Delayed Umbilical Cord Clamping- Know the facts so you can make the call.
The process of Delayed Umbilical Cord Clamping involves allowing the cord to finish pulsating or the placenta to be delivered before clamping, but what are the benefits? According to the journal of Obstetrics, Gynaecology and Reproductive Medicine (2017), the timing of umbilical cord clamping is “believed to greatly affect placental transfusion rate and therefore neonatal and infant circulation” (Argyridis, 2017). It is also believed that increased haemoglobin levels and lower iron deficiency rates are closely related to a 30-60 second delay in cord clamping. Allowing time for complete placental transfusion can encourage blood circulation within the infant and further supports the delivery of nutrients to body systems and oxygen perfusion (Pittman, 2011). A study completed by British Medical Journal involved 400 randomized full term infants born after a low risk pregnancy, with the first group experiencing cord clamping 180 seconds or more after delivery and the second group 10 seconds or less after delivery. It was found that at four months of age, there were no compelling differences in haemoglobin levels between the two groups, however average ferritin levels were 45% higher as well as a lower levels of iron deficiency within those infants who experienced delayed cord clamping (Andersson et al. 2011). “Delayed cord clamping, compared with early clamping, resulted in improved iron status and reduced prevalence of iron deficiency at 4 months of age, and reduced prevalence of neonatal anaemia, without demonstrable adverse effects” Andersson et al (2011). There has also been evidence of possible neurodevelopmental benefit later in life for infants who have had delayed cord clamping (Argyridis, 2017). As for adverse maternal outcomes like post partum haemorrhage, according to the journal of Obstetrics, Gynaecology and Reproductive Medicine (2017), there has been no correlation between these outcomes and the delay in cord clamping (Argyridis, 2017). The World Health Organization however, recommends at least 1-3 minutes before the clamping of the umbilical cord in the prevention and treatment of post partum haemorrhage. “The evidence base for recommendations on the optimal timing of umbilical cord clamping for the prevention of postpartum haemorrhage includes both vaginal and caesarean births” (WHO, 2012). The recommendation for vaginal and caesarean as well as pre and full term infants were of the equal importance to the WHO guideline development group. It was recommended that umbilical cord clamping of less than 1 minute after birth is not recommended unless emergency requirements need to take place (resuscitation etc.). Focusing on what is appropriate for your birth at the time is essential, however with the above information and statistics available, it raises the question of instant cord clamping practice and the evidence surrounding it. What’s the rush…?
Andersson, O., Hellström-Westas, L., Andersson, D. and Domellöf, M., 2011. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial. Bmj, 343, p.d7157.
Argyridis, S., 2017. Delayed cord clamping. Obstetrics, Gynaecology & Reproductive Medicine.
Pittman, R.N., 2011. The circulatory system and oxygen transport.
World Health Organization (WHO), 2012, Optimal timing of cord clamping for the prevention of iron deficiency anaemia in infants, <http://www.who.int/elena/titles/full_recommendations/cord_clamping/en/>
Photo credit Dr. Adhi Arya.