Friday, June 8, 2012

Delayed Cord Clamping

Anyone heard about or did delayed cord clamping?  Delayed cord clamping is when you delay cutting the umbilical cord for at least 30 seconds but as much as 2-3 minutes or until the cord stops pulsing after birth.  I have been reading a lot about this recently and it appears that more and more healthcare professionals are allowing mothers to delay the clamping of the umbilical cord.  Why would you want to delay the clamping of the umbilical cord?

Several major medical journals, including the British Medical Journal and the American Medical Association have published articles regarding delayed cord clamping.  Even the World Health Organization has dropped early clamping from its guidelines and the Royal College of Obstetricians and Gynaecologists have changed their guidelines to indicate that "the cord should not be clamped earlier than is necessary, based on a clinical assessment of the situation."  By delaying the clamping of the cord, more of the cord blood can go back into the baby.  It allows an increase in the baby of red cell counts and iron stores.  With this increase in cord blood, the risk of anemia in the infant was decreased when compared to infants with immediate clamping.  This effect was seen up to 6 months later.  This is especially important in developing countries where mothers have a higher risk of delivering a baby while anemic.

With all of this in mind, why is it a widely accepted practice to clamp the cord immediately after birth even in the absence of any "sound scientific evidence?"  Apparently, it was believed that not immediately clamping the cord would put the mother at risk for hemorrhage or put the baby at risk for jaundice.  However, there is no evidence to suggest that these are issues in clinical practice.  There were no more cases of jaundice in babies who had delayed the clamping of the cord compared to babies who had their cords clamped immediately.  It was also believed to increase the risk of polycythemia which is a condition in which the "proportion of blood volume that is occupied by red blood cells increases."  "Although late clamping was associated with a moderate increase in blood viscosity, none of the polycythemic infants evaluated in this review were symptomatic (ie, had symptoms of central nervous system, cardiopulmonary, gastrointestinal tract, or renal impairment)."

Obviously there are times when delayed cord clamping is not feasible.  If you are planning on donating or storing your umbilical stem cells, then the cord must be clamped immediately after birth.  Also, if a complication were to arise that may harm the baby or the mother (like hemorrhaging), then the cord obviously must be cut immediately.

My two-year old was born with thick meconium.  He had his first bowel movement while passing through the birth canal.  Meconium is what they call the first bowel movement of the baby.  He was in danger of meconium aspiration syndrome so they had to cut the cord and clean him up before he had time to aspirate (breathe in) the meconium.  Obviously this was not a choice when he was born but I am definitely considering it for this child.  We are not going to "bank" our cord blood and our hospital, unfortunately, does not accept cord blood for donation so rather than letting it go to waste, I would rather that blood go straight to my baby.  I'm curious if anyone else has done delayed cord clamping and what was the outcome?

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