Why there is even a debate over this topic is a testimony to how slow evidence-based practices are to take root in hospitals across the nation. There really is no debate over this matter. Multiple research studies make it very clear: waiting several minutes after birth to cut the umbilical cord of newborns is beneficial to a newborn's health. Unfortunately, medical dogma remains and old habits die hard. And so the debate remains and what should clearly be a standard of practice is still not consistently being observed by midwives and obstetricians across the United States. And so, yet again, it is up the parents to educate themselves on the matter and make sure that their wishes are followed regarding cord clamping following delivery.
So what exactly is cord clamping, and why does it matter when it occurs? More often than not, clamping of the umbilical cord is simply something that new parents see as a ceremonial task that often gets handed over to the father. The cord is clamped, then cut, and a small plastic clamp placed near the newborns belly that will remain for 24 hours or so. Eventually, the stump of the umbilical cord falls off. Simple, right? It's not quite that simple, unfortunately. The umbilical cord is the life-line from baby to mother. In-utero, baby receives oxygen and nutrients from it's mother through the umbilical cord. Deoxygenated and nutrient-depleted blood is then removed from the baby via that same cord. Immediately following birth, blood is still being pumped from the placenta inside the mother into her newborn child. The umbilical cord pulsates with each beat of mom's heart and can easily be felt by simply grasping the cord. Typically, an umbilical cord will pulsate 2-3 minutes after a baby is born. In water births that occur in warm water, pulsation may continue 5 minutes or longer (World Health Organization - WHO). Studies have shown that after 1 minutes of pulsating, 80 ml of blood have been pushed into the newborn. By 3 minutes, this number rises to 100 ml. A baby is typically born with 75 mg/kg of body iron. Waiting just 3 minutes to clamp the cord increase that number to about 115-125 mg/kg. The effects of this are long term. At 6 months of age, babies that received cord clamping after pulsation had stopped had higher levels of iron than babies that had early cord clamping (WHO).
The Cochrane Review summed up their most recent findings regarding cord clamping at follows: “The suggested neonatal benefits associated with this increased placental transfusion include higher haemoglobin levels (Prendiville 1989), additional iron stores and less anaemia later in infancy (Chaparro 2006; WHO 1998b), higher red blood cell flow to vital organs, better cardiopulmonary adaptation, and increased duration of early breastfeeding (Mercer 2001; Mercer 2006). There is growing evidence that delaying cord clamping confers improved iron status in infants up to six months post birth (Chaparro 2006; Mercer 2006; van Rheenen 2004).”
Also being pushed into baby during these few extra precious minutes are those ever-so-precious stem-cells. Stem cells are cells that can develop into other cells. Researcher Paul Sanberg from the University of Florida recently published an article in the Journal of Cellular and Molecular Medicine that concluded that waiting to clamp the umbilical cord could reduce the infant's risk of many illnesses, including "respiratory distress, chronic lung disease, brain hemorrhages, anemia, sepsis and eye disease." Fascinating. Especially since giving vitamin K injections to babies immediately after birth are routinely given to help prevent brain hemorrhages. Vitamin K started being given for this reason during the 1960s. Early clamping of the cord was first suggested in the 1930s (in order to minimize the amount of anesthesia baby would receive from mom's blood) and became routine by the 1960s. While I have not been able to find any studies that could confirm it, I cannot help but wonder if this new technique of early clamping of the umbilical cord lead to a greater risk of brain hemorrhages in infants, which in turn lead to giving vitamin K shots. Is this, yet again, another example when (overall) less medical intervention during birth is actually better?
Humans are the only mammals that severe the umbilical cord of their young so early after birth. Most animals will - after a while - gnaw through the cord to separate the placenta from the newborn. Chimpanzees ignore the cord altogether and allow it to remain attached. After several days, the cord will dry and fall off (as does the stump of the cut cord with all newborns). Several cultures around the world practice this method (commonly referred to as a Lotus Birth). Diaries from pioneers reveal that this method was practiced at times in order to avoid causing an infection when clean instruments and supplies were not available. While leaving the umbilical cord attached for several days does not seem exactly practical, leaving it attached for 3-5 minutes after birth is. The cord will cease pulsating as the last of the blood is pushed into the newborn and a gelatinous substance called Wharton's jelly inside the cord helps it to occlude naturally within 5-10 minutes.
I could find no studies, unfortunately, that addressed premature clamping of the cord when resuscitation was required.
And the downfalls of waiting to clamp and cut the cord? Several studies have suggested that delaying cord clamping may result in a higher incidence of hyperbilirubinemia (jaundice). Other studies do not find this link. Either way, almost all breastfed babies will experience some sort of jaundice during their first 5-10 days of life. It is a very normal part of a baby adapting to the outside world and, when properly managed, is nothing to worry about. Frequent breastfeeding (every 2 hours) and exposure to a little sunlight will help clear almost all babies of this very normal condition. Little Bear had jaundice the first week of her life and was treated with a little light and lots of breast milk! (**Note: Rarely, jaundice can become a life-threatening condition. If yellowing worsens, baby becomes lethargic, or feeding/elimination habits change, contact your physician or midwife immediately.) Yet others suggest that an increase in jaundice may indeed be related to delaying cord clamping only if labor is augmented with the drug pitocin (a drug very commonly used in labor). One of the side-effects of pitocin is jaundice and it makes sense that the more blood that is pushed in from the cord would also mean more pitocin from the the mother is also reaching baby. No studies that I have found have been done to look at pitocin and jaundice rates with cord clamping.
And so there we have it. A myriad of reasons why delaying cord clamping and cutting by 1-3 minutes is beneficial to the health of your baby. The debate, in my opinion, is not a debate at all. Modern science is, yet again, proving what humans have known and practiced for thousands of years. Waiting to cut the cord is best. Premature cutting of the cord is a 50-year old practice that should be left to historical textbooks, just like lobotomies and bloodletting. Unfortunately, this practice still continues. It is up to us as expectant and new parents to insist that this practice is stopped so that our children receive the most health benefits possible from the moment they take their first breath.
