Optimal cord clamping

What is it?

The umbilical cord connects baby to it’s lifeline of the placenta. The cord contains one vein carrying oxygen and nutrient-rich blood from the placenta to the baby, and two arteries which carry carbon dioxide rich blood and waste away from baby to the placenta for purification. Once baby is born it is often routine practice to clamp and cut this cord before the placenta is delivered. Delayed or Optimal cord clamping is when the cord is not clamped immediately but instead delayed until the blood, iron, platelets (for clotting) and stem cells (for healing) have all drained out of the cord and back into the baby. It accounts for around 1/3 of baby’s blood volume. This usually takes 3-5 minutes in which time baby can be happy skin to skin.

Why is it done?

Immediate cord clamping stems from the practice of giving an injection of a hormonal drug after birth in the 1960. This drug is very effective and makes the uterus contract extremely efficiently and so it has always been popular in birth as it delivers the placenta quickly and reduces the risk of bleeding. It is only recently that the effects to the baby are being considered.

cord clamping pic to show difference in blood

What’s the research?

There is a lot of research which shows a direct link between immediate cord clamping and anaemia especially in the first year of baby’s life and even into school age. There is ongoing research into other effects such as behavioural problems, social and motor skills. Babies, particularly premature babies, who have optimal cord clamping have better blood pressure, need fewer blood transfusions, improved clotting and have a lower risk of a bowel condition called necrotizing enterocolitis (NEC).

What are the current guidelines?

Guidelines and policies are changing around the world and so many trusts are moving away from immediate cord clamping. Optimal cord clamping can be done in all types of birth- natural, medicalised, caesarean. If baby needs resuscitation then 1 minute of optimal clamping is still recommended as this gets the oxygenated blood to the baby. The National Institute of Clinical Excellence (NICE) guidelines suggest 1-5 minutes, and there is a campaign called #waitforwhite which encourages waiting until the cord has completely stopped pulsating.

What can parents do?

The Royal College of Midwives encourage parents to have a look at the research and make an informed choice and then to state in their birth preferences if they want optimal cord clamping. Dads play a particular role in this. Dads can remind their midwife or doctor at delivery that they would like to delay clamping the cord and many practitioners appreciate a gentle reminder. Some antenatal trusts have stickers to put onto your pregnancy notes.

Want more info?

Look up research by Judith Mercer- rethinking placental transfusion and www.Bloodtobaby.com

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