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Delayed Cord Clamping

At starting solids classes I always get questions about when to start solids and concern with iron levels. It's true that the most important nutrient your baby needs from food after 6 months of age is iron. Their stores from before birth run out at around 6 months of age, and iron is important for both physical and mental development. But did you know that there's something you can do during the birth that will positively or negatively affect your baby's iron stores for months? Delayed umbilical cord clamping. While iron levels are easy to check with a blood test, I would be less concerned about a baby slow to take to solids who had delayed cord clamping, as they have been shown to have higher iron levels.

What is delayed cord clamping? Leaving the umbilical cord attached to the placenta until it stops pulsing, which takes about 3-7 minutes (1). Depending on your doctor, many clamp the baby's umbilical cord within 30 seconds (midwives practice delayed clamping). The reason you do not want the early cord clamping, is that about 450ml of blood  (or 1/3 of the baby's total blood volume!) is in the placenta and needs a few minutes to transfer to the baby. Now that the baby's lungs, gut, kidney and liver will be fully functioning outside of the womb, the placenta (which does these tasks for baby inside the womb) no longer needs this blood. But the baby does – it’s not “extra” blood. It’s full of stem cells, immune cells and red blood cells. This video by childbirth educator Penny Simkin shows a great demonstration of placenta to baby blood transfer.

What are the benefits? Decreased risk of iron deficiency anemia, particularly in low birth weight infants or babies born to moms with low iron stores (2). Baby's blood will provide them with sufficient iron for 6-8 months, if they are allowed to receive it all at birth. Besides iron levels, delayed cord clamping provides the baby with better oxygen transportation and higher red blood cell flow to vital organs.

Delayed cord clamping is especially important in low birth weight and higher risk babies, most likely the ones to be cut from the cord ASAP for resuscitation. Which can instead be done at mom’s side, with the cord still attached to the placenta. The baby benefits from the oxygenated blood coming from the placenta, offering more time to resuscitate, decreased risk of sepsis, need for blood transfusions and low blood pressure. Delayed cord clamping can protect against organ damage and brain injury in premature infants: when the small baby doesn't have all of it's blood supply, the limited blood gets re-directed to where it's most needed (i.e. heart) and away from less critical organs (i.e. brain) (3).

What are the risks? None. Best evidence shows delayed cord clamping is safer (4).  So why isn’t it standard of practice everywhere? There’s an old belief (which has been disproven) that higher levels of jaundice occur in babies that receive their full blood volume at birth (5). Or possibly because of the “in-and-out” mentalities of some hospitals that do not take the mom and baby’s health as #1 priority. So if you didn't work this into your last birth plan, be sure to do so for your next baby!

 

1)  WHO: “Optimal timing of umbilical cord clamping,” Essential delivery care practices for maternal and newborn health and nutrition. Retrieved from: http://amro.who.int/English/AD/FCH/CA/Delivery_care_practices.pdf

2) Chaparro CM, Neufeld LM, Tena Alavez G, Eguia-Liz Cedillo R, Dewey KG. Effect of timing of umbilical cord clamping on
iron status in Mexican infants: a randomised controlled trial. Lancet 2006;367:1997-2004.

3) Mercer, J. Skovgaard, R. & Erickson-Owens, D. “Fetal to neonatal transition: first, do no harm“, Normal Childbirth: Evidence and Debate second edition (2008) edited by Downe, S. pp149-
174

(4) Mercer J. Current best evidence: a review of the literature on umbilical cord clamping. J Midwifery Womens Health2001 Nov-Dec;46(6):402-14

5) Mercer, J. et al, Delayed Cord Clamping in Very Preterm Infants Reduces the Incidence of
Intraventricular Hemorrhage and Late-Onset Sepsis: A Randomized, Controlled Trial. Pediatrics Vol. 117 No. 4 April 1, 2006 pp. 1235 -1242.

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