As midwives, it is essential that we understand the importance of the “Third Stage” of labor, and in particular when and how to cut the umbilical cord. In this informative guest post from Birth Without Fear, Mama Bice gives an in-depth overview of the reasons delayed cord clamping is so critical, including the importance of immediate skin-to-skin contact, prevention of blood loss and avoidance of oxygen deprivation. She also calls into question the myth that delayed cord cutting causes jaundice in newborns.
The “Third Stage” of labor is one that is often forgotten. This is the span of time between the birth of the baby and the expulsion of the placenta. The typical medical birth looks like this for the third stage: baby emerges, cord is clamped immediately, baby is taken by a nurse to a warmer, mother is injected with pitocin, cord is tugged and the placenta is pushed out through force such as a nurse or the doctor pushing on the abdomen.
While I find a lot wrong with that whole picture I want to focus on the part that really effects your baby the most (in my opinion) – immediate cord clamping.
First, and fundamentally – when the cord is cut within seconds this allows that baby to be taken from the mother. It is proven that skin-to-skin directly after birth, and for the first hours, is best for mother and baby barring medical emergency. If the baby is still connected to you, they can’t take baby and you get skin-to-skin.
But the most important aspect of cord clamping to me is the loss of blood to your newborn. “Blood Loss?” you might say – after all the cord is clamped off at both ends, this is not a messy process. The blood loss I am talking about is all the blood that has been left in the cord and placenta and that belongs to your baby – up to HALF of your newborn’s blood is still waiting to go into the body when the cord is clamped immediately.
Let us get a quick education in how the cord reacts if left alone. The cord will normally pulse (deliver blood to the baby) for about 3 minutes after the birth – sometimes longer. The cord then clamps itself. Yep, that’s right – it does the job for you.
This amazing cord contains Wharton’s Jelly. During pregnancy and the birth this jelly protects the arteries and veins in the cord – this is why knots and tangled babies are fine the majority of the time – the Wharton’s Jelly keeps the cord firm and unable to collapse. After the birth the Jelly slowly “clamps” down on the arteries first, then the umbilical vein. The cord will slowly turn from heavy and firm (and colored) to limp and white. At this point it can be cut with little to no mess at all – no medical clamps needed!
Now back to the immediate clamping of the cord – which is common medical practice.
The immediate effects of this are pretty common sense – after all, what would you do with half your blood missing? Your body could not move oxygen as well, could not clean out impurities as fast, and your iron levels would be horrible. Oh, and you would most likely need major medical care. Luckily newborns are pretty tough – but why do we take the risk?
To get the “visual” of this issue, here is a great and quick video that shows visually the blood volumes we are talking about here. I also have found an amazing resource in this group of videos by an OB/GYN who lectured on this subject during Grand Rounds. It is in four parts and long, but very worth the time to watch. (And perhaps to pass along to your OB/GYN?)
Jaundice is one of the big questions that comes up with delayed clamping. After all, doesn’t more blood mean more blood to “clean” to get rid of bilirubin? In fact, when women talk with me about what their doctors have to say about delayed cord clamping, they normally say this is brought up as the #1 reason to not delay.
However, studies show that while jaundice is slightly increased, it is a benign increase. In other words – more “tan” babies but no increase in SICK babies. After all, not all jaundice is harmful, in fact it is pretty normal. There was no increase in the amount of babies needing phototherapy or other clinical issues relating to jaundice.
Blood iron levels are something that pediatricians watch in little ones. Many parents are told that infants need extra iron during the first six months, be that from formula (which has added iron) or from drops given to the breastfed infant.
However, one has to wonder if this issue has cropped up due to the practice of immediate cord clamping, since studies show better iron levels in infants who have delayed cord clamping. Even better – this effect lasts until about six months of age – the age many babies are ready to start solids and therefore get more iron in a natural way.
When studies looked at infants within 24 hours after birth, at 2-3 months of age, and at six months, all the studies showed higher iron and ferritin levels for those with late-clamping. This seems to say that our babies were made by design to store enough iron to keep themselves healthy until they start solid foods. Of course, this only happens if we let nature take its course as intended.
Another effect of early cord clamping is less oxygen. This makes sense – after all, your blood carries your oxygen. If you don’t have enough blood, you don’t have enough oxygen. This is why many midwives will call the cord/placental unit a “resuscitation kit” – if baby is having trouble starting up right away that extra blood and oxygen from the placenta and cord can help the lungs get to work – and provide the baby with oxygen in the meantime (like the placenta has been doing for the past 40 or so weeks).
These studies even show that preterm infants are better off getting delayed clamping if at all possible. Cesarean section births were included and the benefit is pronounced for these infants as well – no doubt due to the higher instance of resuscitation needed after cesarean sections.
Loss of oxygen and proper blood flow at birth could also be a risk factor for Autism later, though no major studies have been done relating to cord clamping and Autism.
With all the evidence pointing to leaving the cord alone for at least 3 minutes (or heck, why not until the placenta emerges – or longer!) – even for a cesarean section or preterm infants – why are we still cutting cords willy nilly? Your guess is as good as mine. But the good news – we can change this – talk to your care provider, show them the information. Change some minds – and maybe some births.
Resources used for this post:
Third Stage of Labour – Benefits of A Natural Approach; By Dr Sarah J Buckley, (c) 2005
Late vs Early Clamping of the Umbilical Cord in Full-term Neonates – Systematic Review and Meta-analysis of Controlled Trials; By Eileen K. Hutton, PhD; Eman S. Hassan, MBBCh, 2007
Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomized controlled trial; Ola Andersson, consultant in neonatology, Lena Hellström-Westas, professor of perinatal medicine, Dan Andersson, head of departments of pediatrics, obstetrics and gynecology, Magnus Domellöf, associate professor, head of pediatrics; 2011
Mama Bice, writer for Birth Without Fear, is a wife, mother, and aspiring midwife. Her personal areas of interest are in birth, breastfeeding, and Harry Potter. Having had a natural out-of-hospital birth already, and planning home births for her future children, she believes that an empowering birth experience (no matter where it takes place) is important for every mother and family. Her feisty side comes out at times, but compassionate support is her goal. Birth Without Fear is a place for women to share how they overcame fears to have a great birth, to heal from traumatic birth, and to prepare to birth without fear!
See the original post on the Birth Without Fear Blog.