Delayed cord clamping: Settling the debate

"Told you so!"

Aristotle was on to something, way back in the B.C.’s, when he wrote approvingly of the midwifery practice of not cutting the cord until the placenta was delivered.

He was also struck by the midwives’ practice of “stripping” the umbilical cord in emergencies: forcing the blood remaining in the umbilical cord back into a newly born baby in need of reviving. 

‘‘Frequently the child appears to be born dead, when it is feeble and when, before the tying of the cord, a flux of blood occurs into the cord and adjacent parts. Some nurses who have already acquired skill squeeze (the blood) back out of the cord (into the child’s body) and at once the baby, who had previously been as if drained of blood, comes to life again.’’

For Aristotle and centuries of midwives, cord clamping was a thing best done slowly.

Clamping the cord: early or late?

In the 1970s western hospital-based medicine abandoned the practice of “delayed” cord clamping*–that is, waiting until the cord stops pulsing to cut it.  In an effort to decrease postpartum hemorrhage, “early” clamping–cutting the cord as soon as possible–became the norm. But new research now proves that, as far as umbilical cords go, the old way is still the best.

Researchers in Sweden recently showed that delayed clamping is not only safe, it’s highly beneficial to babies. In a world in which iron deficiency damages the brains of millions of children a year (including here in the U.S. – more on that in a later post), delayed clamping allows more iron-rich blood to pass from the placenta to the baby at birth.

The Swedish researchers found that all measures of iron metabolism were improved in four month-olds who were treated with delayed clamping. No complications or side effects were noted. 

It’s time for hospitals to re-adopt delayed clamping as standard procedure, just as nature intended.  To borrow another Aristotle-ism, “Nature does nothing without reason or in vain.” Amen.

* * * * * * *

*(“Natural” would be a better term than “delayed”, seeing as that’s when nature chooses to close down the blood vessels in the cord. But I don’t get a vote on these things, so we’ll go with “delayed.”)

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14 Comments

Filed under Maternal-child health, Natural childbirth, Newborns

14 responses to “Delayed cord clamping: Settling the debate

  1. I just want to know why you don’t get to vote on these things? You should.

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    • In a fair world (ie, one in which I got to do whatever I want) I would rename a lot of medical stuff, maybe starting with things like “acne vulgaris.” Isn’t life hard enough on teens with zits without calling them vulgar, too? How about “acne fabuloso” or “pimples a la Justin Bieber”? Alas, for some inexplicable reason, these things are not up to me…

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  2. Great post Mark, now we’ve been talking about the new Safe sleep recommendations… could you comment.

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  3. Clever guy, Aristotles was, indeed, and choosing his wording well. As a species that tends to thinking it can improve on nature’s blueprint, we also tend to name odd what is natural, like breastfeeding for the set time is called ”prolonged nursing” and breastfeeding in the designed rhythm ”frequent nursing”. Well at least ”delayed” cord clamping will assure that ”frequently” breastfed children will not run out of iron if mother ”prolongs” their nursing

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  4. Reblogged this on modern midwifery and commented:
    This is a brilliant, loving the historic views of delayed cord clamping! Think this may be a good reference at some point ………….

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  5. I’m all for delayed cord clamping for the benefit of the baby and to further wait until it stopped pulsating for the benefit of both mother and baby as it is gentler. As long as the cord is pulsating the risk of haemorrhaging from the uterus is minimal as the placenta is still attached. The cord can continue to pulsate for some time, many times for as long as 20 minutes. I also have found from personal experience that the blood loss seems less at delivery when women opt for physiological birth of the placenta which is opposite from what textbooks tells us midwives. Now I have found research to support my findings that there is actually less blood loss when undertaking physiological management of delivering the placenta (Dixon et al 2011); http://www.sciencedirect.com/science/article/pii/S0266613811001823

    Slightly off the subject but very much for delayed cord clamping! Yet another thought provoking blog Dr Sloane!

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  6. Pingback: Physiological third stage and the benefits | missobstetrix

  7. Ola Andersson

    Thanks for blogging about our paper, and I agree “delayed” is not a correct expression.

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  8. Pingback: Due in September 2012: Second Trimester here we go, watch our bellies start to grow! - Page 32

  9. There seems to be a shocking lack of knowledge about newborn transition physiology among doctors especially. They seem to be more interested in getting the cord clamped so they can have the blood gases determined, than to let the baby have the amount of blood from the placenta which is meant to be a life line and resuscitation aid before they have their respiration established. As if this transition takes only a second!
    A lot of research has been done to explore the connection between low cord blood pH, high PCO2, high Base excess and low 5-minute Apgar. Has it ever struck them that the blood sampling it self may lead to a low 5-minute Apgar? And that this intervention leaves the baby in deep shit if there has been an asphyxia episode? The resuscitation then starts on a hypotensive / hypovolemic baby, with lack of reparative stem cells and lack of red blood cells to carry oxygen.

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  10. Waiting a couple of minutes after shipping to reduce the umbilical cord is better for a newborn’s health, study suggests. Delaying cord clamping reduces the danger that the baby will have iron deficiency anaemia without considerable side effects, the authors told the BMJ. The Planet Health Organization dropped early clamping from its recommendations some years ago.

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