Today's post is short...I know...we "just did" this topic last week.  The reason I am bringing it to your attention again is because there was a news splash in regards to cord clamping yesterday.

The Cochrane Library released a review that came to the conclusion that (emphasis mine),  "Although early cord clamping has been thought to reduce the risk of bleeding after birth (postpartum haemorrhage), this review of 15 randomised trials involving a total of 3911 women and infant pairs showed no significant difference in postpartum haemorrhage rates when early and late cord clamping (generally between one and three minutes) were compared. There were, however, some potentially important advantages of delayed cord clamping in healthy term infants, such as higher birthweight, early haemoglobin concentration, and increased iron reserves up to six months after birth. These need to be balanced against a small additional risk of jaundice in newborns that requires phototherapy."

You can read the complete report HERE.  It definitely merits a good look and a discussion with your care provider if you believe that delayed cord clamping is something you want to do with your baby.  I offer THIS article from the New York Times to read more about the concerns that OB/GYNS have traditionally had in regards to delaying cord clamping.  It may help you have a more productive conversation with your care provider if you have an idea of what their protocols are and why.

I think it's important to note that the benefits were to "healthy term infants".  Please read the report with with a grain of salt and understand that different decisions may need to be made when a mother or baby is at risk.  Please don't beat yourself up if you have/had to make a different choice; sometimes simply because you did not have all the information at hand to discuss with your care provider.

Want to learn more about cord clamping and do your own research?  You can read Cassandra's post titled, "Info Sheet: Cord Clamping" HERE.

Wishing you and your littles a great weekend!  

 

CORD CLAMPINGcan be immediate or delayed.  Today we look at the common practice of immediate cord clamping, and the alternative, delayed cord clamping.

 

Immediate Cord Clamping: (ICC) clamping the umbilical cord immediately following the birth of baby, generally carried out in the first 60 seconds after birth. World Health Organization (WHO)

According to ACOG “In most deliveries today, the cord is clamped within 15–20 seconds after birth.”

 

Early cord clamping originally came into practice in the 1950s as an attempt to reduce the instance of neonatal jaundice and as a method to protect newborns from drugs that were given to their mothers. In the 1990s, the American College of Obstetrics and Gynecology (ACOG) called for early clamping for legal purposes. Today the procedure is routinely performed by most obstetricians, while most midwives prefer delayed clamping.

 

We spent some time searching for historical trends in jaundice.  We found none.  It seems that neither hyperbilirubinemia (too much bilirubin that causes the visual effects we call jaundice) nor kernicterus (permanent brain damage caused by hyperbilirubinemia) are reportable diseases.  Since they are not reportable, there are no charts that show whether or not jaundice rates have fluctuated one way or another since the advent of ICC. 

The optimal time to clamp and cut the umbilical cord after birth has been an ongoing controversy in obstetrics for many years. Web MD released earlier this year that, “There's growing evidence the current practice of cutting the cord straight after the baby is born may mean the baby doesn't get enough iron. This could lead to anaemia in some cases.”

 

According to the World Heath Organization, “Delaying cord clamping allows blood flow between the placenta and neonate to continue, which may improve iron status in the infant for up to six months after birth. This may be particularly relevant for infants living in low-resource settings with less access to iron-rich foods.”

 

Last year ACOG released a statement that preterm infants benefit most from delayed cord clamping and that delaying until at least 30-60 seconds after delivery benefits all babies. They concluded their committee opinion by stating that “More research is needed to help evaluate the optimal timing of cord clamping” and have not released any official guideline changes as of today.

 

Finally, just released on July 11, 2013, The Cochrane Library review concluded that, "Although early cord clamping has been thought to reduce the risk of bleeding after birth (postpartum haemorrhage), this review of 15 randomised trials involving a total of 3911 women and infant pairs showed no significant difference in postpartum haemorrhage rates when early and late cord clamping (generally between one and three minutes) were compared. There were, however, some potentially important advantages of delayed cord clamping in healthy term infants, such as higher birthweight, early haemoglobin concentration, and increased iron reserves up to six months after birth. These need to be balanced against a small additional risk of jaundice in newborns that requires phototherapy."

 

When cord clamping is delayed infants have shown:

 

 

 

Science & Sensibility: Common Objectives to Delayed Cord Clamping – What’s the Evidence Say?

 

BBC News Health: Cutting cord early ‘risk to babies’

 

BMJ Group: Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial

 

Penny Simkin: Delayed Cord Clamping

 

Academic OB/GYN: Delayed Cord Clamping Grand Rounds

Visual Progression of Umbilical Cord after birth:
http://www.nurturingheartsbirthservices.com/blog/?p=1542