Thanks to a decade of campaigning and the determination of UK midwife Amanda Burleigh, the practice of cutting the umbilical cord seconds after birth is set to become a thing of the past.
The procedure became standard practice in the 1950s to prevent the hormone injection given post birth (to help expel the placenta) from entering the baby’s bloodstream.
However, numerous studies have since concluded that immediate cord clamping deprives newborns of up to a third of their blood volume, which included vital blood cells, including iron and white blood cells.
The National Institute of Health and Care Excellence, a peak body that provides national guidance and advice to improve health care in the UK, has now updated its medical guidelines with respect to cord clamping after birth. The new regulations for doctors and midwives now state cutting of the cord should not happen “earlier than one minute from the birth of the baby.” The new regulations also state that mothers should have the final say on how long the cord is left intact.
Amanda first questioned the practice of immediate cord clamping when she realised she was seeing a higher incidence of children with health issues. Her hunch that there was a connection to immediate cord clamping paid off, after she began to uncover evidence that supported a higher incidence of iron deficiency anaemia in babies who had their cords cut immediately after birth.
Iron deficiency anaemia has been linked to impaired brain development, particularly cognitive and behaviour delays. Another study revealed that immediate cord clamping resulted in lower birth weight. As early as 1995, research showed that delayed cord clamping provided babies with a significant 32% increase in blood volume.
While the evidence supports the change in guidelines, Amanda says resistance to changing the protocol has been strong, with doctors and midwives entrenched in the old practice and feeling there is no reason to change. Many medical staff still cite jaundice and the baby receiving ‘too much blood’ as a reason to clamp and cut immediately. Yet there are no evidenced-based research studies that validate these claims.
Now that NICE has changed its guidelines to reflect the best practice evidence, Amanda hopes that practitioners will be less resistant to change.
In Australia and the US, there is a rising trend of women taking ownership of this critical stage of their birth. Many are now requesting a natural third stage with the umbilical cord being left intact, until it has stopped pulsating or until the placenta has separated. As consumers of the maternity care system, demand for evidence based practice can influence change. It is vital birthing woman are informed and made aware of the choices available to them and request their caregivers follow best practice guidelines. Most studies have shown benefits after delaying clamping for at least two minutes, so leaving the cord well alone is ideal. There have been no reported side effects of waiting longer.
Amanda, recently named Midwife of the Year by the British Journal Of Midwifery, plans to keep campaigning for global change around the practice of cord clamping. Writing for the Telegraph she says “I couldn’t sit back and ignore what I had seen when it became visible to me. Because if we see something that’s wrong, we have to change it. I think we’ll look back in years to come and realise that immediate cord clamping was not a good idea.”
Interestingly, in 1801, Erasmus Darwin warned, “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.”
Hopefully, we'll finally get see this long overdue change — around the world.
More information about delayed cord clamping can be found here: