Delayed Cord Clamping
Delayed Umbilical Cord Clamping is such an important topic to talk about because the implications of immediate cord clamping and cutting are harmful and not evidence based practice at all. There is plenty of research that supports delayed cord clamping! But yet sadly immediate clamping and cutting of the umbilical cord is still widely practiced. This applies to vaginal birth as well as caesarian section. Delayed cord clamping can be done during a caesarian section. I believe that a majority of care providers have insufficient knowledge about the important reasons for delayed cord clamping so as parents it is important that you do your own research and be proactive about your choices.
‘The optimal time to clamp the umbilical cord for all infants regardless of gestational age or fetal weight is when the circulation in the cord has ceased, and the cord is flat and pulseless’ (World Health Organisation 2007). The most optimal time of clamping and cutting of the cord is after the birth of the placenta or if that is not possible, until the cord has stopped pulsating.
The blood that is circulating in the cord and the placenta is actually part of the baby’s total circulating blood volume. The average amount of blood in circulation between placenta and cord is 100mls. This equates to one third of the baby’s entire circulation that the baby will lose at birth by immediate cord clamping! Imagine if an adult would lose on third or 1.5 litre of their overall circulating blood volume? How would they feel? Probably sick and unstable!
This photo shows a mother who gave birth to twins vaginally. Twin A had immediate cord clamping and Twin B experienced delayed cord clamping. The difference in colour is striking!
Delayed Cord Clamping will help the baby to make important physiological changes that have to happen immediately after birth. At the moment of birth the baby has to take over some very important functions that the placenta performed whilst the baby was still in the womb. An important example is breathing! Only 8% of the placental circulation goes to the lungs whilst the baby is in the womb but after birth that percentage increases to 40%! So where do the required ‘extra’ 32% come from? From the blood that is circulating in the cord and the placenta. I have written ‘extra’ in inverted commas because it is not really extra. It is the blood that belongs to the baby and that is part of the baby’s blood volume even so it is ‘stored outside’ the baby’s body at birth. If the cord gets clamped and cut immediately there will be no ‘extra’ blood to perfuse the lungs. Subsequently the now anaemic baby’s body will have to prioritise where to send its precious blood to, to the detriment of other vital organs that are left compromised.
‘But if your baby is flat at birth we will have to cut and clamp the cord straight away and take your baby to the resuscitation area …’
If the baby is a little slow to take their first breath or to establish regular breathing the placenta is an important back up mechanism. The placenta still provides oxygenated, warm and pH-regulated blood to the baby as long as the cord is still pulsating. In most cases the baby self-resuscitated with the ‘extra’ blood volume. Babies are born with their own resuscitation equipment! If the baby does need CPR this can also be done with the cord left inatct on a special resuscitation table that can be positioned next to the mother. This equipment is mainly used in the UK and unfortunately not yet in Australia.
The cord blood is a rich source of iron. The iron content of 100mls of cord blood is equivalent to the iron content of 100 litres of breast milk! Iron deficiency anaemia in infancy can be a major problem for children in the first year of life as iron is needed for optimal health and brain development. Low iron levels have been linked to neural development problems.
Delayed Cord Clamping and Caesarean Section
Delayed cord clamping can also be done during a caesarean section. However, this will need to be negotiated with your care provider and not all care providers will support delayed cord clamping during a caesarean section.
Cord Blood Banking
No adult would think of volunteering for donation of their red blood cells to the Red Cross if they are already suffering from anaemia or have recently experienced some major acute blood loss. No medical practitioner would recommend that as good practice! So what are we doing to our babies? Cord Blood Banking will require the cord to be cut and clamped immediately after birth in order to maximise the blood collection volume for storage. The consequence is that your baby will miss out on getting any blood from the cord or the placenta, including his or her own stem cells!
Cord blood banking is done for harvesting of the pluripotent stem cells that are in the cord blood that are then put into storage. Pluripotent means that these stem cells can transform into different types of cells of the body like cells of the immune system, cardiovascular or central nervous system cells for example. Stem cells can repair damage to the brain and according to some literature stem cells have been used to treat cerebral palsy.
The cord blood that the baby gets from delayed cord clamping can be considered his or her first ‘stem cell transplant’. What would be consequences of the baby missing out on those stem cells…? ‘… the artificial loss of stem cells at birth could potentially impact later development and predispose the infant to diseases, such as, Chronic Lung Disease, Asthma, Diabetes Mellitus, Epilepsy, Cerebral Palsy, Parkinson’s Disease, infections and cancer’ (Tolosa 2010). The chance of the banked cord blood ever to be used by the child is 1 in 2000, which is extremely remote! ‘Cord blood donation should be discouraged when cord blood stored in a bank is to be directed for later personal or family use, because most conditions that might be helped by cord blood stem cells already exist in the infants cord blood’ (American Academy of Paediatrics2007). Also the cord blood storage duration is unknown.
Your baby is the best cord blood bank!