To Delay Or Not To Delay?

Delayed Cord Clamping – By Helen Cotter

The practice of delayed cord clamping involves leaving the cord to pulsate for two to three minutes after birth until it stops pulsing, or the placenta appears at the introitus.  As the cord continues to pulsate, the baby receives more oxygenated blood.  During this time, the baby receives 25-40% more blood volume from the placenta than it has at the moment of birth.    Proponents of this practice believe that delayed cord clamping promotes an easier transition to the outside world for baby.  They also believe that there are benefits to receiving this additional blood because additional iron stores could help prevent neonatal anemia.  Compounding the difficulty of infantile anemia, breastfed babies don’t receive iron through breast milk and so need to have enough stored until they begin eating solid foods.  Studies revealed that delayed cord clamping increases neonatal iron stores, both at birth and for up to six months after birth.  A joint statement from the International Federation of Gynecology and Obstetrics and the International Confederation of Midwives recommends that “delayed cord clamping be incorporated as part of the active management approach to placental delivery.”

Opponents of delayed cord clamping are concerned about the following possible harmful effects:  excessive maternal blood loss, neonatal respiratory distress, polycythemia (an excess of red blood cells), hyperviscosity syndrome (an increase in the thickness and consistency of the blood; often seen with polycythemia, and can lead to spontaneous bleeding from mucous membranes), and hyperbilirubinemia (a precursor to neonatal jaundice; caused by inability of the immature liver to process the by-products of red blood cells breaking down).  All included studies found an increase of hyperbilirubinemia in babies with delayed cord clamping.  Buth the increase was within a physiological range, which meant there was no need for treatment.  Of the studies that analyzed other outcomes, none found any difference in rates of respiratory distress, polycythemia, hyperviscosity syndrome, or maternal blood loss.

The implications for midwifery practice are that delayed cord clamping is beneficial for babies (especially when the iron status of the mother is compromised), and should be incorporated into practice whenever possible.  It is apparent from the studies that delayed cord clamping is compatible with active management of third stage labor and that there are no risks to the baby or the mother.  The practice has therefore been shown to be safe, and should be implemented to improve the iron status of infants at birth and for the first six months of life.

~ by cmb0414 on April 16, 2010.

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