7 Myths About Delayed Cord Clamping

7 Myths About Delayed Cord Clamping
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Many maternity care providers continue to clamp the umbilical cord straight after an uncomplicated vaginal birth, despite the significant benefits of delayed cord clamping being very well known.

Delayed cord clamping (DCC) is the practice of leaving a baby’s umbilical cord unclamped and uncut, until after it’s finished pulsating — or until after the placenta has separated.

After your baby is born, her lungs take over the job of oxygenating her blood. When this happens, the vessels in the cord contract, and after 2-3 minutes, the blood flow to the placenta stops.

Waiting until the blood has stopped flowing from the placenta to the baby allows a more natural transition to life outside the womb. The blood in the placenta and cord flows to the baby, providing up to an extra 30% (almost one third) blood volume, including red blood cells, stem cells and iron.

Yet, some care providers still continue with immediate cord clamping, because they do not trust the transition process in the first moments following birth. Other care providers have only been taught about immediate cord clamping, and are reluctant to change their practice — even though there is little evidence to support it.

Often parents are told that DCC is not possible for a number of reasons. Here are 6 myths about DCC:

Myth #1: Only Premature Babies Benefit From DCC

It is true that premature babies gain massive benefits from DCC, including lowering the risk of bleeding on the brain and bowel injury. Premature babies gain the extra blood via the placenta and cord, improving their iron levels and reducing the need for blood transfusions.

If premature babies are provided with all these benefits, what about healthy, full term babies? There has been less research in this area but the few studies that have been done show similar results to those looking at preterm babies.

Full term babies that have delayed cord clamping have a much smoother transition to breathing than those whose cords are immediately clamped.

Myth #2: DCC Can Lead To Jaundice

One of the main objections to DCC is that babies are at greater risk of jaundice (hyperbilirubinemia). Bilirubin is produced when red blood cells breakdown and usually passes through the liver.

Jaundice occurs when bilirubin builds up faster than a newborn’s liver can pass it out of the body, turning the skin and eyes a yellow colour. Most babies have mild jaundice in the first few weeks after birth as their liver is still maturing. It is generally harmless but severe cases can cause deafness and brain damage if not treated properly, usually by phototherapy.

Studies have shown that delayed cord clamping shows no greater need for phototherapy between babies who had immediate cord clamping and those who had DCC.

Myth #3: DCC Can Lead To Severe Post Birth Bleeding

Early cord clamping was first documented as being harmful to babies as long ago as 1801 by Erasmus Darwin, who wrote: “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.”

Despite those early warnings of harm to babies, immediate cord clamping came into obstetric vogue during the 1960s. At the time it was believed that clamping the cord as soon as the baby was born prevented severe bleeding or postpartum haemorrhage (PPH).

Since then, ongoing research has failed to show that immediate cord clamping prevents PPH, yet the practice is firmly entrenched in most hospitals today. One very common practice that is linked to PPH is induction of labour with pharmaceutical drugs.

Myth #4: The Cord Needs To Be Cut If The Baby Needs Help Breathing

Approximately 10% of all newborns require some assistance to begin breathing after birth. About 1% of those babies will need resuscitation measures implemented to help them transition to life outside the uterus and in most cases it is known before birth that help will be needed.

Babies usually take their first breath outside the womb about ten seconds after birth. The first few breaths can be hard work for babies and may be shallow and even irregular. During this time, if the umbilical cord is left intact and is still pulsing, your baby is still receiving oxygen from the placenta.

Newborns who are born floppy, not moving, not breathing or crying need to be assessed and probably require resuscitation. While portable resuscitation units exist, they are rarely available in hospital settings. Most resuscitation equipment is kept in a fixed unit, usually on the other side of the birth room. Standard practice is to cut the umbilical cord and move the baby to the resuscitation table.

It is possible for babies to be assessed and assisted while remaining skin to skin or next to the mother but rarely implemented in hospitals due to lack of portable equipment and resuscitation guidelines.

Myth #5: If Baby Is On Your Stomach No Blood Can Flow From The Placenta

While gravity does matter in terms of placental transfusion, it only affects the length of time it takes. A baby that is placed at the same level or below the placenta receives full transfusion in about 3 minutes. A baby who is placed above the placenta (on the mother’s stomach or chest) will receive full transfusion in around 5 minutes.

Myth #6: The Baby Will Get Too Much Blood

After birth, the blood circulation that has sustained your baby for 9 months continues while baby establishes respiration. The flow of blood from placenta to baby and back to placenta does not end the moment the baby is born, so your baby receiving too much blood is almost physically impossible.

Between 0.4 to 4% of newborns develop polycythaemia, which is a high level of red blood cells. Delayed cord clamping is often blamed for polycythaemia but it also occurs as a result of placental insufficiency (when the placenta has not been working properly during pregnancy). Babies who are small for gestational age, or born to mothers who smoke or are diabetic can also develop polycythaemia.

Newborns with polycythaemia might have a ruddy or dusky color, are lethargic and may be poor feeders. Usually no treatment is required except to ensure baby is getting enough fluids.

In about 50% of babies with polycythaemia the blood can become too thick (hyperviscosity). This slows the flow of blood through blood vessels and interferes with oxygen delivery. In mild cases hyperviscosity requires no treatment. Severe cases of hyperviscosity might require treatment such as intravenous fluids (IV) or removal of some of the baby’s blood and replacing it with fluid (partial exchange transfusion).

Delayed cord clamping is becoming more desirable for parents as the evidence shows that immediate cord clamping has little to no benefit to babies and mothers. Immediately after birth, it can be easy to be focusing only on your baby and forget what is happening with the cord and placenta. Before the birth of your baby, ensure your care provider is clearly informed of your wishes to leave your baby’s cord intact.

Myth #7: Delayed Cord Clamping and Cord Blood Storage Are Compatible

Some parents are interested in banking their baby’s cord blood, believing it may save their baby from possible serious diseases in future. In an attempt to get the best of both worlds, they decide that they’d like to have both DCC and cord blood banking. Cord blood banks will even assure these parents that both can be done.

However, upon asking one leading Australian cord blood bank, they advised BellyBelly that they’d want to clamp the cord at one minute. Studies have shown 2-3 minutes is required for the benefits reported in studies.

Besides, why deprive your baby of those all important stem cells at birth — maybe they need them while still young? There’s also a great deal of question about stored cord blood’s usefulness as babies get older, which you can read about here.

Delayed cord clamping is set to become standard practice in the UK after 10 years of lobbying. So if it’s important enough for UK babies, it’s important enough for babies around the world.

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CONTRIBUTOR

Sam McCulloch enjoys talking so much about birth that she decided to become a birth educator and doula, supporting parents in making informed choices about their birth experience. In her spare time she watches Downton Abbey and has numerous creative projects on the go. She is mother to three beautiful little humans.


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