Friday, January 13, 2012

Delayed Cord Clamping... Best for Babe.

Until recently, immediate clamping and cutting the cord was routine obstetrics. The baby was born and the cord was clamped within seconds, extinguishing the flow of quality blood from the placenta to the newborn. Till this day, many newborns still suffer through this as many physicians have yet to adopt the practice of delayed cord cutting.
Many studies have shown that by delaying cord clamping, even just 30 seconds, babies benefit immensely. The rich blood that continues to flow to the baby contains vital stem cells, hemoglobin, iron, ferritin and oxygen. In return the liver continues to produce toxins which are released via the cord to the placenta. As nature would have intended, studies show that babies benefit from a natural approach to the matter instead of the intervention of clamping prematurely.
Lets take each component separately and dissect the benefits to the babe. Hematopoietic stem cells are cells that differentiate into cells that build bone, cartilage, connective tissue and are also very effective in aiding the body's natural inflammatory response to damaged or injured cells. Research has shown that stem cells can mediate against cancer and immune disorders as well. Many of us are aware that the option of banking cord blood for late use is becoming increasing popular despite the extreme financial obligation. Why not bank those precious stem cells in the baby, where they belong?
Hemoglobin is a blood component that carries and deliveries oxygen throughout the body. By delaying cord clamping by even 1 minute babies receive 80 milliliters more blood and up to 100 milliliters at three minutes. By giving our babies more hemoglobin we are also reducing the likelihood of respiratory distress and tachypnea (rapid breathing)of the newborn thus eliminating a trip to the NICU.
Immediate versus delayed umbilical cord clamping in premature neonates born < 35 weeks: a prospective, randomized, controlled study (11)
Randomized 60 infants to clamping at 5-10 seconds vs. 30-45 seconds.  Delayed clamping infants had higher BPs and hematocrits.  Infants < 1500 grams with delayed clamping needed less mechanical ventilation and surfactant.  Trend towards more polycythemia in delayed group, but not statistically significant.
Iron and ferritin, a blood product that stores iron,  are a major factor during infancy especially in anemic societies. Babies are prone to becoming anemic which can negatively effect neurodevelopment. When this extra iron is added to the approximately 75 mg/kg of body iron that a full-term newborn is born with, the total amount of iron can reach 115–125 mg/kg of body weight, which may help prevent iron deficiency during the first year of life.
Iron levels are considerably higher in infants at four months and six months of age when compared to babies whose cord was immediately clamped.
Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomized controlled trial(9)
Randomized 476 infants to immediate or 2 minute delayed clamping and followed them for 6 months.  Delayed clamped babies had higher MCVs (81 vs. 79.5), higher ferritins (50.7 vs. 34.4), and higher total body iron.  Effects were greater in infants born to iron deficient mothers.  Delayed clamping increased total iron stores by 27-47mg.  A follow up study showed that lead exposed infants with delayed clamping also had lower serum lead levels than immediate clamped infants, likely due to iron mediates changes in lead absorption.

Cord clamping seems perfectly reasonable when were talking about a vaginal delivery of a healthy term infant, but what about babies born via cesarean, pre-term or those that are compromised? How can we ensure that those babies, who may benefit most, receive the valuable cord blood that nature intended? Some medical professionals error on the side that even though babies are born prematurely it is in their best interest to delay cord clamping even if it delays resuscitation as surely receiving extra amounts of oxygenated blood would provide more than what premature lungs can. Studies also show that there is less risk of Intraventricular hemorrhage and necrotizing colitis which are prevalent in pre-term infants. This has yet to be adopted in neonatal resuscitation guidelines and need further research before considered safe.
Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial(7)
Randomized 72 VLBW infants (< 1500 grams) to immediate or delayed cord clamping (5-10 vs. 30-45 seconds).  Delayed cord clamp infants had significantly less IVH (5/36 in delayed group vs. 13/36 in immediate group, p = 0.03) and less late onset sepsis (1/36 vs. 8/36, p = 0.03).
Cesarean born babies pose further questions and changes in policy. Allowing skin to skin with the mother is quite progressive during this surgical procedure but delaying the cord clamping seems nearly impossible as prolonged sewing up the mother carries more risks. I guess the problem and question here lies much deeper and goes back to the alarmingly increased rate of cesarean births not only here in the US but worldwide.

I find that discussing Lotus Birth coincides with this topic. Lotus birthing is taking delayed cord clamping one step further in which the placenta remains attached until the cord detaches from the infant around 10 days postpartum. This practice remains controversial as some practitioners find that a decomposing placenta is a prime feeding ground for bacteria that may travel up towards the infant. Others believe that having a Lotus Birth allows for the most naturally occurring process to take place. Dr. Sarah J. Buckley endorses this practice and has written a book titled, "Gentle Birth, Gentle Mothering". You can also read and listen to her viewpoints on her website,

There is a protocol to consider when contemplating a Lotus Birth. You should also consider how you will maneuver the baby and the placenta at the same time. This may also be a factor when you have visitors over and how they feel about handling the infant (which may be a positive thing during the immediate postpartum period:)). Most importantly do your due diligence and weigh out the pros and cons. I have also included a list containing the protocol of having a Lotus Birth.
Protocol Of Lotus Birth
  • When the baby is born, leave the umbilical cord intact. If the cord is around the baby's neck, simply lift it over.

  • Wait for the natural delivery of the placenta. Do not use oxytocin - this forces too much too soon into the infant and compromises the placenta delivery.

  • When the placenta delivers, place it into a receiving bowl beside the mother.

  • Wait for full transfusion of the umbilical blood into the baby before handling the placenta.

  • Gently wash the placenta with warm water and pat dry.

  • Place the placenta into a sieve or colander for 24hrs to allow drainage.

  • Wrap the placenta in absorbent material, a nappy or cloth and put in into a placenta bag. The covering is changed daily or more often if seepage occurs. Alternatively, the placenta may be laid on a bed of sea salt (which is changed daily) and liberally covered with salt.

  • The baby is held and fed as the mother wishes.

  • The baby is clothed loosely.

  • The baby can be bathed as usual - keep the placenta with it.

  • Keep movement to a minimum

  • There are many more things to consider with regards to the placenta in which I hope to later blog about. I find it all very fascinating to learn about all of the alternatives and how culturally we view the placenta very differently. Until then...


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