dutchess delayed cord clamping westchester

D is for Delayed Cord Clamping

Delayed Cord Clamping is the prolongation of time between the delivery of your baby and the clamping and cutting of their umbilical cord; the delay can range from 30 seconds to 5 minutes or more after delivery. This practice is in contrast to immediate cord clamping, which typically occurs within 10 to 3o seconds of delivery. Cord clamping used to be performed immediately as it was thought to reduce the risk of maternal hemorrhage. However, research has not proven this to be the case.

Delaying cord clamping allows for the transfer of up to one-third more blood from the placenta to the infant. This blood volume increase is associated with an increase in iron storage (iron is vital for healthy neurological development) and a decrease in iron-deficient anemia (side effects of iron-deficient anemia can include cognitive impairment and problems with the central nervous system. The additional blood the baby receives can provide them with as much as a 4-6 month supply of iron. The World Health Organization (WHO) now recommends waiting no less than one minute before clamping, and ideally waiting 1-3 minutes, for all births.

A 2017 study by the American College of Obstetricians and Gynecologists found that “delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life.” While there appeared to be a slight increase in the incidence of jaundice, it was felt that providers who practice delayed cord clamping in term infants should have a plan in place to monitor for and treat jaundice.

The following are the current ACOG recommendations regarding the timing of cord clamping:

  • In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes.
  • Delayed umbilical cord clamping is associated with significant neonatal benefits in preterm infants, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage.
  • Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30–60 seconds after birth.
  • There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing delayed umbilical cord clamping. Consequently, obstetrician–gynecologists and other obstetric care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor and treat neonatal jaundice.
  • Delayed umbilical cord clamping does not increase the risk of postpartum hemorrhage.

Committee Opinion on Delayed Umbilical Cord Clamping After Birth

Potential Risks

Research is still unclear if there are any potential detriments to the health of the newborn from delaying cord clamping. While some studies have found an increase in the incidence of jaundice in infants who’s cords were not immediately clamped, jaundice is easily detected and non-invasively treated with phototherapy (rarely resulting in serious complications). Jaundice is caused by a build up of bilirubin in the blood (bilirubin is a product of the breakdown of red blood cells).

Another potential risk is polycythemia, which is an elevated red blood cell count. A study found higher levels of red blood cells in babies with delayed cord clamping, however this study was performed in a rather homogeneous population located outside of the United States. A Cochrane meta-analysis did not support the findings of the increased likelihood of polycythemia. The increase in neonatal hematocrit in babies with delayed clamping of the umbilical cord (versus immediate clamping) does not result in a significan thickening of the blood that could be contributed to the delay alone.

An increase in blood volume was thought to delay the absorption of lung fluid, resulting in transient rapid breathing. A study found that a similar number of infants were admitted for respiratory distress with delayed cord clamping as with immediate cord clamping. This suggests that delaying clamping puts babies at no additional risk of respiratory distress.

There’s not enough time

Some providers try to argue that they do not have enough time in the delivery room to delay cord clamping. But keep in mind that of the additional blood volume, half is transferred within one minute of delivery. By three minutes, more than 90% of this additional blood volume has been transfused. In the first three minutes after your baby is born, the placenta has not yet been delivered and little else is happening in the delivery room. APGAR scores can be assessed while the baby is skin-to-skin with the mother after delivery.

The only time during a non-emergent delivery of baby where delayed cord clamping may not be advised is during a C-section. With a surgical delivery, the longer the abdomen is left open, the greater the risk of infection; surgeons do their best to minimize the amount of time you are open on the table during a Cesarean delivery.

“I was told I cannot have skin-to-skin and delay cord clamping unless my baby is over my pelvis”

Unless your baby’s cord is especially short, this is not true. It was previously believed that if the baby was held higher than the level of the placenta that there would be a backflow of blood from the baby to the placenta. This is untrue for several reasons, which we will explore:

  • Once the baby is birthed and begins to cry, the lungs need more blood. The increased demand for blood in the lungs drops baby’s systemic blood pressure lower than the pressure in the placenta. Since blood flows along a pressure gradient (from high pressure to low pressure), the blood will go from the placenta to the baby.
  • The increased blood oxygen saturation, which results from the baby breathing on his own, causes the closing of the umbilical artery, reducing the likelihood of blood flow from the baby to the placenta. The umbilical vein (which prenatally carried blood from the placenta to the baby) is not sensitive to oxygen saturation, and remains open, further decreasing the likelihood of the backflow of blood from the baby to the placenta.
  • While gravity does impact the speed of the blood flow along the pressure gradient, it does not prevent the movement. The pressure gradient is still present and the baby will still receive the additional blood volume but it may take a little longer (5 minutes vs 3 minutes).

Should I delay cord clamping in my baby?

That is a decision that only you and your OB/GYN or midwife can make, depending on the health of you and your baby and the circumstances surrounding your baby’s delivery. We strongly suggest having this discussion with your medical team prenatally to ensure that your entire birthing team is on the same page come your baby’s birth day.

It is important to note that none of these studies have included infants who were born in distress. Some researchers believe that this population may actually benefit from delayed cord clamping as the increase blood volume can help with blood pressure, breathing, and circulatory problems. It is also believed that placental blood, which is rich in stem cells, could help to repair damage suffered during a difficult birth.

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