Delayed or ‘optimum’ cord clamping

When you get pregnant and start reading things online, talk to friends and watch positive birth videos on YouTube, you will very quickly get across the term of “delayed cord clamping”. Now what is this about, where did it all start and how to make an informed choice?

What is it?

Delayed Cord Clamping or DCC is the prolongation of the time between the delivery of a newborn and the clamping/cutting of the umbilical cord. The practice is to wait until the blood in the cord has ceased pulsing . I personally enjoy the definition of Optimum Cord Clamping rather than ‘Delayed’, as suggested by Dr. Alan Greene, a pediatrician and leading voice of the TICC TOCC Movement (Transitioning Immediate Cord Clamping to Optimal Cord Care).

From fish to baby

Did you know that throughout your pregnancy, you baby’s lungs are filled with amniotic fluid? Baby cannot breath in water of course but he still needs oxygen. Your blood transfers the oxygen to his blood through the placenta and the umbilical cord. This incredible organ fulfills the functions of lungs as well as kidney, gut and liver!

At the moment of birth, everything changes: suddenly baby takes his first breath and the little alveoli in his lungs will fill with air for the very first time while his heart will pump blood to his lungs in order to take up the oxygen. It is a pretty drastic and intense change for this new little being who needs to adapt to life outside the womb!

Nature knows best so she provided the baby with not one but two breathing tools during the first few minutes of the delivery. The new one: breathing through the lungs and the old one: the umbilical cord that continues to pump blood from the placenta until baby’s breathing is well established. This ‘reservoir’ of blood also helps the lungs to take on their role of new fully-operational breathing system.

Not only have people around the world traditionally waited for the cord to stop pulsing until the 20th century innovation but other mammals instinctively waits for the cord to stop pulsing as well.

SO WHY CUT THE CORD IMMEDIATELY THEN?

Immediate Cord Clamping (ICC) or Early Cord Clamping (ECC) was popularized in the Western World in 1913 as one of three pillars of active management of the third stage of labor. This practice is still widely adopted every on the globe as the standard of care during the delivery of the placenta. The umbilical cord is clamped immediately after birth, within 10 to 30 seconds. It has been the preferred option from medical practitioners for 2 reasons : firstly it allowed for an immediate transfer of the baby to the neonatologist or the midwife in case of respiratory distress and secondly it was believed that it enabled a speedy delivery of the placenta that would lead to a reduced risk of postpartum hemorrhage.

Back in the 1950s, it might have made more “sense” to cut the cord so early as women were heavily drugged during labour and it was not uncommon to need to resuscitate babies immediately as the drugs would cause respiratory distress. Nowdays the drugs used during labour do not have such a strong impact on baby.

The World Health Organisation (WHO) published a document recommending that the umbilical cord should not be clamped earlier than necessary and their findings suggest that the recommendation is between one to three minutes after delivery. Immediate cord clamping (ICC) is not recommended unless the newborn is asphyxiated and needs immediate resuscitation.

“In situations of extreme distress – for example, if the baby takes several minutes to breathe – this reservoir of oxygenated blood [the cord and placenta] can be life-saving, but, ironically, standard practice is to cut the cord immediately if resuscitation is needed.” says Dr Sarah Buckley in her book “Gentle Birth, Gentle Mothering”.

Concerning the risk of postpartum hemorrhage, there is actually no statistical evidence proving that delayed cord clamping would result in an increased blood loss. Sarah Buckley suggests in the contrary that there is some evidence that the practice of clamping the cord immediately could actually contribute to postpartum hemorrhage (PPH) and retained placenta by trapping extra blood within the placenta. And that other western practices may contribute to hemorrhage: oxytocin, episiotomy, perineal trauma, forceps delivery, no-privacy and intimacy during birth provoking adrenaline spikes and fight/flight responses, …

One of the main reasons why parents might choose the Early Cord Clamping, is if they decide to bank the cord blood and /or tissue. The private family cord blood banks recommend no more than 1 minute of delayed cord clamping before attempting a cord blood collection and even waiting that long might put the sample at risk as it will reduce the quantity necessary for the sample. Optimum Cord Clamping, if parents decide to wait until the cord stops pulsing, is not realistically compatible with the collection of Blood Cord. It is a personal decision that belongs to each couple, whether to delay the cord clamping or to collect for banking. Parents needs to make their own research and see what best fits their family’s situation.

Image by Pixabay
Image from placentaassociation.com/
WHY CHOOSE OPTIMUM (DELAYED) CORD CLAMPING?

It is estimated that early clamping deprives the baby of 54 to 160 ml of blood, which represents 1/3 to 1/2 of a baby’s total blood volume at birth. Huge right?!

Doctor Sarah Buckley indicates that clamping the cord before the infant’s first breath results in blood being sacrificed from other organs to establish pulmonary perfusion [blood supply to the lungs].

Where the baby is lifted above the uterus before clamping — for example during caesarean surgery — blood will drain back to the placenta by gravity, making these babies especially liable to receive less than their expected blood volume. The consequence of this may be an increased risk of respiratory (breathing) distress. Several studies have shown this condition, which is common in caesarean-born babies, to be eliminated when a full placental transfusion is allowed, she ads.

Waiting for the cord to stop pulsating will boost your newborn’s iron stores, lowering his risk of anemia in the first 6 months of life. Even when iron deficiency is not severe enough to cause anemia, it has been linked to lasting damage to the developing brain. Infancy is thus both one of the most important as well as most common life cycle windows for iron deficiency.

Baby will also get a bigger influx in stem cells and maternal antibodies that are essential for her health.

A 2015 study published in JAMA Pediatrics indicates that Delayed Cord Clamping may be associated with improved fine motor and social skills years at age 4.

It is important to note that today, in some low-income countries as many as 95% of delivery clinicians surveyed practice immediate cord clamping, following the model and recommendation from us, Westerners, resulting in up to 10x the risk of developing iron deficiency anemia in countries were the nutrition may not be able to compensate that deficiency.

As mentioned by Dr Alan Greene on his blog: Anemia hinders a quarter of the global population, and is disproportionately concentrated in low-income groups. Iron deficiency is the leading cause of anemia. The World Health Organization estimates that solving iron deficiency in a developing nation would increase productivity by 20 percent.

Alan Greene’s TEDx video on Optimum Cord Clamping:

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