Cutting the cord

A growing number of women have been demanding that their umbilical cords not be cut immediately after childbirth as per the usual practice. Instead, they are now asking midwives not to clamp or cut the cord until after pulsations have ceased, or until after the placenta is delivered. Recent recommendations from US obstetricians have suggested waiting at least 30 to 60 seconds after birth for all healthy newborns, as the extra time allows a lot of oxygen-rich blood to reach the baby through the umbilical cord shortly after birth.

“Delayed cutting is considered waiting one minute or longer to cut the cord. This means sometimes delaying the cord cutting until the pulsations in the cord stop — a practice which research has shown to have noted benefits,” said Dr Keisha Buchanan, obstetrician-gynaecologist at ICON Medical centre.

She said that at the time of birth, the blood in the placenta and umbilical cord consists of approximately an extra one-third of the baby’s total blood volume, which means that cutting the cord immediately after birth will deprive the baby of some blood.

“The blood is rich in iron, which prevents conditions such as anaemia, clotting factors (that prevent bleeding), stem cells that can help to repair damaged tissues, red blood cells and white blood cells (including cancer-fighting T-cells) to help fight disease and infection,” Dr Buchanan advised.

In the case of premature babies, delayed clamping can also help to prevent low blood pressure, inflammation in the baby’s intestines that can be deadly, decreases the risk of bleeding in the brain, and prevents general bleeding problems. In addition, it also decreases the need for blood transfusions.

While these benefits are every mother’s dream, as with every good thing there is a drawback or two as well as situations that may not encourage delayed clamping.

“When a baby is delivered by way of a Caesarean section, delayed cord clamping may not be as easy to achieve as with a vaginal delivery. This is because as soon as a baby is delivered, in the case of a Caesarean section birth, the placenta needs to be quickly delivered to allow closing back the womb and decreasing maternal bleeding,” Dr Buchanan explained.

At birth there are sometimes circumstances which could also hamper the possibility of delayed clamping.

“After the baby is delivered he or she may need warmth, stimulation, suctioning of the airways, extra oxygen, and these can many times be provided while cord clamping is delayed. However, if the area where the baby is resuscitated is far from the bed where the delivery takes place, and the baby is having breathing difficulties or not breathing, sometimes the cord may have to be cut immediately to allow transfer of the baby to the resuscitation area,” Dr Buchanan said.

Ideally, she said, the resuscitation area should be beside the delivery bed, and while this is not always the case, if the mother requests delayed clamping, then preparations should be made to allow this.

Another downside to delayed clamping is a small risk of jaundice developing in the baby after birth.