The umbilical cord provides for all of the transport of oxygen and nutrients to your baby, from 5 weeks gestation, until the time it is cut after delivery. The baby’s blood is much more concentrated whilst in utero and progressively dilutes in the first days after birth as a normal process once it is breathing normal air.
In years past, it was considered routine practice to clamp and cut the cord within the first 30 seconds after the birth. However, this has changed in the last few years to delaying this process for at least 60 seconds after the birth, if both the mother and baby are well. This has been found to have a number of research proven benefits in both full term and very premature infants.
Why would you delay cord clamping?
In terms of infants, the delayed clamping has been found to improve the baby’s iron store (particularly in breast fed infants) over the first six months. After 6 months, the infant’s dietary intake normally supplies adequate iron. There also appears to be a slight reduction in resuscitation efforts and the possible admission to Special Care Nursery.
If, at the time of birth, the baby definitely needs resuscitation or the mother is bleeding significantly, then delayed cord clamping is not advisable. There also appears to be a slightly higher rate of neonatal jaundice in babies who have been delivered with delayed cord clamping. When the baby is delivered, for maximum auto-transfusion benefit, the baby should be kept for the first 60 seconds below the level of the placenta. That isn’t always what parents would normally expect after all the hard work!
What can it mean for premature babies?
In very premature babies (born before 30 weeks) the magnitude of benefit appears to be much larger. In a recent review of multiple research studies, a team from the University of Sydney found at least a 10% improvement in overall survival. Other studies around the world have suggested even as much as a 30% improvement in survival of these tiny neonates. The benefits were particularly seen in a reduction of spontaneous brain bleeding, spontaneous bowel loop death, reduced incidence of sepsis and a demonstrable improvement in transitional circulation and blood pressure in the newborn neonate.
These benefits seen in very premature baby are causing a significant difference in after birth management across all hospitals. The small benefit in full term babies is worth achieving in otherwise uncomplicated births. Obstetricians and midwives should strive to delay cord clamping whenever it is safe to do so. For more information, be sure to speak to your obstetrician.
