Umbilical cord clamping—just 90 seconds makes a difference
The optimal time to clamp the umbilical cord is unclear. The need to research the optimal timing became apparent with the finding that more and more children are anaemic in early childhood. A review of studies shows that early clamping negatively affects iron levels in newborns (Paddock, 2013). For this reason, a number of studies have been carried out showing that it is better for the newborn if we wait at least 90 seconds before clamping the cord. Based on this, the WHO (2014) issued a recommendation that the cord be clamped between 1 and 3 minutes after birth. In cases where the newborn needs immediate resuscitation and care from a neonatologist, the cord should be clamped earlier than one minute after birth.
Bhatt, Polglase, Wallace, te Pas, and Hooper (2014) believe that a precisely defined time for cord clamping is not optimal for all newborns and that the timing should be determined by the newborn’s physiology. Tolosa, Park, Eve, Klasko, Borlongan, and Sanberg (2010) say that later cord clamping is not associated with certain physiological conditions in the newborn, such as jaundice, grunting, tachypnoea, polycythaemia, and hyperviscosity, as can be found in some articles. There are more benefits than harms if we don’t clamp the cord too early. Ersdal, Linde, Mduma, Auesdat, and Perlman (2014) report a higher likelihood of death and hospitalisations after discharge if the cord is clamped immediately after the baby starts breathing spontaneously. Mercer, Vohr, McGrath, Padbury, Wallach, and Oh (2006) showed in their study of preterm infants who had to be intubated immediately after birth that there was no difference in mortality between preterm infants intubated before cord clamping and after it; however, they observed that preterm infants whose cords were clamped after intubation had fewer brain haemorrhages and developed sepsis less often.
Cranford (2011) states that we should wait to clamp the cord until the placenta is delivered, or at least until the cord stops pulsating. This way, the newborn receives 40–50% more blood, haematocrit increases by 45%, the number of red blood cells increases by about 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 haemorrhagic disease of the newborn—hypoprothrombinaemia (Evans, 2012, cited in Fogelson, 2011). Maloy (2013) also states that the cord should be clamped once it has done its job—when it stops pulsating. At that point, it changes from firm, bluish-purple to an “exhausted” white cord. She advises couples to ask midwives to clamp the cord only after the placenta is delivered. That way we can be 100% sure that the placenta and cord have done their job. 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. Wharton’s jelly will also solidify, and blood from the newborn will not travel back to the placenta. Tritten (2012) never separates mother and baby. She says that all routine procedures can be done on or next to the mother, and that the cord should be clamped when the placenta is delivered. If we wait for the placenta and cord to do their work, the baby will also certainly receive enough stem cells.
Further research is still needed on delayed cord clamping and its impact on breastfeeding and bonding, since an intact cord in itself requires physical closeness between mother and baby (Eichenbaum-Pikser, Zasloff, 2009). This means that deciding when to clamp the cord remains in the hands of midwifery care providers. In Slovenia, these are maternity hospitals and four independent midwives. The decision is based mainly on personal preferences. As professionals, we need to stay open and look for the best option for the baby and the mother. From the research summarised, we can see that even 90 seconds can make a big difference to a newborn’s quality of life. From practice, we know that most often we follow one of the mentioned “P’s” in the delivery room for a better birth experience—“Listen to the birthing woman”—and 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 shows why it’s important to wait before clamping the umbilical cord. I think her presentation is worth showing to healthcare professionals who work with women in labour, as they will be able to see the harm done if we don’t wait before clamping the cord.
New Technology at Sharp Mary Birch
A presentation by a doctor raising awareness among other healthcare professionals to leave the cord intact, even if the baby needs paediatric care. In the video, they have a movable “niche” for newborns. Very commendable, as a doctor will listen to a doctor sooner, even though some midwives have been trying to introduce this practice for quite some time. Maybe one day we will also have such platforms for newborns who need immediate paediatric care after birth.
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