When to cut a baby’s umbilical cord has long been a topic of debate; while most doctors and midwives still follow the recommended protocol of 30 seconds after birth, there are others that have claimed for years that there are benefits to waiting. Who’s right? It seems the latter group, according to a recent study. That study may very well change the current recommendations at the Royal College of Midwives in the UK. However, it will still be primarily up to physicians to decide when the cut should be made.
The original recommendations have been followed for years, often without question. The assumption was that cutting the cord nearly immediately after birth helped to protect the baby from too much exposure to a synthetic hormone give to mothers to help speed up the labor process and help with the delivery of the placenta. Cutting the cord early was also thought to help reduce the chances of jaundice in infants and the risk of bleeding in mothers. Unfortunately, no evidence has been found to back up these assumptions, and new studies are finding that there are significant health benefits for baby when cord cutting is delayed, even by just a few minutes.
According to the new information, vital stem cells are transferred to baby when allowed to stay attached to the umbilical cord shortly after birth. It is thought that this extra surge of stem cells, along with the extra burst of blood cells from mom, can help reduce the chances of anemia and iron deficiencies, on into childhood.
The study, conducted in Sweden, found that infants who were clamped and cut at three minutes had less than a one percent chance of iron deficiency at four months of age when compared to six percent of infants that were clamped immediately after birth. Additionally, researchers found no increase in jaundice or other complications that were thought to result from delayed clamping.
A major study in the U.S., which involved more than 1,900 newborns, found that only a two-minute delay in clamping and cutting was enough to reduce the risk of anemia by half and low iron levels y one-third.
Dr. Patrick van Rheenan, a consultant pediatrician at Groningen University in the Netherlands said in an editorial published in the same journal as the study:
“How much evidence is needed to convince obstetricians and midwives that it is worthwhile to wait for three minutes to allow for placental transfusion?”
Apparently, there is now enough evidence because the World Health Organization dropped their early clamping guidelines back in 2007, and the Royal College of Midwives in the UK is now planning to change their curriculum guidelines to fit the new evidence. They had already updated the curriculum last year to recommend that the cord “should not be clamped earlier than necessary, based on clinical assessment of the situation,” but further advisement is being planned in the upcoming months.
“We are supporting the midwives not to clamp the cord immediately,” said Meri Jokinen, practice and standards development advisor at the RCM said. “We’ve not finalized the guidelines and in terms of how long it will recommend delaying clamping for, we don’t know. Guidelines drawn up by different organizations vary from one to five minutes, and even up to ten. Most midwives will have to use their judgment in terms of the clinical situation. It is more likely to happen within three to five minutes.”
Jokinen added that the guidelines are being changed, not just because of the evidence in the studies, but also because women have actually been requesting that the cord not be cut immediately.
“The issue here was studies started to show that with early clamping, you’re delaying a baby a boost of blood and it was recognized that hemoglobin levels were much lower later on,” she said. ”It is said that babies who are healthy and well would benefit from greater hemoglobin levels. Women have also asked us to give their babies to them while they are attached.”
Of course, hospitals will still be able to decide on their own birth protocols, and physicians will have the final say in when to cut the cord. While many are likely to follow RCM policy, others may still decide to stick with the old recommendations.
David Hutchon, a retired consultant obstetrician and gynecologist, who has campaigned for policy changes in cord-cutting for years, says that the upcoming changes are “very welcome,” but adds, “Whether doctors will take any notice is another issue. There’s a lot of ignorance out there and people have just blindly followed guidance for years without questioning it.”
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