September 22, 2020

Why wait to cut and clamp the umbilical cord?


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The-benefits-of-waiting-to-cut-the-umbilical-cordBy Doula Delight From Bahamaislandsinfo

Immediate clamping and cutting of the umbilical cord after birth is routine in most delivery rooms. This practice of immediately separating the newborn from his mother and removing him to an artificially heated environment is now questioned because of new research findings. Evidence-based practice, that which is based upon current research outcomes, suggests that both of these interventions are harmful because they handicap a newborn’s transition to his extrauterine existance.

Delayed clamping of the umbilical cord (waiting until the cord has stopped pulsating, an indication that placenta-to-baby transfer of blood is complete) is as nature would have it for many reasons. During pregnancy, because the fetal lungs are not the organ of oxygen exchange and the placenta is, most fetal blood bypasses the lungs. This way the placentally-oxygenated blood wastes no time in a relatively inert space accomplishing little. However, after birth, with many more feet of blood vessels to perfuse (oxygenate), the baby will need more blood to fill those vessels to oxygenate him adequately.

As soon as the newborn takes his first breath, the lungs will become the oxygenator of the baby (it was the job of the placenta prior to birth). To transfuse the many feet of lung vasculature (blood vessels), the newborn will require an instant 30% increase in his circulating blood volume. That is precisely the volume of blood that the placenta retains prior to birth. This “stashed” blood volume is stored blood as though on deposit by the fetus and held in reserve for the instant withdrawal that will be needed to fill the blood vessels of the newborn’s lungs once his “breathing” lungs become responsible for oxygenating the neonate (newborn). The placental to newborn exchange fills the baby with his full complement of blood. This increased blood volume is necessary for oxygenation of the newborn. This placental-to- baby transfusion, by increasing the circulating blood volume, creates an “inter-lung” circulatory pressure strong enough to push fluid from the newborn lungs out of the air sacs.

Maintaining placental circulation after birth by leaving the umbilical cord intact allows the newborn time to jump start after birth. Giving the baby a “protected time of adjustment to his new world and his new way of breathing,” permits a gentle physiologic transition to become possible. By leaving the oxygen giving placental-cord-baby-conduit intact, until the baby has fully transitioned to being oxygenated by his lungs, there is no need to remove the baby from his mother’s arms for stimulation or resuscitation. In fact, non-breathing babies, who require resuscitative help, benefit greatly by receiving placental support (meaning leaving the umbilical cord intact) until the slow to start baby takes hold and is breathing on his own.

Other benefits of delayed cord clamping abound. The increased iron stores, promoted by an increase in the newborn blood volume protects the young infant form anemia, a risk for and consequence of the rapid growth of babies.6 With delayed cutting of the cord, the stem-cell rich fetal blood transfuses the newborn with obvious immunologic benefits. Delayed clamping of the cord is a protective benefit to preterm infants and even extremely preterm babies relative to respiratory distress, brain hemorrhage, infections, and chronic lung disease. Because of these many benefits, delayed cord clamping is recommended for babies born by Cesarean birth. Concerns about neonatal jaundice and the increased risk of maternal hemorrhage with delayed cord cutting have not been sustained by research outcomes.

While some believe that three to five minutes is the time necessary to wait before severing the cord, many midwives wait until the placenta spontaneously separates (usually within 30 minutes after birth) before cutting the baby’s lifeline. It is generally accepted that once the cord has stopped pulsating, communion between the placenta and fetus has ended and the placenta’s supportive responsibility to the baby has ended. Not until then should the cord be cut.

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