Recently, many expectant mothers and fathers in our practice have inquired about our philosophy on the timing of clamping the umbilical cord after delivery. Here is a review of the issues.
Delaying umbilical cord clamping for two to three minutes results in a substantial transfusion of blood from the placenta into the newborn child
- It has been postulated that delayed cord clamping may increase the risk of “thick blood” and respiratory symptoms in the newborn with increased need for phototherapy
- Delayed umbilical cord clamping has been suggested as a measure to prevent infant iron deficiency
- Iron is essential for several aspects of brain development, including myelination, dendritogenesis, neurotransmitter function, and neuronal and glial energy metabolism. Iron deficiency anemia in young children is associated with long lasting cognitive and behavioral deficits. Iron deficiency without established anemia has also been associated with altered affective responding, impaired motor development, and cognitive delays. Two recent meta-analyses have concluded that iron supplementation improves psychomotor and mental development in infants and children
- A recent analysis of the National Health and Nutrition Examination Survey III found the prevalence rates of iron deficiency and iron-deficiency anemia among US toddlers to be 9% and 3%, respectively
- Until recently only a few controlled trials had assessed effects of delayed cord clamping on infant health beyond the neonatal period. These studies were all performed in low and middle income populations with a high prevalence of iron deficiency anemia (India, Guatemala, Mexico and Zambia)
- A Swedish study published in the British Medical Journal last November compares the effects of early and late cord clamping in a higher income country and this is what they did and this is what they found:
Cord clamping was delayed by holding the newborn infant at a level about 20 cm below the vulva for 30 seconds and then placing the baby on the mother’s abdomen for a total of 3 minutes or more. Babies born by cesarean section were placed in the mother’s lap before clamping in accordance with clinical routines.
Delayed cord clamping improved iron status and decreased the risk for iron deficiency at 4 months of age among infants born at term in a country with a low prevalence of iron deficiency anemia
Delayed clamping was not associated with neonatal jaundice or other adverse effects
All of that being said, Dr. Bill Parer from UCSF states that the research on this topic is “all over the map”. It is his belief that this will prove to be a “tempest in a teapot” since it is a technique which provides very little benefit in our low risk patient population with the possible exception of prematures. He also adds that the benefits are probably mostly derived in the first 30 seconds after delivery and he doesn’t advise waiting until the cord stops pulsing. There is currently a study on delaying cord clamping at UCSF with preemies below 35 weeks gestation. Stay tuned for an update.
Collecting cord blood for storage is becoming more popular with patients in our practice and parents should be aware that delayed clamping of the cord will render cord blood collection for storage less successful. Since the idea is to transfuse a significant volume of the cord blood back into the baby, less will be available to collect and store.
And this from our own Dr. Fung Lam:
“When you have a normal vaginal delivery with a healthy baby, you have the precious opportunity to receive your newborn child directly into your arms. Delayed cord clamping will deny you this remarkable experience with no proven benefit for healthy newborns.”