by Amanda Burleigh and Hannah Tizard
Optimal cord clamping.
Conception to birth is a miracle, but many people are not aware that immediately following delivery of your baby the placenta and cord continue their function in transferring valuable cord blood to the baby whilst the baby transitions to life outside their mother. Transition is so important whilst baby uses their lungs to oxygenate their body for the very first time.
For approximately 50-60 years most birth attendants have clamped and cut the cord immediately the baby has been born, often before the baby has taken its first breath. There has never been any evidence to support this practice and recent national and international guidance recommends the umbilical cord should be left intact for at least one minute. Immediate cord clamping can deprive the baby of at least 30% of their intended blood volume and research shows that babies can gain up to 214g in the first five minutes following birth if the cord is left unclamped. (Farrar 2010) Further research shows that babies who have immediate cord clamping have a greater incidence of iron deficiency anaemia as valuable red cells are left behind and that out of this same group of babies some male babies have decreased fine motor and social skills at the age of four. (Andersson 2011) Cord blood also has a very high concentration of stem cells, important in development throughout the baby’s whole life. (Mercer 2012).
New NICE guidance published in December 2014 recommends delaying cord clamping for at least one minute for all babies regardless of delivery unless the baby’s heart rate is less than 60bpm and not getting faster. This is an extremely rare occurrence. Some babies can be a little stunned at delivery but it is important to remember that the placenta and cord are still transferring oxygenated blood through to the baby as they did when baby was in the uterus and the majority of babies will spontaneously recover without any intervention when the cord is left intact. Your birth attendant will dry the baby to stimulate them and place the baby in skin to skin to help with transition, temperature control and bonding. Early feeding can help this process along and can also aid placental delivery and reduce blood loss immediately following delivery. All of this can be done with the cord intact.
When the cord has fully completed its function, it will stop pulsating. Your baby will have received all their intended blood volume and the cord will be empty and white. As this is the healthiest way for the baby to be delivered we have commenced a campaign called #waitforwhite to raise awareness.
With informed choice it is a common practice to administer an oxytocic (hormone) drug by injection after the baby is born to help deliver the placenta and reduce the incidence of post-partum haemorrhage. Historically this injection is often given immediately after delivery but in uncomplicated births, ideally in low risk women it could be given a few minutes after birth (or when the cord has stopped pulsating) and the cord clamped a few minutes after administration of the injection. This way the baby gets their full transfusion with no interference. Many birth units have adopted this method of managing the third stage of labour and it is called delayed active management.
Physiological third stage of labour.
After informed choice many parents choose to have no drugs to aid the delivery of the placenta and allow the placenta to deliver itself. The cord is left intact throughout the whole process. Normally the placenta delivers within the first 20-30 minutes, although some can take longer.
Some parents opt to leave the placenta and baby attached to each other until the cord dries out and separation occurs naturally. This takes a few days.
Farrar D, Airey R, Law GR, Tuffnel D, Cattle B, Duley L. Measuring placental transfusions for term babies: weighing babies with cord intact. BJOG. 2011;118:70-75.
Andersson O, Hellstrom-Westas L, Andersson D, Domellof M. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial. BMJ. 2011;343:d7157.
Andersson, O., Lindquist, B., Lindgren, M., Stjernqvist, K., Domellöf, M. and Hellström-Westas, L. (2015). Effect of Delayed Cord Clamping on Neurodevelopment at 4 Years of Age. JAMA Pediatrics, 169(7), p.631.
Mercer, J. and Erickson-Owens, D. (2012). Rethinking Placental Transfusion and Cord Clamping Issues. The Journal of Perinatal & Neonatal Nursing, 26(3), pp.202-217.
NICE (2014) Intrapartum care: care of healthy women and their babies during childbirth. http://www.nice.org.uk/guidance/CG190. Accessed 10th September 2015