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041714-02-01

Birth: in defense of delayed cord cutting
Waiting to cut the umbilical cord can result in a healthier baby, research shows.

DOWNEY – Through the placenta via the umbilical cord passes all the nourishment for your unborn baby. Whatever your growing baby needs, the placenta pulls it from the mother and passes it on.

To have a healthy baby, the importance of a healthy, well-functioning placenta can not be stressed enough. At any given moment one-fourth to one-third of the baby’s blood supply is flowing through the placenta.

Humans are the only mammal which, historically, prematurely separates the newborn from the life-sustaining force of its placenta. Slowly this is changing. Per Williams Obstetrics textbook, the mainstay of OB education for the majority of medical schools, “If…the infant is placed at or below the level of the (vagina)…for three minutes ..an average of 80 ml of blood may be shifted from the placenta to the infant. (This)…provides about 50 mg of iron, which reduces the frequency of iron-deficiency anemia later in infancy.”

Most physicians still traditionally clamp and cut the umbilical cord as soon as the entire body of the newborn is birthed from the mother. They do what they learned in medical school from the practicing OB physicians of the time. The textbook has changed since a lot of them graduated, and many are not aware of the published change of practice to delay the clamping and cutting of the umbilical cord.

Research has not shown any strong scientific support for immediate cord clamping and cutting – it is an entrenched medical habit among most OB’s. If you are delivering with a midwife, it is usually a standard part of their training to delay the clamping and cutting. Kaiser hospitals all have midwives for their low-risk deliveries.

One argument an OB doctor may have is immediate cord clamping prevents post partum hemorrhage, i.e. bleeding right after birth, but large studies have shown no significant differences in this area per Cochrane reviews.

Babies with delayed cord cutting (DCC) have an increase in total blood volume which shows a smoother cardiopulmonary transition at birth. The extra blood is equivalent to the volume to fully perfuse the fetal lungs, liver and kidneys at birth. Another benefit is the concentration of stem cells which have an essential role in the development of immune, respiratory, cardiovascular and central nervous systems. Immediate cord clamping (ICC) leaves these critical cells still in the placenta.

Ten percent of the general U.S. toddler population has anemia, and it’s above 20 percent in certain socio-economic populations. DCC gives these children a four to six month supply of iron so they don’t have to play catch up later in life.

Besides anemia, iron is essential in early infancy for rapid brain growth and development. Studies of infants with iron problems have uncovered deficits in cognitive processing which may lead to permanently decreased IQ, including attention and memory problems. Further studies need to be done on a potential link to ADHD and autism.

Breast milk is low in iron as a mother’s body uses its iron stores to replace blood lost during childbirth. Many pediatricians do recommend iron supplements to the exclusive breast fed baby for this reason.

One may raise concerns about back flow from the baby – blood returning to the placenta. After birth the baby’s blood pressure is so much lower than the pressure in the placenta that the blood flow goes with the pressure gradient and flows to the baby, except in very limited circumstances.

Another argument against DCC is neonatal jaundice, since bilirubin, the source of jaundice, originates in red blood cells. But studies have shown the majority of these babies have stable bilirubin levels. The rationale being attributed to the greater blood volume means greater blood flow through the liver to process the bilirubin more efficiently.

How does gravity affect the flow of blood with the baby in the ideal position of skin to skin on the mothers’ abdomen or chest?  Basically it affects the speed of the placental transfusion with stable pressures. The full transfusion takes up to five minutes in this position, where for a baby kept lower than the placenta it takes about three minutes.

In summary, there is much evidence of the benefits of DCC, i.e. the healthier neonatal cardiopulmonary transition, the prevention of iron deficiency at a critical time in brain development, the rich supply of stem cells, the burden of proof to those who choose ICC, why they feel it should be continued.

Reference: Science & Sensibility 11/13/12 by Sharon Muza with Dr. Mark Sloan, pediatrician and author of “Birth Day: A Pediatrician Explores the Science, the History and the Wonder of Childbirth”

Rita Shertick, RN, BSN, is a staff nurse at PIH Health Hospital – Downey. She also is a nursing school instructor at American Career College and is an adjunct faculty member at Long Beach City College and Cypress College.

 

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Published: April 17, 2014 – Volume 13 – Issue 01



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