Delayed Cord Clamping
Umbilical cord blood is a baby's life blood until birth. It contains many wonderfully precious cells, like stem cells, red blood cells and white blood cells (including cancer-fighting T-cells) to help fight disease and infection. It makes sense that delayed cord clamping is a great option for newly born babies.
Yet common practice is to quickly cut off this source of valuable cells at the moment of birth. Three reasons for this are:
- Carers who believe that there is little or no benefit in delayed cord clamping, despite numerous studies and recommendations
- Carers who believe that delayed cord clamping can cause complications, despite numerous studies and recommendations
- Carers being in a hurry to finish the birth… despite numerous studies and recommendations
Giving birth ‘in the system’ plays a big part if the medical carer or establishment you give birth in wants to hurry up the process and get onto the next birth.
If that doesn’t derail you from delayed cord clamping already, there is now another hurdle – more recently, businesses have been set up to store this precious cord blood for you in case of future diseases.
This all sounds great in theory, but why deprive a baby of those super cells at birth and then give them back on the very small chance that a problem will appear later in life? Could there be a link to not having those super cells at birth and those illnesses?
Storing cord blood is not only extremely expensive, but it is also worth finding out exactly what cord blood has been successful in helping, and how common those conditions really are.
How Likely Is It That My Baby Will Need Stored Stem Cells?
According to Dr Sarah Buckley, in her well researched book Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices by Dr. Sarah Buckley:
- The likelihood of low-risk children needing their own stored cells has been estimated at 1 in 20,000
- Cord blood donations are likely to be ineffective for the treatment of adults, because the number of stem cells is too small
- Cord blood may contain pre-leukaemic changes and may increase the risk of relapse
- Autologous cord blood is only suitable for children who develop solid tumours, lymphomas or auto-immune disorders
- All other uses are speculative.
Then there is this from the Choice (a consumer advocacy organisation) website:
“The most common reason for transplantation in childhood is for leukaemia, but a donor's own cord blood is unlikely to be used. The most appropriate source of stem cells is another person, either a family member or an anonymous stem cell donor.”
Collection is also very lucrative for the collector (midwives get offered training in this too; some decline but some do it). Collectors get paid large amounts of money for doing the procedure. A midwife shares her thoughts about what she calls ‘stealing babies blood’ as an ex-collector of cord blood – cord blood collection – confessions of a vampire midwife.
It’s Not Just About Stem Cells – But a Whole Lot of Blood Too
Studies like this one published in 1995 show that infants who have delayed cord clamping end up with a whopping 32% more blood volume than infants who have immediate cord clamping – without any increased risks.
In a presentation to fellow medical professionals, delayed cord clamping advocate, Doctor Nicholas Fogelson says, “Delayed cord clamping clearly increases fetal haemoglobin, blood volume and iron stores. The evidence supports a clinical benefit of delayed clamping. There's really no strong evidence against delaying the cord clamping. When we talk about interventions in medicine, really, the burden of evidence is on the intervention. People say, “Delayed cord clamping, you can’t prove that that's an intervention that helps.” I'm like, “Oh, no, no, no, no! Delayed cord clamping is what we evolved to do. We evolved to get the blood that's in the placenta. I don't have to prove that that's right. You need to prove to me that phlebotomizing the baby of forty percent of its blood volume is right.”
You can watch Doctor Fogelson's full presentation at the end of this article.
In 2010, yet another study on the benefits of delayed cord clamping was published, which you can read here. They stated that early clamping may interfere with ’nature’s first stem cell transplant’.
A 2013 study on delayed cord clamping has just been published in the Cochrane database, again supporting the practice of delayed cord clamping.
Timing Of Cord Clamping
There has been an increasing number of studies published with regards to the timing of cord clamping, including a 16-month study which was published in 2006. You can read more about that study here. It was conducted at Hospital de Gineco Obstetrica in Mexico City, where over 350 mother/baby pairs were part of the study.
This study, consistently with many others, has provided solid evidence of the benefits of delayed clamping. The main benefits being:
- Increased levels of iron
- Lower risk of anaemia
- Fewer transfusions, and
- Fewer incidences of intraventricular haemorrhage.
A two-minute delay in cord clamping increased the child's iron reserve by 27-47 mg of iron, which is equivalent to 1-2 months of an infant's iron requirements. This could help to prevent iron deficiency from developing before 6 months of age.
A study from the University of Granada (2007) has similar findings, you can read it here.
While delayed clamping is beneficial for babies across the board, the studies found that the impact of delayed clamping is particularly significant for infants who have low birth weights, are born to iron-deficient mothers, are premature, or those who do not receive baby formula or iron-fortified milk.
Given that mother nature provided breastmilk for babies and not formulas, you would think she also supplied that valuable source of iron for a reason too. You may have noticed that formula companies promote iron deficiency rates to sell their products.
The studies have suggested that delayed clamping, for as little as two minutes, should be implemented as standard practice, however this is yet to happen at many hospitals. Some couples choose to leave the cord unclamped until it has stopped pulsating, which could take a few minutes or it could take ten – either way, the baby is able to have his or her supply of placental blood.
Delayed Cord Clamping & Donating/Storing Cord Blood
Delayed cord clamping is not often compatible with cord blood donation or storage. The reason being is that in order for them to collect the amount of blood they want to store, some collectors will say that they need the cord cut immediately, and some (as confirmed by one of the biggest Australian cord blood collection companies, as recently as September 2013) will only allow up to 60 seconds before they want the cord clamped.
This is not long enough for most of the benefits to reach your baby. If you would like your baby to have it’s full supply of cord blood, you may need to reconsider you plans to donate or store cord blood.
From the above recent study (2010) the following comments were made on cord collection:
“There remains no consensus among scientists and clinicians on cord clamping and proper cord blood collection,” concluded co-author and obstetrician Dr. Stephen Klasko, senior vice president of USF Health and dean of the USF College of Medicine. “The most important thing is to avoid losing valuable stems cells during and just after delivery.” So prevention is clearly better than cure – your baby will be better off keeping what is rightfully theirs.
Delayed Cord Clamping & Jaundice
You may be told that delayed clamping causes jaundice in babies by your carer or hospital. This is not true.
Babies are no more likely to become jaundiced by delaying cord clamping and there is no relation to jaundice and the time of the cord being clamped. In the studies, the bilirubin levels were within normal range no matter when the cord was clamped. (Excess bilirubin levels are what is associated with jaundice).
Here are some statements from recent studies to back this claim:
“There were no significant differences for other secondary outcome measures: plasma bilirubin levels at 24 to 48 hours, neonatal morbidity (respiratory distress, tachypnea, grunting, jaundice, seizures, sepsis, necrotizing enterocolitis), mortality (none), neonatal intensive care unit admission, length of hospital stay, disease up to 1 month of age, weight or rate of breast-feeding at 1 month, maternal postpartum blood-loss volume, and maternal hematocrit level at 24 hours postpartum.”
“Plasma bilirubin values as well as hyperbilirubinemia rates were similar in the 3 groups, which goes along with other authors’ observations.”
from the 2007 study at the University of Granada:
“…the clamping of the umbilical cord of newborns from full-term pregnancies, two minutes after the infant is expelled from the womb, makes no difference to hematocrit or hemoglobin levels of the umbilical cord vein compared to clamping the cord within 20 seconds. Thus, the study shows that early clamping (which is widely performed) is not justified.”
Further to this, Dr. Sarah Buckley’s well-researched article, A Natural Approach to the Third Stage of Labour’ states:
“Some studies have shown an increased risk of polycythemia (more red blood cells in the blood) and jaundice when the cord is clamped later. Polycythemia may be beneficial, in that more red cells means more oxygen being delivered to the tissues. The risk that polycythemia will cause the blood to become too thick (hyperviscosity syndrome), which is often used as an argument against delayed cord clamping, seems to be negligible in healthy babies. (Morley 1998)
Jaundice is almost certain when a baby gets his or her full quota of blood, and is caused by the breakdown of the normal excess of blood to produce bilirubin, the pigment that causes the yellow appearance of a jaundiced baby. There is, however, no evidence of adverse effects from this. (Morley 1998). One author has proposed that jaundice, which is present in almost all human infants to some extent, and which is often prolonged by breastfeeding, may actually be beneficial because of the anti-oxidant properties of bilirubin. (Gartner 1998)”
Delayed Cord Clamping & Blood Volume
You may also hear of concerns over the increase in blood volume and red blood cell volumes, overloading the heart and causing respiratory difficulties, as a result of delayed clamping. Again, this is not substantiated.
According to an article from the World Health Organization, they state: “These effects have not, however, been demonstrated. In fact, there is probably a self-regulatory mechanism in the infant which limits the extent of placental transfusion. Moreover, there is evidence that the circulatory system of the newborn is capable of rapid adjustment to an increase in blood volume and viscosity by increased fluid extravasation and dilation of blood vessels.”
Delayed Cord Clamping & Maternal Haemorrhage
Again, another unsubstantiated claim. As per the earlier studies, there was no significant maternal postpartum blood-loss volume which is echoed in the World Health Organisation article:
“Although there was some evidence that early clamping reduces the duration of the third stage of labour, there was no significant effect on the incidence of postpartum haemorrhage”.
Why Its Important To Watch The Cord!
Just after you have given birth, the last thing you are paying attention to is the umbilical cord! So if after reading this article you have decided not to have the cord clamped immediately, make sure you make it well known with your caregiver and at the hospital that you want to delay clamping of the cord, so your baby can have it’s full store of blood. Even in births I attend as a doula where my clients have requested this, the parents get lost in the moment of the birth and my eyes are on that umbilical cord. I’d highly recommend you consider a doula to help protect your birth preferences, amongst many other benefits which will make a difference to your birth experience. Also consider writing out your birth preferences and making sure the hospital, doctor and midwives have a copy – even leave one in your room to make sure they are clear.
Of course, there are some circumstances where the cord will need to be clamped immediately, including if you choose to have the third stage injection of syntometrine (which is like the drug they use through a drip to induce/augment you) to expel the placenta faster – obviously the cord will need to be cut right away in this managed form of third stage. You can chose a normal physiological third stage if you haven’t had syntocinon (pitocin in the USA) during your labour.
Why Aren’t More Obstetricians Delaying Cord Clamping?
You may be wondering why delayed cord clamping isn’t standard practice around the world. Why wouldn’t it be, if it means healthier babies and has no adverse effects? The answer is very clear – most obstetricians are reluctant to take up this practice.
According to THIS survey on the ‘Attitude of Obstetricians Towards Delayed Cord Clamping’, as published in the Journal of Obstetrics and Gynaecology, the results came back glaringly demonstrating that the reason obstetricians haven’t implemented delayed cord clamping is… wait for it… ‘difficulty implementing it into practice’. Yes, really.
I’m sure many of you are wondering why so many obstetricians really are so reluctant to implement a simple process which has such massive benefits for babies at the very beginning of their life. Why can’t a midwife clamp the cord later if the obstetrician is too busy?
Allowing the cord blood to flow until pulsation has ceased is yet another very sensible and healthy process that was practiced decades ago, before obstetrics even existed. So why doesn’t every baby deserve at least two minutes undisturbed? What happened to The Hippocratic Oath, historically sworn by doctors and other healthcare professionals, to practice medicine ethically? First, do no harm.
Erasmus Darwin published this in 1801:
“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.”
The Royal College of Obstetricians and Gynaecologists MUST and SHOULD produce guidelines for delayed cord clamping in obstetric practice for healthier mothers and babies. Then we would have no use for the term ‘delayed’ in cord clamping, as leaving the cord alone would be standard practice, and then, they would be in line with their oath on this issue.
Cord Clamping – A Final Word
Don’t be embarrassed or afraid to speak up if you believe your baby would benefit from delayed cord clamping – you wont get a second chance once the cord has been cut! Print off this article as well as the studies and present them to your carer if you would like to discuss delayed cord clamping with them.
More doctors are beginning to speak up about this issue, so lets all share what we find and help make major changes to the way we treat maternity care, which is so very important.
Finally, here is the fantastic four part presentation mentioned earlier. Doctor Nicholas Fogelson of Academic ObGyn discusses the physiologic and clinical impacts of delayed umbilical cord clamping, hoping to change the practice in his industry. In the video, he is presenting a lecture in the January 2011 joint Pediatric/Obgyn Grand Rounds at the University of South Carolina School of Medicine.
- DCC Fan Page On Facebook – Join a very active and informative Facebook page I created on delayed cord clamping.