Delayed cord clamping, you can’t not.

about-meIf you’re planning for birth, delayed cord clamping is something you should know about.

In most hospitals across Australia immediate cord clamping is common practice and standard procedure in the 3rd stage of birth.   That is, as soon as the baby is born, a clamp is placed across the umbilical cord to stop the blood flow from placenta to baby and the cord is then cut  (by midwife, obstetrician, dad, mum or birth companion).  This procedure is one part of an ‘Active Management of the 3rd stage of labour’.  Active management of labour is pretty much what it says it is, actively managing a woman’s labour by routinely intervening in the natural process in order to reduce and manage risk.

The 3rd stage of labour (birthing the placenta) is still heavily ‘actively’ managed these days.  The mother receives an injection of synthetic oxytocin in the thigh as the baby is born to ‘release’ the placenta quickly, the umbilical cord is clamped immediately and the umbilical cord is sometimes also pulled to encourage the placenta to release from the uterine wall quickly.

A physiological or natural 3rd stage of labour allows the cord to finish pulsating before being clamped, involves no injection of synthetic oxytocin and no cord traction to release the placenta.  The placenta releases naturally as the body produces the hormone oxytocin, which stimulates the uterus to contract and therefore encourages the placenta to detach.  Interactions between mother and baby like skin-to-skin, smell, sounds and breastfeeding will stimulate the release of oxytocin naturally.

Here is a picture of what the cord looks like after birth from 1 minute after birth to 6 minutes after birth so you can easily see the progression from lots of blood coursing through at 1 minute to it being almost complete at 6 minutes.


image courtesy of Nurturing Birth Services

With delayed cord clamping, the placenta, which has been responsible for supplying nutrients and oxygen to the baby for 9 months transfers a significant amount of blood to the baby via the cord. Penny Simkin explains this really simply on this you-tube clip showing how the placenta contains approximately 1/3 of the baby’s total blood volume after birth.  Within 2 minutes approximately 70% of the blood has been transferred with the further 30% transferring within 3-5 or even 10 minutes.

Since 2007, the World Health Organisation has advised 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 (approximately 3 minutes or more after birth) and that immediate cord clamping “prevents your baby from receiving adequate blood volume and consequently sufficient iron stores”.

The benefits of delayed cord clamping include “higher haemoglobin levels (Prendiville 1989), additional iron stores and less anaemia later in infancy (Chaparoo 2006; WHO 1998b), higher red blood cell flow to vital organs, better cardiopulmonary adaptation, and increased duration of early breastfeeding (Mercer 2001; Mercer 2006).”  Cohrane Review

Even when special circumstances arise such as the baby requiring resuscitation or suffering meconium aspiration, research now suggests it is preferable to leave the baby attached to the cord and beside the mother rather than cutting the cord immediately and taking the baby away.  “While the cord is attached the baby is receiving some oxygen, which is better than none”. Rachel Reed explains this in more detail on her blog Midwife Thinking.

Women are routinely ‘told’ that early cord clamping is a necessary component of active management of the third stage of labour yet, you can have a Cesarean Section and still have delayed cord clamping.  You can have active management of the placenta and still have delayed cord clamping, it’s your body, your baby and your informed choice.

Sources:
http://midwifethinking.com/2012/05/05/an-actively-managed-placental-birth-might-be-the-best-option-for-most-women/
http://midwifethinking.com/2010/08/26/the-placenta-essential-resuscitation-equipment/
http://apps.who.int/rhl/reviews/CD004074.pdf
http://www.youtube.com/watch?v=W3RywNup2CM&list=PLy7P1tTq6yLUQ8pKr9o6DJzh7230krUC4
http://amro.who.int/English/AD/FCH/CA/Delivery_care_practices.pdf
http://www.nurturingheartsbirthservices.com/blog/?p=154

Carla Morgan HypnoBirthing

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