Delayed cord clamping (or Optimal Cord Clamping – OCC) as the healthy norm.

If someone told you that something that you can do to your precious tiny newborn could take away a third of his or her crucial blood supply, you wouldn’t do it, would you?

If someone also told you that a routine procedure, with no known benefit, was going to deprive your baby of important stem cells, brain power cells, immune system cells, iron and really important vitamins and minerals, again I bet you would say no thanks.

Well, this happening to most of our babies now, and we can stop it so easily and simply – just don’t cut the cord yet!

Even if a baby is compromised and is in need of some help with breathing or resusutation… do you think that cutting off the lifeline that has kept him or her alive for the last 9 or so months is a good plan? When you think of it logically, it doesn’t make sense does it.

So, the next question that people ask me is why do health care practitioners do something so wrong then?

Maybe because once upon a time someone believed that if you didn’t clamp the cord the blood would travel back from the baby into the uterus causing baby to loose blood? Well, we know this isn’t true.

Maybe because time is against us in the delivery room? Sad, but true, and so blooming wrong! Birth should not be hurried, and the short time that it takes for that essential blood transfusion really shouldn’t be compromised.

Maybe because Doctors and Obstetrician’s like to do their job without restriction? Yes, maybe it is easier to handle a baby when not attached to it’s lifeline still… BUT… for the duration of the pregnancy the placenta has been delivering oxygen to the baby, so now is not the time to remove that oxygen supply.

What happens to our brains when we are depleted of oxygen? We can get brain damage?

I’m wondering about Autism links?

Anyway, enough of my rambling thoughts, here is an article written by the award winning Midwife of The Year, and Campaigner for Optimal Cord Clamping, Amanda Burleigh. There is a whole load of science behind this, not just my heartfelt waffle. Please consider giving a few minutes to sign the petition to implement this change immediately for the sake of our babies.

OPTIMAL CORD CLAMPING

Immediate (early or premature) cord clamping has been practised in hospitals around the world for approximately 50 years.  During this procedure the umbilical cord is clamped and cut as soon as the baby is born, often before the baby has taken their first breath.  Immediate clamping usually follows the injection of a drug (or combination of drugs) to rapidly contract the uterus.  This helps shorten the third stage of labour, with the intention of preventing excessive bleeding after birth.  However, this belief is not supported by the currently available evidence.

When immediate cord camping was first implemented, it would appear that no thought was given to the function of the umbilical cord or the placenta in helping a baby’s breathing and circulation to adapt to life outside the uterus.  It has been documented that premature cord clamping causes the baby to lose up to 40% of their intended blood volume.  A baby whose cord is left intact will gain up to 210g in the first five minutes following birth. (Farrar et al 2010).  Increasingly the evidence has shown that this deficiency in all the components of cord blood can be detrimental to babies.

As well as losing oxygen-carrying red blood cells, fetal blood contains high levels of stem cells which are building blocks for growth or repair and white cells which are vital for a healthy immune system.

‘Delayed cord clamping, compared with early clamping, resulted in improved iron status and reduced prevalence of iron deficiency at four months of age, and reduced prevalence of neonatal anaemia, without demonstrable adverse effects.  Thus, the available evidence suggests that it is important to prevent iron deficiency in infants in order to achieve optimal brain development.’ Andersson 2011

After birth the umbilical cord will continue to pulsate until breathing is properly established. This can vary from a couple of minutes to just before the birth of the placenta.

In recent years, many World Organisations (WHO, FIGO, RCOG, UNICEF, ICM, ILCOR and RCM) have all changed their guidelines for an actively managed third stage to recommend delaying cord clamping for a minimum of one minute, with a delay in clamping of three to five minutes recommended as beneficial.

In November 2012 the Royal College of Midwives updated their guidelines. They state that:

‘Delayed Cord Clamping is currently the recommended practice known to benefit the neonate in improving iron status up to six months but with a possible risk of jaundice that requires physiotherapy.’  (Resuscitation Council 2010 McDonald and Middleton 2009 WHO 2007, Mercer et al 2007)

There are two methods of managing third stage and delivering the placenta.

Active Management
‘Involves giving a prophylactic uterotonic, cord clamping and controlled cord traction.’ (RCM 2012)
‘Timing of the uterotonic can vary from delivery of the shoulder, after the birth but before delivery of the placenta, or after delivery of the placenta.  The timing of administering the drug needs to be considered alongside the timing of clamping of the cord, as the effects of these separate actions interact and their timing may make a difference to optimal outcomes.’ (NCT Evidence based Briefing October 2006)

Physiological Management
Involves promoting the use of gravity and the mother’s bodily systems to birth the placenta, with no administration of uterotonic (uterus contracting) drugs and no clamping or cutting of the cord until after the placenta is delivered.  (Begley et al 2011)

The New RCM Guidelines also state: ‘When physiological management is offered to women as a reasonable option, many will choose it.’ (Rogers and Wood 1999)

Informed choice
Optimal Cord Clamping would ideally follow the physiological processes, where there is no intervention and the cord is allowed to complete pulsation naturally.  However, as many midwives feel more confident in actively managing third stage, delayed cord clamping can be easily managed by delaying the injection of uterotonic drugs until the baby is crying (or feeding) lustily and skin to skin is underway.  Whilst the cord is pulsating there is little chance of haemorrhage as the placenta is still attached and functioning.  When the baby is in optimum condition the uterotonic can be administered in conjunction with clamping and cutting of the cord to avoid a high-pressure surge of blood which may not be ideal for the finely-balanced newborn circulation.  This mixed method of management would benefit mother and baby and still enable professionals to be confident in the care given.

During caesarean sections a delay in clamping for a minute or two is beneficial for the baby and will not increase the risk for most mothers and babies.

Increasing numbers of hospitals around the UK are adopting new guidelines to implement delaying cord clamping.  Other hospitals are reluctant to change until given guidance by NICE.  NICE are intending to update their guidelines, but not until November 2014 which is almost two years away, too long considering the amount of evidence to show that immediate cord clamping can be detrimental.  One of the arguments for the delay is that although active management and immediate clamping is recommended in the guidance, women should be offered informed choice.  However, in reality, audits show that this is not always the case.

I have started a petition, in the hope that public opinion will persuade NICE to bring forward their review date.  Please consider signing it and pave the way for evidence-based cord clamping.

http://www.change.org/petitions/nice-implement-delayed-cord-clamping-immediately

Amanda Burleigh  RM  RGN

In association with The Fertility & Birth (FAB) Network
www.fertilityandbirth.co.uk