Delayed Clamping of the Umbilical Cord: A Review with Implications for Practice

Gina Eichenbaum-Pikser, CNM, MSN; Joanna S. Zasloff, CNM, MSN

Disclosures

J Midwifery Womens Health. 2009;5(4):321-326. 

In This Article

Special Considerations

Delayed Cord Clamping for Preterm Infants

Delayed cord clamping has been shown to be especially beneficial for preterm infants. In industrialized countries, 60% to 80% of preterm infants born before 32 weeks of gestation require blood transfusions.[6] Increases in Hgb levels and RBC volume are associated with a reduction in the need for blood transfusion, either for anemia or low blood pressure, in the first 6 weeks of life.[6,8] In addition, the risk of intraventricular hemorrhage, a significant cause of neonatal morbidity and mortality in premature infants, is reduced with the use of delayed cord clamping.[6] In an RCT of 37 premature infants at 34 to 37 weeks of gestation, Ultee et al.[12] found that infants with delayed cord clamping had significantly higher Hgb levels than those with immediate cord clamping (13.4 mmol/l [1.9], n = 19 versus 11.1 mmol/l [1.7], n = 18) at 1 hour postpartum and continued to have higher Hgb levels up to 10 weeks of age (6.7 mmol/l [0.75], n = 19 versus 6.0 mmol/l [0.65], n = 18).[12] Interestingly, there was no difference between the groups in ferritin levels at 10 weeks. Ultee et al.[12] found no difference between the delayed and immediate groups in terms of mean glucose levels and the number of infants born with a blood glucose of < 2.0 mmol/l.

Strauss et al.[13] found that circulating RBC volume/mass increased after delayed cord clamping (74.4 mL/kg) versus immediate cord clamping (62.7 mL/kg) in preterm infants. Interestingly, the increase in RBC volume/mass was not observed immediately in the neonates with delayed cord clamping, but it lead to significantly higher Hct levels by day 7 that continued throughout the first 28 days of life.

Delayed Cord Clamping in Developing Countries

Delayed cord clamping may be particularly beneficial to newborns in developing countries and resource-poor environments because it is a safe and inexpensive way to prevent infant anemia.[8] Particularly in countries where severe anemia of the mother and newborn is common, and in countries where blood transfusions are not readily available, delayed cord clamping should be considered for all infants regardless of gestational age. Perhaps in these settings, using gravity for added blood transfusion after the cord has stopped pulsing would be particularly beneficial in order to ensure the maximum amount of placental blood is reaching the newborn.

Lotus Birth

Lotus birth or "umbilical nonseverance" is a practice where the umbilical cord is never cut from the placenta. Many cultures around the world view the placenta with high spiritual regard, and the practice is based on the belief that allowing the baby to stay attached to the placenta is both nonviolent and allows for an easier transition into life for the newborn.[14] The placenta is cleaned and covered with a mixture of salts and herbs and wrapped in a cloth until it naturally disintegrates in about 3 to 7 days.[14] It is more difficult to pass the baby around, therefore decreasing exposure to infection. We could find no scientific studies evaluating the benefits of this practice.

Cord Blood Banking

Cord blood banking may conflict with practicing delayed cord clamping because blood banking facilities require a substantial amount of umbilical blood to ensure proper stem cell harvesting.[10] In a conversation with two reputable cord blood banking companies, Viacord and CBR, no recommendations were given concerning the number of units of cord blood needed for adequate banking.[15] In order to collect 100 million stem cells, which is the minimum amount of cells needed for transplant, both Viacord and CBR recommend that practitioners immediately clamp the cord. Neither company was opposed to delayed cord clamping but explained that delayed cord clamping may lower the stem cell count leaving it unusable (personal communication; Fred Foster at Viacord and Fred Ganzales at CBR, October 27, 2008). Because immediate cord clamping will decrease the amount of blood transfused to the newborn, increasing the baby's chances of developing anemia, it is important that midwives and parents evaluate the needs of the newborn when deciding to bank cord blood.[10]

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