delayed cord clamping

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Every mammal baby is connected with the mother through the umbilical cord. The mother´s blood never mixes with that of the baby´s, thanks to the placenta. When the baby is born, the umbilical cord and placenta are full of the baby´s blood, up to 1/3 of it according to Dr. Alan Green, a renowned pediatrician. In premature babies, the blood remaining in the placenta may be a lot more, reaching 50% of the baby´s total blood volume! [2] The mothers of all mammal species have the innate knowledge to wait until all the blood is transferred to the baby (it takes between 2-5 minutes), and then they cut the cord after the placenta is delivered. The cord has dark purple color and is pulsing when there is still blood inside, pushing it towards the baby, but becomes white, relaxed and with no detectable pulse when the blood transfer is finished. It is impossible to get confused. But there is a grand exception to this rule: humans. We just clamp the cord straight away and deny our babies the luxury of having all their blood in their little bodies.

The history of cord clamping

The history of early cord clamping is a fascinating, and at the same time, a sad story. The American College of Obstetricians and Gynecologists says that early clamping was introduced in the 50s and early 60s, when, based on poor scientific proof, it was established that 90% of the baby´s blood was already transferred to the baby after the first few breaths, therefore cutting the cord progressively sooner after birth became a popular trend in obstetrics [1]. Now, the cord is routinely clamped within the first 15-20 seconds after birth, a practice known as immediate cord clamping.

But Faith Gibson, a veteran midwife and a member of the Midwifery Advisory Council, presents a very different story [2]. Early cord clamping was actually introduced very early in the 20th century by American obstetricians. Hospital births were not common at that time (about 5%), but giving general anesthesia to the mother (read narcotics, chloroform or ether) was a standard procedure. Unfortunately, in this way, these chemicals were passing through the cord to the unborn baby causing profound respiratory problems. Clamping the cord as early as possible was essentially an effort to limit the amount of chloroform or ether passed to the baby from the unconscious mother. [Note: Whatever is injected in the mother´s bloodstream passes to the baby, as it was the case with these early anesthetic efforts. The epidural, which is so popular now, is injected directly in the spinal tube and therefore is not passing to the mother´s or the baby´s blood]. Kathy Valeii from Birth Anarchy, who has written extensively about the history of birth, informs us that that dark period in obstetrics coincides with a systematic effort to view birth as a pathological process, redefining normal birth as a surgical procedure that must be performed by physicians-surgeons [3,2]. Fast forward to 2015, more than 60% of women take epidural anesthesia in labor, almost a third give birth via cesarean section (US, data from 2013) and only a miniscule percentage of births take place at home.

Where we are now

So, now, the umbilical cord of billions of babies is cut prematurely way before the baby´s blood manages to return in the baby´s body. The result is a lot of blood lost, blood that can make a huge difference in the immediate and future health of the baby. This is precious blood wasted for nothing, nothing at all; welcome to modern medicine. Denying newborns of 1/3 of their blood puts them in significant risk for anemia, which can later affect brain development and cognitive abilities [4]. In the video at the end of the article, Dr. Green insists on the negative long-term effects of immediate cord clamping in the baby´s health and to society in general.

More than a century after this practice was popularized, science started to revisit the topic of the proper timing of cord cutting. They thought that maybe premature babies who struggle to survive might need the 50% of their blood after all. And maybe if premature babies do better with delayed cord clamping, maybe it is a good idea for full-term babies too! So we have several studies trying to find out whether waiting for a bit longer before we cut the cord could harm the baby. Unsurprisingly it doesn’t harm them. In fact, it has become such common sense and knowledge that delayed cord clamping cannot possibly be harmful for the baby, but it is highly beneficial instead, that the World Health Organization (WHO) issued an international guideline recommending delayed cord clamping as an essential public health strategy that promotes improved maternal and infant health [5]. Senior doctors from UK also defend waiting for the cord to stop pulsating before clamping it and insist that cutting it prematurely only puts babies in risk unnecessarily [4].

I am not going to do that

I am not going to go back to the original studies showing that optimal or delayed cord clamping is not harmful because I think it is just silly to try to find out if allowing the baby to get the full amount of its blood after birth is a bad or even a neutral thing.

For a reference consider this: losing 30-40% of the blood is a Class 3 hemorrhage for an adult requiring blood transfusion, while the heart struggles to oxygenate all the tissues and the blood pressure drops rapidly. Loss of 40% or more of blood volume for an adult person is considered a Class 4 hemorrhage (the most severe, yet potentially survivable bleeding), requiring immediate and major resuscitation efforts to prevent the heart and other organs from shutting down. What I don’t understand is that if all this is so well-established and considered logical for adults, why newborns are treated so differently and we let them lose 30% of their blood for no reason at all.

Also, I am not even going to go into arguments about the usefulness of immediate cord clamping in order to give time to collect placenta blood for banking, as it was claimed by the American Congress of Obstetricians and Gynecologists. Seriously people. In my world, it is just strange to consider blood banking needs more important than the health of any baby. But maybe that is just me! (Sure, if parents want to collect placenta blood, they have the right and option to do so, but isn’t this something to be decided on an individual basis?) At the end of the day, are we having babies so that the placenta blood banking business thrives? I will briefly present however, some of these year´s (2015) latest studies which show that optimal or delayed cord clamping gives babies a definite health head start.

*There is no doubt that in some cases, the baby, the mother or both need immediate resuscitation efforts or other specific treatments and maybe there is not time to wait, so the cord must be clamped as soon as possible. However, these cases are the exceptions, not the rule, and therefore it makes no sense to insist on universal immediate cord clamping, when it is only needed in rare cases*

Some of the research

delayed cord clampingSo, we have strong evidence that preterm babies (less than 32 weeks of pregnancy) have increased blood volume when the umbilical cord is clamped between 60-75 seconds after birth as opposed to clamping it within 30-45 seconds [6]. While 60-75 seconds is hardly enough time to allow for a full blood transfer from the cord to the baby, we can already see that compared to the early cord clamping, these few extra seconds result in reduced need for blood transfusion, respiratory interventions and less hypothermia for the baby. Without having to give any drugs, without requiring any effort, just for waiting a bit longer. This is a significant benefit for waiting 40 more seconds before clamping the cord. And it costs nothing!

Another study found that the results of clamping the cord of term babies within 90-120 seconds after birth are clearly visible 2 months postpartum! [7]. Blood hematocrit, hemoglobin and iron levels were all higher with delayed cord clamping, which means that these babies were protected from developing anemia early in life. A last piece of evidence, re-emphasizes that delayed cord clamping = babies doing much better from the very beginning [8]. Here, premature babies who had their cord cut immediately required more blood transfusions and were more likely to have persistent hypotension, although they received 3 times more treatments for raising their blood pressure.

Knowing that Class 3 bleeding requires transfusions and is characterized by low blood pressure, is this finding really a surprise?

Closing thoughts

There is a lot more evidence to consider when it comes to delayed cord clamping vs. immediate cord clamping. After a while you get to see a clear pattern, which is the very reasonable and simple fact that newborn babies, just like adults, do better with all their blood in its position, which is inside the body. The few pieces of evidence I present above add little knowledge to what we know already for a few years now. A review of the medical literature from 2012 already emphasizes all these benefits for babies [9].

As with all medical interventions and life in general, there is no greater power than knowledge. The current medical system will (hopefully) adopt and finally accept the simple truth that waiting for the cord to stop pulsating is the natural way to do this, which by the way helps babies and their mothers thrive from the very beginning. Until this knowledge is included in medical reference books, it is the responsibility of the mothers, like me and you to be aware of the long-lasting power of such simple choices in our babies´ lives, which we have a duty to safeguard always.

References

[1] The American congress of obstetricians and gynecologists. 2012. Timing of the umbilical cord clamping after birth.
[2] Faith Gibson. 2012. History and impact of premature cord clamping – Part 1.
[3] Kathy Valeii. 2012. How birth 100 years ago impacts birth today.
[4] The Guardian. 2013. Cutting cord too early puts babies at risk, NHS warned.
[5] Guideline: Delayed Umbilical Cord Clamping for Improved Maternal and Infant Health and Nutrition Outcomes. Geneva: World Health Organization; 2014. WHO Guidelines Approved by the Guidelines Review Committee.
[6] Song D. et al. 2015. Duration of Cord Clamping and Neonatal Outcomes in Very Preterm Infants. PLoS One. 10(9):e0138829. doi: 10.1371/journal.pone.0138829. eCollection 2015.
[7] Aktug Ertekin A. et al. 2015. Early versus delayed cord clamping: Effects on hematologic status in term infants. J Matern Fetal Neonatal Med.13:1-16.
[8] Backes CH. et al. 2015. Timing of umbilical cord clamping among infants born at 22 through 27 weeks’ gestation. J Perinatol. doi: 10.1038/jp.2015.117.
[9] Tonse N. et al. 2012. OPTIMAL TIMING FOR CLAMPING THE UMBILICAL CORD AFTER BIRTH. Clin Perinatol. 39(4): 10.1016/j.clp.2012.09.006.

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