Delayed Cord Clamping pros and cons for pregnant woman

In most post-natal situations, the umbilical cord is clamped within 1 minute of the baby being born, but with delayed cord clamping this procedure does not occur until at least 2 minutes has passed, usually longer.

The idea is to wait until the cord has stopped pulsing, which means that no more blood is being passed to the baby from the placenta, and then the cord is clamped. More and more parents are opting to have this done because it is believed to have great benefits to the newborn infant and research into this area certainly seems to support those claims.

WorlWHO Guideline - delayed umbilical cord clampingd Health Organization
“Delayed umbilical cord clamping (not earlier than 1 min after birth) is recommended for improved maternal and infant health and nutrition outcomes.”

Despite there being almost no risks to infants and their mothers when performing delayed cord clamping, it is important to note that delayed cord clamping should only be carried out on healthy infants and mothers without complications.

The World Health Organisation suggests that this procedure is safe to use on babies who are born full-term or prematurely as long as they do not require assistance in breathing; the cord being attached to the baby and mother can significantly hamper resuscitation efforts.

Evidence

 

Why not to cut the umbilical cord to early?

A very commen procedure is to cut the umbilical cord after 30 seconds after birth. But as Penny Simkin shows  there is good reasons to wait for at least two minutes until the cord stops pulsating.

When a baby is born their is babies blood in the babies body, but also out in the placenta and over the course of a view minutes the placenta will drain to the baby. Their also will be a litle bit of back and forth. But the goal is to get the placenta blood to the baby. All this blood belongs to the baby. The following blood indication is for an average size baby at birth.

When we leave the umbilical cord intact what happens is that graduately over time the blood that is out in the placenta will transfer to the baby, it takes a while, studies show us that about in two minutes 70% of the placenta blood will be transfered to the baby. But if we will wait till the cord stops pulsating all the blood that can get to the baby will done so.


45Tube-450ml30 ml blood
Shared between the babies body and the placenta at birth.

 

300 ml blood
The amount of blood in the babies body.

 

150 ml blood
The amount of blood remaining in the placenta after birth. If you wish to donate your baby’s cord blood you cannot delay cord clamping, because the donation needs to be at least 100 ml and this can only be obtained if the cord is cut and clamped immediately. Here you will find a good overview of the pros and cons of cord blood banking.

 

Delayed cord clamping Pros

Perhaps the biggest and most important benefit to delayed cord clamping is the extra iron stores that are built up in the baby thanks to the extra blood they receive during this process.

It is thought that babies who have their cords clamped immediately after birth are at significantly higher risk of suffering from anaemia within the first few months of life; this is due to a lower level of iron. On the other hand, babies who received delayed cord clamping appeared not to suffer from anaemia and, indeed, had plenty of iron stored in their bodies to see them through until weaning began.

Of course, the levels of iron that a baby has to begin with depends largely on a number of factors such as if they were born premature or full-term; whether or not the mother suffered from iron deficiencies during pregnancy; and the actual size of the baby, as bigger infants tend to have larger stores of iron compared to smaller infants.

Other benefits that have been reported include protection from lead poisoning, healthier birth weights and higher concentrations of haemoglobin, which is important for transporting oxygen around the body. In fact, the increased haemoglobin levels may be a contributing factor to the increase in oxygenation of the brain tissues of premature infants, which was reported in a study published in 2007 by Baenziger et al.

 

Delayed cord clamping Cons

At the moment, the evidence to suggest that jaundice will occur in babies who undergo delayed cord clamping is a little patchy; some health professionals think it does, and there have been studies to back this up, whilst others remain unconvinced, clearly some more work in this area needs to occur.

A common misconception is that delaying cord clamping will increase the risk of haemorrhaging for the mother, this is not the case and a study published in 2008, by McDonald et al, found that there was no significant difference between haemorrhaging in mothers where cords were clamped immediately after birth and mothers where cord clamping was delayed. ]
There is concern over something called polycythemia, which is basically the opposite of anaemia and means that the baby has too many red blood cells, but there is no substantial evidence to suggest that this causes any health issues for infants.

There has also been concern noted from health professionals working with women who are HIV positive. They worry that delaying cord clamping and cutting could pose a risk to the baby if the partially detached placenta becomes exposed to a small amount of maternal blood, which in turn could pose a risk of infection for the baby. However, the World Health Organisation believes that the benefits of delayed cord clamping greatly outweigh the risks of contamination from the mother’s blood.

Delayed cord clamping research

You may be wondering what evidence there is to support the above claims; well, a number of studies have been carried out over recent years relating to delayed cord clamping. As mentioned above, a study that was published in 2007 by Baenziger et al showed that premature babies who underwent delayed cord clamping experienced an increase in the oxygenation of their brain tissue. They studied 39 babies whose average length of gestation at birth was 30.4 weeks. 15 of these babies would undergo delayed cord clamping of up to 90 seconds and the remainder would not. The team monitored the volume of blood flowing to the brain and the levels of oxygen in the brain tissue at 4 hours and 24 hours of age. They found that whilst the volume of blood flowing to the brain did not change, the level of oxygen in the tissues had increased in those babies who had received delayed cord clamping in comparison to those who had not.

In 2008, Susan McDonald and Phillippa Middleton (Summary) gathered research from a number of trials that were documented in the Cochrane Pregnancy and Childbirth Group Register. They looked at 11 trials that included more than 2,900 mothers and their infants in order to assess the outcomes for mother and baby in relation to delayed cord clamping. From 5 of these studies, which observed just over 2,200 women, they discovered that there was no substantial difference in the number of mothers who suffered from haemorrhaging, whether their babies received delayed cord clamping or not. They also noted that babies who had delayed clamping were at a higher risk of needing treatment for jaundice compared to those who were clamped immediately after birth; although they also discovered that delayed clamping did increase the levels of haemoglobin in babies, which improves the blood’s ability to carry oxygen and nutrients around the body.

A study that was published in 2006 by Chaparro et al attempted to determine the effects that delayed clamping had on the levels of iron in babies up to 6 months after they were born. The team enlisted the help of 476 mothers, of which 358 completed the study; some would receive a delay of 2 minutes before the cord was clamped, the others would have cords clamped within 10 seconds of birth. They found that at 6 months of age the babies who received delayed cord clamping had higher levels of iron in their blood than those who did not. In 2007, Chaparro published another study, this time with a different team, that had researched the effects of delayed cord clamping on infants who were exposed to high levels of lead. As with the previous investigation, some of the babies had their cords clamped within 10 seconds of birth and others had it clamped after 2 minutes. The team measured the concentration of lead in the babies’ blood at birth and at 6 months. Their results found that infants who had their cords clamped early had higher levels of lead in their systems, which is believed to be due to the lower levels of iron stores in their bodies – iron aids in lead absorption and helps prevent lead poisoning. The conclusions the researchers drew from this was that delayed cord clamping significantly reduced the risk of lead poisoning in infants living in areas where this is a problem. Both studies carried out by Chaparro and her teams were based in Mexico City, Mexico.

Conclusion

As you can see, there is quite a substantial body of evidence that has already been amassed in relation to delayed cord clamping, although there are some areas that could benefit from further research. One thing that seems to ring loud and clear, though, is that on the whole delayed cord clamping is beneficial to babies, whether born full-term or premature, and does not pose a risk to the mother. Infants will benefit from higher levels of iron in the blood; better oxygenation of brain tissues; and protection from lead poisoning. Despite the small possible risks associated with delayed cord clamping, it is clear that the positives far outweigh the negatives.