Birth: Delaying Umbilical Cord Clamping

Clamping and cutting of the umbilical cord should be delayed for three minutes after birth, particularly for pre-term infants, suggests a senior doctor in the British Medical Journal. 28/08/2007

Early clamping and cutting of the umbilical cord is widely practised as part of the management of labour, but recent studies suggest that it may be harmful to the baby. Dr Andrew Weeks, a senior lecturer in obstetrics at the University of Liverpool, looked at the evidence behind cord clamping. For the mother, trials show that early cord clamping has no ill effects, he writes.

But what about the baby: At birth, he says, the umbilical cord sends oxygen-rich blood to the lungs until breathing establishes. So as long as the cord is unclamped, the average transfusion to the newborn is equivalent to 21 percent of the neonate’s final blood volume and three quarters of the transfusion occurs in the first minute after birth. For babies born at term, the main effect of this large autotransfusion is to increase their iron status.

This may be lifesaving in areas where anaemia is endemic. In the developed world, however, there have been concerns that it could increase the risk of polycythaemia and hyperbilirubinaemia (abnormally high levels of red blood cells and bile pigments in the bloodstream, often leading to jaundice). But trials show this is not the case.

For pre-term babies the beneficial effects of delayed clamping may be greater, he says. Although the studies are smaller, delayed clamping is consistently associated with reductions in anaemia, bleeding in the brain, and the need for transfusion.

He proposes that in normal deliveries, delaying cord clamping for three minutes with the baby on the mother’s abdomen should not be too difficult. The situation is a little more complex for babies born by caesarean section or for those who need support soon after birth. Nevertheless, it is these babies who may benefit most from a delay in cord clamping. For them, a policy of ‘wait a minute’ would be pragmatic, he says.

Source: British Medical Journal