Cord Clamping – Even 90 Seconds Makes a Difference
The optimal time for cord clamping is unclear. The need to research the optimal time for cord clamping emerged with the finding that more and more children in early childhood are anemic. A review of studies proves that early clamping negatively affects iron content in newborns (Paddock, 2013). Thus, quite a few studies have been conducted on this topic, proving that it is better for the newborn if we wait at least 90 seconds before clamping the cord. Based on this, WHO (2014) formed a recommendation that the cord should be clamped between 1 and 3 minutes after birth. In cases where the newborn requires immediate resuscitation and neonatologist care, the cord should be clamped earlier than one minute after birth.
Bhatt, Polglase, Wallace, te Pas, Hooper (2014) believe that a precisely determined time for cord clamping is not optimal for all newborns and that the time for clamping should be determined by the newborn’s physiology. Tolosa, Park, Eve, Klasko, Borlongan, and Sanberg (2010) say that delayed cord clamping is not associated with certain physiological phenomena in the newborn, such as jaundice, grunting, tachypnea, polycythemia, and hyperviscosity, as can be found in some articles. There are more benefits than harm if we do not clamp the cord too early. Ersdal, Linde, Mduma, Auesdat, Perlman (2014) cite a higher probability of death and hospitalizations after discharge if the cord is clamped immediately after the baby breathes spontaneously. Mercer, Vohr, McGrath, Padbury, Wallach, Oh (2006) in their study with premature infants who had to be intubated immediately after birth proved that although there was no difference in mortality between premature infants who were intubated before and after cord clamping, they observed that premature infants who had their cord clamped after intubation had fewer brain hemorrhages and were less likely to develop sepsis.
Cranford (2011) states that we should wait with cord clamping long enough for the placenta to be delivered or at least long enough for the cord to stop pulsating. This way the newborn receives 40–50% more blood, hematocrit increases by 45%, the number of red blood cells increases by approximately 50%, ferritin levels increase, and the baby receives more clotting factors than if the cord is clamped before it stops pulsating. Blood viscosity also increases, which prevents the occurrence of hemorrhagic disease of the newborn – hypoprothrombinemia (Evans, 2012 cited in Fogelson, 2011). Maloy (2013) also states that the cord should be clamped when it has completed its function, when it stops pulsating. At that point, it changes from a firm, blue-violet color to an “exhausted” white cord. He advises that couples ask midwives to clamp the cord only after the placenta is delivered. This way we can be 100% sure that the placenta and cord have completed their function. O’Bryant (2010) also states that we should give the mother and newborn time after birth, at least one hour. During this time the placenta will be delivered and the cord will certainly stop pulsating, so there is no need for clamping. At that point, Wharton’s jelly will also solidify and blood from the newborn will not flow back into the placenta. Tritten (2012) never separates mother and baby. She says that all routine procedures can be performed on or next to the mother and the cord should be clamped when the placenta is delivered. If we wait for the placenta and cord to complete their work, the baby will certainly receive enough stem cells.
Further research needs to be done in connection with delayed cord clamping and its impact on breastfeeding and bonding, as an intact cord inherently requires physical closeness between mother and baby (Eichenbaum-Pikser, Zasloff, 2009). Thus, determining the time for cord clamping remains in the hands of midwifery service providers. In Slovenia, these are maternity hospitals and four independent midwives. The decision is based primarily on personal preferences. As professionals, we must be open and find the best option for the baby and mother. From the summarized research, we see that even 90 seconds can greatly change the quality of life of the newborn. We know from practice that we most often follow one of the mentioned P’s in the delivery room for a better birth experience – “Listen to the woman giving birth” and we clamp the cord at the woman’s request (when it stops pulsating).
[youtube]https://www.youtube.com/watch?v=W3RywNup2CM&feature=youtu.be[/youtube]A video by Penny Simkin that practically demonstrates why it is important to wait with cord clamping. I believe her presentation is worth showing to healthcare workers who work with women giving birth, as they will be able to see what harm is done if we do not wait with cord clamping.
New Technology at Sharp Mary Birch
A presentation by a doctor who educates other healthcare workers to leave the cord unclamped, even if the baby needs pediatric care. In the video, they have a mobile “warmer” for newborns. Very commendable, as a doctor will listen to a doctor sooner, even though some midwives have wanted to introduce this practice for some time. Perhaps one day we will also have such platforms for newborns who need immediate pediatric care after birth.
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