The Evidence Says: Delayed Cord Clamping

One of the emotional touch points circulating in social media regarding birthing practices is the subject of delayed cord clamping (DCC).  Medical and nursing schools may not be teaching about DCC, perhaps in part due to the December 2012 ACOG Opinion² that stated “Currently, insufficient evidence exists to support or refute the benefits from delayed umbilical cord clamping for term infants that are born in settings with rich resources.”

ACOG does support DCC in preterm infants.  “As with term infants, delaying umbilical cord clamping

to 30–60 seconds after birth with the infant at a level below the placenta is associated with neonatal benefits, including improved transitional circulation, better establishment of red blood cell volume, and decreased need for blood transfusion. The single most important clinical benefit for preterm infants is the possibility for a nearly 50% reduction in intraventricular hemorrhage.”

However, Dr. Mark Sloan, author of Birth Day: A Pediatrician Explores the Science, the History and the Wonder of Childbirth, states that “medical habits can be glacially slow in changing.” http://www.scienceandsensibility.org/?p=5730

A 2011 study³ of 400 full term infants found that delayed cord clamping resulted in improved ferritin levels and reduced the prevalence of iron deficiency at 4 months of age.  Added to that, dcc also reduced the prevalence of neonatal anemia at 2 days of age without increasing the rate of respiratory symptoms or need for phototherapy.  Conversely, early cord clamping has been linked to hypovolemia, anemia and low iron stores in the neonate.⁴

In 2009, the Academic OB/GYN Blog¹ stated that “after some research I found that there was some pretty compelling evidence that indeed, early clamping is harmful for the baby.  So much evidence in fact, that I am a bit surprised that as a community, OBs in the US have not developed a culture of delayed routine cord clamping for neonatal benefit.”

Mary Ceallaigh, Lotus Birth advocate and midwife educator was interviewed by the New York Post⁶ saying that the best reasons for a Lotus Birth is that there is complete transfer of placental/cord blood into the baby and allows for the mother and baby to focus on bonding rather than “who’s cutting the cord”.

We are just beginning to see a surge in evidence supporting DCC.  Initial research remains positive.  And as Levy⁵ stated, “the balance of available data suggests that delayed cordclamping should be the method of choice.”

References

      1. http://academicobgyn.com/2009/12/03/delayed-cord-clamping-should-be-standard-practice-in-obstetrics/

2. http://www.acog.org/Resources%20And%20Publications/Committee%20Opinions/Committee%20on%20Obstetric%20Practice/Timing%20of%20Umbilical%20Cord%20Clamping%20After%20Birth.aspx

3.       Andersson, O. et al.   Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomized controlled trial.  BMJ 2011; 343: d7157.
4.       Hutchon, DJ. Immediate or early cord clamping vs delayed clamping.  Journal of Obstetrics and Gynecology 2012 Nov, 32(8): 724-9.
5.       Levy, T. and Blickstein I.  Timing of cord clamping revisited. Journal of Perinatal Medicine 2006; 34(4): 293-7.
6.       Lotus Birth trend keeps umbilical cord and placenta attached to baby for Days.  New York Post April 11, 2013.