Last year, I wrote a series of blogs titled “The Evidence Says”. This series of evidence-based maternity care blogs were very popular and I have had many requests to do another series this year. So for the first in the 2010 series, the topic is….delayed cord clamping.
Back in the time when we were living in caves and wearing fig leaves, we didn’t have the technology, sanitary conditions or even perhaps the knowledge to clamp and cut the umbilical cord on a newborn. For that reason, and perhaps others, Mother Nature covered the umbilical cord with a protective and insulating mucous tissue called Wharton’s Jelly. Wharton's jelly, when exposed to temperature and moisture differences, collapses structures within the umbilical cord and thus will provide a physiological clamping of the cord, approximately 5 minutes after birth. One wonders if early clamping of the cord in today’s maternity care setting results in lesser blood volume that was intended for the baby?
Lotus birth is the practice of leaving the umbilical cord unclamped and attached to the placenta after birth of both the baby and the placenta. In a Lotus Birth, the placenta is typically wrapped and carried with the baby until the cord naturally dries and detaches a few days after birth. Often, the placenta is treated with salts and herbs to preserve the meat and prevent spoiling and odor. Cultural disposal of the placenta varies from planting under a tree (the tree then becomes the child’s tree), to making a very nourishing placental soup, to dehydration and encapsulation for the mother to take by mouth. Studies are being done as to the impact of ingestion of the placenta on the postpartum period.
A review of current medical literature (2005-2010) finds overwhelming recommendations that late cord clamping can be advantageous for newborns by improving iron status and does not increase the risk of postpartum hemorrhage (Cochrane Database Syst Review. 2008 Apr 16;(2):CD004074.). A 2007 article in the Journal of the American Medical Association found that delay clamping in full term babies is beneficial to the newborn and the increase in polycythemia was benign. (Journal of the American Medical Association 2007 Mar 21;297(11):1241-52. Hutton EK, Hassan ES “Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials”.)
When looking at the effect of placentofetal transfusion on cerebral oxygenation in preterm infants, delayed clamping of the umbilical cord actually improved cerebral oxygenation in these infants in the first 24 hours. (Pediatrics. 2007 Mar;119(3):455-9).
Finally, an article in the British Medical Journal addressed concerns that delayed cord clamping could not only increase polycythemia but also cause hyperbilirubinaemia (abnormally high levels of red blood cells and bile pigments in the bloodstream, often leading to jaundice). However, trials show this is not the case. (British Medical Journal 2007, August 17 18;335(7615):312-3. Weeks, A. “Umbilical Cord Clamping After Birth”).
Obviously, if the newborn was compromised during labor or birth and needs specific and emergent care, the possibility of delayed cord clamping may also be compromised.