Delayed Cord Clamping

placenta-pic-blog

Bea is up all night studying for her exams the next day. While scanning over maternal and child care concepts, she comes across an article about delayed cord clamping. “The benefits if delayed cord clamping,” it says. Wait, what? Did she read it right? Delaying clamping the umbilical cord has benefits?

Both confused and curious, she clicks on the article and reads on. Who knows, this topic might appear in her exams, right?

A boost in neurodevelopment

The umbilical cord blood serves as the baby’s life blood until birth as it contains many wonderfully precious cells, like stem cells, red blood cells and white blood cells (including cancer-fighting T-cells) to help fight disease and infection.

However, the common practice is to quickly cut off this source of valuable cells at the moment of birth. But recently, there have been studies emerging regarding the benefit of delayed cord clamping.

According to a study, a couple of extra minutes attached to the umbilical cord at birth may translate into a small boost in neurodevelopment several years later. Those children whose cords were cut more than three minutes after birth had slightly higher social skills and fine motor skills than those whose cords were cut within 10 seconds. However, the results showed no differences in IQ.

Dr. Heike Rabe, a neonatologist at Brighton & Sussex Medical School in the United Kingdom, states that “there is growing evidence from a number of studies that all infants, those born at term and those born early, benefit from receiving extra blood from the placenta at birth.”

By delaying the clamping of the cord more blood is allowed to transfer from the placenta to the infant, sometimes increasing the infant’s blood volume by up to a third. The iron in the blood increases infants’ iron storage, and iron is essential for healthy brain development.

Rabe adds, “the extra blood at birth helps the baby to cope better with the transition from life in the womb, where everything is provided for them by the placenta and the mother, to the outside world. Their lungs get more blood so that the exchange of oxygen into the blood can take place smoothly.”

Studies supporting the delay of cord clamping

Several studies have shown higher levels of iron and other positive effects later in infancy among babies whose cords were clamped after several minutes, but few studies have looked at results past infancy.

In one study, researchers randomly allocated half of 263 healthy Swedish full-term newborns to have their cords clamped more than three minutes after birth. The other half were clamped less than 10 seconds after birth.

Four years later, the children underwent a series of assessments for IQ, motor skills, social skills, problem-solving, communication skills and behavior. Results revealed that those with delayed cord clamping showed modestly higher scores in social skills and fine motor skills. When separated by sex, only the boys showed statistically significant improvement.

Risks

Despite these benefits, the American Congress of Obstetricians and Gynecologists has not yet endorsed the practice, citing insufficient evidence for full-term infants and the World Health Organization recommends delayed cord clamping of not less than one minute.

Some studies have found a higher risk of jaundice, a buildup of bilirubin in the blood from the breakdown of red blood cells. Another potential risk is a condition called polycythemia, according to Dr. Scott Lorch, an associate professor of pediatrics at the University of Pennsylvania Perelman School of Medicine and director of the Center for Perinatal and Pediatric Health Disparities Research at Children’s Hospital of Philadelphia.

According to him, “Polycythemia can have medical consequences for the infant, including blood clots, respiratory distress and even strokes in the worst-case scenario.”

There are also studies which have found higher levels of red blood cells in babies with delayed cord clamping, but there were no complications.

As of the moment, studies on delayed cord clamping have excluded infants born in distress, such as those with breathing difficulties or other problems. But according to Rabe, these infants may actually profit most from the practice since these babies often need more blood volume to help with blood pressure, breathing and circulation problems.

“Also, the placental blood is rich with stem cells, which could help to repair any brain damage the baby might have suffered during a difficult birth,” she added. “Milking of the cord would be the easiest way to get the extra blood into the baby quickly in an emergency situation.”

Sources:

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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