Delayed cord clamping for 3 minutes or longer has long term benefits to the neonate, does NO harm and does not affect the mother in a negative way.
Conversely, immediate clamping of the umbilical cord leads to a higher incidence of anaemia or iron deficiency on infants at 4 months of age. Seeing that iron deficiency and lowered blood oxygen levels are associated with delays in early infant development, clamping and cutting the cord immediately after birth seems counterproductive and counter-intuitive. Physiological cord vessel closure occurs after the newborn baby’s lungs are inflated by the extra volume of blood transfused via the umbilical cord from the placenta. This capillary inflation stimulates the gasping reflex and the baby breathes. It is therefore expedient to allow the baby to remain level with the mother’s body for a few minutes after the birth.
But there are other concerns here: When 34% of women who die in childbirth in 3rd world countries and 13% of women (who die in childbirth) in developed countries are dying from post-partum haemorrhage, active management of the third stage of labour saves women’s lives. Active management of the third stage of labour is characterized by immediate cord clamping and administration of an intra-muscular injection of oxytocin. Most medical workers in and out of hospitals have, up till now, been encouraged to follow this protocol globally.
Immediate cord clamping is however detrimental to the newborn and developing infant. Clearly protocols need to be modified.
I recommend the following:
- A comprehensive medical, surgical history and nutritional status must be obtained from ALL pregnant women so as to establish what the risk may be of post-partum haemorrhage (PPH), such as history of haemophilia in the family, nose bleeds, haemorrhage with previous births, approximate expected size of the baby(large babies are associated with PPH), or pregnancy illness such as diabetes and Gestational Proteinuric Hypertension for example.
- Supplementing the mother’s diet with vitamins and minerals and sometimes herbal substances and ensure long term nutritional health by counselling about diet and lifestyle
- Establish what the risk might be of a long labour, exhaustion, large baby, twins etc and be prepared with an intravenous line in situ, Syntocinon or other uterotonics at the ready.
- If a mother is haemorrhaging, attend to this immediately, and establish the source. Sometimes bleeding is due to trauma of the pelvic floor and tearing, when the uterus is actually well contracted. Manual pressure is required in this instance and call for assistance. ‘Delaying cord clamping’ does not mean doing this at the expense of the mother.
- Physiological 3rd stage works best when mother and baby are NOT DISTURBED after the birth. Skin to skin and eye contact between mother and baby is ideal and elicits the release of maternal oxytocin which contracts the uterus and aids the expulsion of the placenta. In an article called “Don’t wake the Mother”, world famous obstetrician Dr Michel Odent documents reasons why mother and baby must be UNDISTURBED for the first hour after birth.
- It works even better if the mother initiates the first contact with her baby. In other words, allow the mother to touch and pick her baby up after birth rather than ‘hand’ the baby to her before she is ready to receive him.
- When a newborn requires resuscitation, attend to this BEFORE worrying about the cord or the placenta. The extra blood flow through the cord to the baby may mean the difference between life and death if a baby is compromised at birth. A hypovolaemic baby is much more difficult to resuscitate and stabilize than a baby with an adequate blood volume.
- Babies born by caesarian section can be laid next to the mother on the operating theatre table and covered with a warm blanket for 1-3 minutes before clamping and cutting the cord is implemented.
In practice I rarely cut the cord before the placenta is expelled. While some parents choose to cut the cord within the first hour of birth, some parents keep the placenta attached until it detaches spontaneously. This is called a lotus birth and it is best to keep the placenta in a salted container to delay decay. The cord dries, shrivels and falls off at the navel of the baby within a few days. The parents preferences around the rituals they may choose should be honoured. The important message here is DON’T CUT THE CORD for at the very least 3-5 minutes after the baby is born.
Erasmus Darwin, a doctor in the 19th century observed:
“Another thing very injurious to the child, is the tying and cutting of the navel string too soon; which should always be left till the child has not only repeatedly breathed but till all pulsation in the cord ceases. As otherwise the child is much weaker than it ought to be, a portion of the blood being left in the placenta, which ought to have been in the child” (Darwin E. (1801) Zoonomia, 3rd edition. London: vol III page 302).