More support for delayed cord clamping

3098564180_52b7d80670An updated RCOG scientific impact paper has added further support for delayed cord clamping. It has warned that immediate cord clamping can be harmful to babies by negatively affecting their blood flow and reducing iron stores. The latter is associated with neurodevelopmental delay in babies.

The paper also acknowledges that early cord clamping, which has been a mainstay of medical management of the birth of the placenta for several decades despite a lack of evidence to support such interference, can negatively interfere with the baby’s transition from fetal to neonatal circulation.

The paper describes our current understanding of what happens physiologically in the baby’s first minutes of life, and explains why immediate cord clamping can be problematic:

“At birth, the umbilical circulation slows and pulmonary vascular resistance falls, rapidly increasing pulmonary blood flow. This is the beginning of the transition from the fetal to the neonatal circulation. Continued flow in the umbilical vein and arteries at birth may be part of the physiological mechanisms assisting the baby as it makes this transition.  Immediate cord clamping may restrict the baby’s ability to deal with the transition from the fetal to the neonatal circulation. While most healthy babies at term adapt without major consequences, for those born preterm or with their cardiorespiratory circulation already impaired, there may be an impact on clinical outcome. A brief delay in cord clamping will increase the baby’s blood volume. With a longer delay there may be other advantages, such as better cardiorespiratory transition and more stable blood pressure, and these might occur even with no further change in net blood volume.”

In the report, delayed (or deferred, as the RCOG have chosen to term it, claiming that “the previously used ‘delayed’ … might be felt to imply later than ideal”, although optimal might be an even better term) cord clamping is defined as being at least two minutes after birth, although women who want the cord to be left intact for longer than this should be supported in this.

The full report can be found here and the BMJ have also reported on it.

Wondering what to do with the extra time between birth and cord clamping?!

Ten things you can do before clamping the umbilical cord…

 

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References

Royal College of Obstetricians & Gynaecologists. Clamping of the umbilical cord and placental transfusion: scientific impact paper No 14. 27 Feb 2015. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/sip14.

photo credit: Cutting the cord via photopin (license)

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