Delayed cord clamping may benefit baby

Waiting even one minute to clamp boosts hemoglobin and iron levels

baby feetContributed by Ronald Hirth, MD

I understand expecting parents have a lot of questions concerning the delivery of their babies. The myriad of choices and decisions seems endless. And while I hate to add to that list, I do think it’s important to share some important information regarding an on-going controversy in obstetrics.

First, a little background. In most U.S. delivery rooms, a baby’s umbilical cord is clamped within 30 seconds after birth. But in many other countries, doctors wait two to three minutes after delivery to clamp and cut the cord. The timing of cord clamping has been the subject of much debate in the medical community over the years. In the past, it was believed that early clamping was associated with better circulation in newborns and reduced risk of hemorrhage in mothers. Since then, several studies have shown definitive benefit in some groups of babies while simultaneously failing to show any real benefit in other groups.

What does delayed cord clamping mean?

Delayed cord clamping means waiting one to three minutes after delivery to clamp and cut the umbilical cord. During this time, blood continues to flow from the placenta to the baby.

What are the benefits of delayed cord clamping?

Recent studies showed that waiting, even just one minute, to clamp offered some benefits for premature babies:

  • Higher hemoglobin (molecule in red blood cells that carries oxygen to the body) levels one to two days after birth.
  • Lower rates of iron deficiency three to six months after birth.
  • Lower rates of intraventricular hemorrhage (bleeding in the brain).

The boost in iron is important, because low iron levels can lead to anemia, causing a range of problems, from decreased appetite, fatigue and irritability in infancy. Unfortunately, for infants that are term, we do not see the same benefits consistently in studies.

What are the risks of delayed cord clamping?

Delayed clamping was associated with a slightly higher risk of jaundice, but healthier blood and iron levels outweigh this small risk, as long as access to treatment (typically, light therapy) is available. No increased risks were found in mothers. However, delaying cord clamping will delay the transfer of the baby from the delivery attendant to the mother for “skin to skin contact” which has several important benefits including the regulation of the infant’s body temperature, early breast feeding and bonding. The infant cannot be raised above the level of the placenta before the cord is clamped because, theoretically, the blood flow in the umbilical cord can reverse. This would likely make the infant anemic. Clamping should not be delayed in an emergency involving either the mother’s or infant’s health.

Will delayed cord clamping become standard now?

The American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics agree that cord clamping for premature infants should be delayed for at least one minute in an otherwise normal delivery. They state the decision for term infants remains controversial and should be left to the patient and her provider. The World Health Organization, however, recommends waiting one to three minutes after birth to clamp the cord.

That said, mothers also have a say in when the cord is clamped. If you’re an expecting mother and think you’d like to delay the clamping of your baby’s umbilical cord, talk with your doctor ahead of time about the potential risks and benefits.

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