Info Sheet: Cord Clamping
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Info Sheet: Cord Clamping

CORD CLAMPINGcan be immediate or delayed.  Today we look at the common practice of immediate cord clamping, and the alternative, delayed cord clamping.
 
Immediate Cord Clamping: (ICC) clamping the umbilical cord immediately following the birth of baby, generally carried out in the first 60 seconds after birth. World Health Organization (WHO)

According to ACOG “In most deliveries today, the cord is clamped within 15–20 seconds after birth.”
 
Cord Clamping
Cord Clamping
A little longer stump left - this baby pictured 30 minutes after birth
Cord Clamping
Cord Clamping
A tight clamp done on baby's 2nd day
Why was it developed? 
Early cord clamping originally came into practice in the 1950s as an attempt to reduce the instance of neonatal jaundice and as a method to protect newborns from drugs that were given to their mothers. In the 1990s, the American College of Obstetrics and Gynecology (ACOG) called for early clamping for legal purposes. Today the procedure is routinely performed by most obstetricians, while most midwives prefer delayed clamping.


 
Has it been effective?
We spent some time searching for historical trends in jaundice.  We found none.  It seems that neither hyperbilirubinemia (too much bilirubin that causes the visual effects we call jaundice) nor kernicterus (permanent brain damage caused by hyperbilirubinemia) are reportable diseases.  Since they are not reportable, there are no charts that show whether or not jaundice rates have fluctuated one way or another since the advent of ICC. 

The optimal time to clamp and cut the umbilical cord after birth has been an ongoing controversy in obstetrics for many years. Web MD released earlier this year that, “There's growing evidence the current practice of cutting the cord straight after the baby is born may mean the baby doesn't get enough iron. This could lead to anaemia in some cases.”
 
According to the World Heath Organization, “Delaying cord clamping allows blood flow between the placenta and neonate to continue, which may improve iron status in the infant for up to six months after birth. This may be particularly relevant for infants living in low-resource settings with less access to iron-rich foods.”
 
Last year ACOG released a statement that preterm infants benefit most from delayed cord clamping and that delaying until at least 30-60 seconds after delivery benefits all babies. They concluded their committee opinion by stating that “More research is needed to help evaluate the optimal timing of cord clamping” and have not released any official guideline changes as of today.
 
Finally, just released on July 11, 2013, The Cochrane Library review concluded that, "Although early cord clamping has been thought to reduce the risk of bleeding after birth (postpartum haemorrhage), this review of 15 randomised trials involving a total of 3911 women and infant pairs showed no significant difference in postpartum haemorrhage rates when early and late cord clamping (generally between one and three minutes) were compared. There were, however, some potentially important advantages of delayed cord clamping in healthy term infants, such as higher birthweight, early haemoglobin concentration, and increased iron reserves up to six months after birth. These need to be balanced against a small additional risk of jaundice in newborns that requires phototherapy."

Pros
o   If infant is asphyxiated and needs to be moved immediately for resuscitation
 
o   Could possibly reduce risk of jaundice, bilirubin concentration has been found to be higher in infants in which cord clamping was delayed
 
Cons
o   Trials have shown infants are deprived of 2.17 g/dl of hemoglobin on average, this puts them at risk for low iron levels during the first 6 months of life
 
When cord clamping is delayed infants have shown:
o   Less need for transfusion
o   Better circulatory stability
o   Less intraventricular haemorrhage (all grades)
o   Lower risk for necrotising enterocolitis
 
 
Links to continue your research and draw your own conclusion about what is best for your family:
 
Science & Sensibility: Common Objectives to Delayed Cord Clamping – What’s the Evidence Say?
 
BBC News Health: Cutting cord early ‘risk to babies’
 
BMJ Group: Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial
 
Penny Simkin: Delayed Cord Clamping
 
Academic OB/GYN: Delayed Cord Clamping Grand Rounds

Visual Progression of Umbilical Cord after birth:
http://www.nurturingheartsbirthservices.com/blog/?p=1542 
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson
Note:  Each of these Information Sheets represents hours of work on out part.  Do you like the info?  Want to share with your readers?  Please DO NOT plagiarize.  Honor us and our time, and the time we spend away from our kiddos, by linking to this information instead of copying it.  Thank you!


Disclaimer:  
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.


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