On The Optimal Time To Cut The Baby’s Umbilical Cord

The New York Times reports on a new analysis that lays out the benefits of waiting at least a minute or so before cutting a newborn’s umbilical cord; the standard practice in mainstream maternity care is an immediate snip, in under 30 seconds.

By delaying the time in which the mother is literally separated from her new baby, more blood can move from the placenta, the report says, which “significantly improves iron stores and hemoglobin levels in newborns and does not increase the risks to mothers.” The study was published Wednesday in The Cochrane Database of Systematic Reviews.

andrechinn/flickr

andrechinn/flickr

Even with mounting evidence of its benefits, delayed cord-clamping remains controversial  (the influential American College of Obstetricians and Gynecologists issued a statement in December saying there’s not enough evidence to endorse or refute the practice). However “delayed” cord cutting — or the preferred term “optimal cord-cutting” has been common among midwives, doulas and mothers around the globe for decades.

Somerville doula Ananda Lowe (my co-writer on a book about birthing practices) recently posted this informative piece about “optimal” cord-cutting following either vaginal or cesarean birth. It’s written by Dr. Alan Greene, who in 2012 launched a worldwide campaign called Transitioning Immediate Cord Camping To Optimal Cord Clamping or TICC TOCC. Greene’s post clearly lays out problem, the history and the physiology of practice, and makes a powerful argument that optimal cord-clamping is a simple, inexpensive fix that can improve the health of infants around the world.  (Be patient with the YouTube video above — it takes Greene more then 10 minutes to get to this point, but the rest of the talk is pretty compelling too.)

Readers, how did you handle cord-clamping? What worked for you? Please let us know.

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  • Nathanael Johnson

    http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004074.pub3/abstract

    “Mean birthweight was significantly higher in the late, compared with
    early, cord clamping (101 g increase 95% CI 45 to 157, random-effects
    model, 12 trials, 3139 infants, I2 62%). Fewer
    infants in the early cord clamping group required phototherapy for
    jaundice than in the late cord clamping group (RR 0.62, 95% CI 0.41 to
    0.96, data from seven trials, 2324 infants with a LCER of 4.36%, I2
    0%). Haemoglobin concentration in infants at 24 to 48 hours was
    significantly lower in the early cord clamping group (MD -1.49 g/dL, 95%
    CI -1.78 to -1.21; 884 infants, I2 59%). This
    difference in haemoglobin concentration was not seen at subsequent
    assessments. However, improvement in iron stores appeared to persist,
    with infants in the early cord clamping over twice as likely to be iron
    deficient at three to six months compared with infants whose cord
    clamping was delayed (RR 2.65 95% CI 1.04 to 6.73, five trials, 1152
    infants, I2 82%). In the only trial to report
    longer-term neurodevelopmental outcomes so far, no overall differences
    between early and late clamping were seen for Ages and Stages
    Questionnaire scores.”

  • Amy Tuteur, MD

    There’s just one problem. The Cochrane review showed that there were NO clinical benefits to delayed cord clamping.

    The authors looked at a variety of outcomes and here is what they found:

    Apgar scores: NO BENEFITS

    NICU admissions: NO BENEFITS

    Respiratory distress: NO BENEFITS

    Jaundice: NO BENEFITS

    Infant hemoglobin: NO BENEFITS

    Infant anemia (hematocrit): NO BENEFITS

    Breastfeeding: NO BENEFITS

    Low iron levels @3-6 mo: Slightly higher iron levels, although it is unclear whether this is a real finding since there were wide variations in the studies reviewed.

    That’s it.

    Yes, babies had higher initial hemoglobin and hematocrit, But that doesn’t mean that higher hemoglobin levels are beneficial and, indeed, the higher hemoglobin levels did not translate to better Apgar scores, less respiratory distress, fewer NICU admissions, or greater breastfeeding success.

    Moreover, it did not translate to lower levels of anemia at 3-6 months. Babies in both groups had the same hemoglobin level and hematocrit at that point, suggesting that the initial transfusion of blood from the cord was unnecessary and the baby had to destroy those blood cells to get to a normal hematocrit.

    So why is everyone jumping up and down about this study?

    That’s the power of the press release … and a paper written to maximize clinically irrelevant effects and minimize the absence of clinical benefit.

    • http://www.facebook.com/futo.buddy Futo Buddy

      it could not hurt though right? I would think the benefit would be more in situations where there is stress of some sort

  • Peggy

    Helped baby immediately into mother’s hands or lifted to mother’s arms and waited for cord to stop pulsing – standard practice for me and virtually all other midwives for almost 30 years ! The increase in newborn hemoglobin has been known for many long years. Don’t understand why this is news. If it’s because Cochrane Collaboration says it’s news, perhaps someone (hello ACOG?) should check out what they say about home birth…….