbilical cord clamping and cutting began in the 1960s when an unproven hypothesis arose among physicians, in which they postulated that immediate cord severance would prevent jaundice. Research has proven that there is no greater risk of pathological jaundice for newborns whose cord clamping and cutting is delayed.[1]

Research, conducted by Ola Andersson, consultant in neonatology, Lena Hellström-Westas, professor of perinatal medicine, Dan Andersson, head of departments of pediatrics, obstetrics and gynecology, Magnus Domellöf, associate professor, head of pediatrics, and featured in the British Medical Journal, states: “There were no significant differences between (immediate cord cut and delayed cord cut: mine) groups in postnatal respiratory symptoms, polycythaemia, or hyperbilirubinaemia requiring phototherapy.”

Another theory was that early cord clamping would prevent too much hemoglobin (Polycythemia ) or blood that is too thick  (hyperviscocity). Some research does show an increased concentration of hemoglobin in the delayed cord clamping group, but it has not harmed babies, nor is it a significant argument for immediate cord severance. [7]

When immediate umbilical cord clamping and cutting was introduced, no research was conducted to determine if it was a safe practice. It could be said that this practice was just introduced for the convenience. of hospital staff who whisk the baby away from the mother to begin weighing, charting, and cleaning the baby afterbirth.

Is profit a motivating factor?

Stem cells are valuable, blood is valuable, and hospitals sell babies’ blood for transfusions and for research and other uses, including transfusion.[1]

Another route of cash flow is related to cord blood banking. Parents are encouraged to choose between:

• Banking their baby’s stem-cell-rich blood for donation
• Banking baby’s blood for future personal use , should the child develop a disease perhaps treatable by blood transfusion, such as leukemia.

The probability that a person in the course of his or her life will ever need a stem cell transplant (whether from umbilical cord blood or bone marrow) has been estimated by the University Hospital in Heidelberg at 0.06% to 0.46%, depending on age.

Correspondingly low, the probability that one’s own cord blood would be used in a transplant is between 1: 1400 and 1: 200,000.[1]

Parents are driven by fear and love for their baby to pay between 1,500 and 2,000 euros ($1,658 and $2,210) or more for the initial “harvesting” of their baby’s blood at birth.

Storage programs, for between ten and twenty-five years cost between 90 and 120 euros ($99 and $133) per year. However the technology to properly store this baby blood is still not adequate to insure that the blood will be usable in the future. Parents are asked to gamble that technology will advance enough to make their investment useful, should the worst case scenario for their child’s health arise.

With that in mind, there is a third option for parents who are convinced of the need for blood banking:

• Harvest the baby’s blood for collection and storage AFTER delaying the clamping and cutting of baby’s umbilical cord, allowing for some of the essential transfusion to take place at the time of birth.

Fear of Litigation

In some countries (especially in the USA), fear of litigation has been used to justify early cord cutting. In 1995, the American Academy of Obstetricians and Gynecologists (ACOG) released an Educational Bulletin (#216) recommending immediate cord clamping in order to obtain cord blood for blood gas studies in case of a future lawsuit. Deviations in blood gas values at birth can reflect asphyxia, or lack of. Lack of asphyxia at birth is viewed as proof in a court of law that a baby was healthy at birth. In other words,  the ACOG recommendation protects its member doctors, not the babies.

“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…
…but in normal birth there should be a valid reason to interfere with the natural procedure.” 
– World Health Organization

[1] Die Wahrscheinlichkeit, dass ein Mensch im Laufe seines Lebens überhaupt eine Stammzelltransplantation (egal ob aus Nabelschnurblut oder Knochenmark) braucht, schätzt die Uniklinik in Heidelberg auf 0,06% bis 0,46% abhängig vom Lebensalter, das erreicht wird. Entsprechend gering ist die Wahrscheinlichkeit, dass bei einer Transplantion das eigene Nabelschnurblut verwendet wird: Die Schätzungen reichen von einer Wahrscheinlichkeit von 1:1400 bis 1:200.000.  http://www.babycenter.de/a36661/warum-ist-nabelschnurbluteinlagerung-umstritten#ixzz3EKUNPq4X

[1] http://midwifethinking.com/2011/02/10/cord-blood-collection-confessions-of-a-vampire-midwife/

[1] The BMJ Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial http://www.bmj.com/content/343/bmj.d7157

[1] BMJ. 2011 Nov 15;343:d7157. doi: 10.1136/bmj.d7157.

[2] Indian Pediatr. 2002 Feb;39(2):130-5.

[3] JOURNAL OF TROPICAL PEDIATRICS, VOL. 58, NO. 6, 2012

[4] Effect of Delayed Cord Clamping on Neurodevelopment at 4 Years of Age A Randomized Clinical Trial Ola Andersson, MD, PhD1; Barbro Lindquist, PhD2; Magnus Lindgren, PhD3; Karin Stjernqvist, PhD3; Magnus Domellöf, MD, PhD4; Lena Hellström-Westas, MD, PhD accessed October, 2015 http://archpedi.jamanetwork.com/article.aspx?articleid=2296145

[7] J Perinat Neonat Nurs r Vo  2012

Rethinking Placental Transfusion and Cord Clamping Issues

Judith S. Mercer, PhD, CNM, FACNM, Debra A. Erickson-Owens, PhD, CNM