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What Every Pregnant Mother Should know about Delayed Cord Clamping

If you are going to deliver a child soon, you should ask your physician about delayed cord clamping.  Studies have repeatedly shown that delay of cord clamping by 1-2 minutes can auto-infuse blood into your newborn infant.

Why is this important?  Well, researchers have also shown that babies who have undergone delayed cord clamping have less chance of iron deficiency anemia 4-6 months later later! [1-3]

And, iron deficiency anemia in infants have been shown to have potential deleterious effects on IQ.  So, if you are smart, consider asking your provider about delayed cord clamping.

Are there any disadvantages of delayed cord clamping?  There are two.  First, your baby may be at increased risk of jaundice.  This is due to the extra red cells.  So, don’t be surprised if your baby has “hyperbilirubinemia.”  Secondly this may limit the ability for cord blood donation.  This is a entirely different debate, which I won’t go into here.

Whenever I deliver babies, I always default to delayed cord clamping.  However, there are times that is not always possible, especially if the baby has “thick” meconium, where transport to the warmer to a resuscitation team is necessary.  But for the majority of the newborns, I always had the infant below the mom for gravity to take effect.  However, new research found that it didn’t matter if the infant was lower than the mother or on the abdomen. [4]

This new research not only supports the fact that placental transfer can happen without the aid of gravity (likely through arterial pressure) but supports the benefits of immediate skin to skin contact.

A summary from NEJM Journal Watch.

Placental Blood Transfusion Equally Effective If Baby Is Placed on Mother

By Joe Elia

Delayed cord clamping provides as much placental blood when the baby is placed on the mother’s chest or abdomen as when it’s held at the level of the vagina, according to a Lancet article.

In a study of gravity’s effects on placental transfusion, researchers randomized some 400 babies born vaginally to one of two groups. Infants in the first group were held at the level of the vagina for 2 minutes after delivery, and in the second, they were placed on the mother’s chest or abdomen.

To measure the amount of placental blood transferred, babies were weighed immediately upon delivery and again after cord clamping. The mean weight gain in both groups was roughly 55 g.

“We should all be considering the merits of delayed cord clamping,” said Allison Bryant of NEJM Journal Watch Women’s Health. “This study helps to eliminate the cumbersome process of holding the neonate lower than the placenta — and away from its mother — and allows for immediate skin-to-skin contact, a technique that has great benefits of its own.”

Great news now for both baby and mother.

-Dr. O.

 

REFERENCES

  1. Hutton, Eileen K., and Eman S. Hassan. “Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials.” Jama 297.11 (2007): 1241-1252.
  2. McDonald, S. J., and P. Middleton. “Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes (Review).” (2009).
  3. Andersson, Ola, et al. “Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial.” BMJ: British Medical Journal 343 (2011). http://www.ncbi.nlm.nih.gov/pubmed/22089242
  4. Nestor E Vain, Daniela S Satragno, Adriana N Gorenstein, Juan E Gordillo, Juan P Berazategui, M Guadalupe Alda, Luis M Prudent. Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trialThe Lancet, 2014; DOI: 10.1016/S0140-6736(14)60197-5