We had already talked about that study published in JAMA Pediatrics that advised delaying clamping of the umbilical cord for a few minutes after delivery, but I think it is a good time to explain in more detail the benefits that are obtained. That report ensured that an action as simple as delaying the moment of punching and cutting, could prevent iron deficiency during childhood of the child. Previous work pointed out that only two minutes influence the development of the baby in the days following birth.
What is the umbilical cord? María José explained very well in this post the functions it has, it is a very important organ as it provides nourishment to the fetus from the placenta. Nourishes and provides oxygen, and continues to deliver oxygen to the baby when his lungs are not yet working or acting as a supplier. It is a matter of minutes, but if it is not clamped there, the cord continues to act as a nexus. Why put so much emphasis? How important is it to wait to cut the umbilical cord?
Yes that is important, but I will go further: if we let it collapse without clamping, you may only have to wait three minutes, Although there are times when the process takes a little longer (up to 20 minutes) it is not an eternity either. Aided by the placenta, it does nothing more than perform another of its important functions, and act as Nature has intended; If the cord still carries oxygen, the baby will have two sources of supply. It is believed that early impingement can disrupt these life support systems, leading to injury.
Umbilical cord: after delivery, wait for it to stop beating.
The practice of letting everything take its natural course prevents cerebral anoxia, and its role in the well-being of babies born with acute fetal distress should not be underestimated. According to this information published on the EPEN website, WHO instste in late clamping or no clamping. There is no time limit, 2 minutes? they may or may not be sufficient; the umbilical cord should stop beating on its own, and ideally the professionals attending the delivery should also wait for the delivery of the placenta.
The cord that no longer fulfills its functions is white, it abandons its mission when it is no longer needed. There are already many voices that ask that Nature be allowed to take its course, there are a series of practices that should not be such, but part of a process: the non-separation of mom and baby, breastfeeding, the late cutting of the cord ... In many aspects of these physiological processes it is better not to intervene, but professionals must also be prepared for possible eventualities. On the subject at hand, the belief that it was necessary to clamp early to prevent bleeding in the mother prevailed one day, and it was also related to the appearance of neonatal jaundice; by the way, the risk of jaundice does not vary depending on what we do with the umbilical cord.
What if it is not clamped? And is clamped very late?
A review of randomized controlled clinical trials seems to conclude that symptomatic polycythemia cannot be associated with late cord cutting. It is a disorder caused by an excess of red blood cells in the blood circulation, which even hinders circulation, and can affect the organs.
Here is a quote from the cited post from EPEN:
Only one case has been described in which there could be a risk that the baby receives more blood than it should: in water deliveries, if the water is more than 37 degrees and the placenta-cord-baby trinomial being under water can lead to vasodilation. There is only one article but there is no research on it. It is recommended to clamp after 5 minutes or empty the pool just in case. Once the water no longer covers the cord or is less than 5'37 there is no risk.
Benefits of late clamping / no clamping of the umbilical cord.
In addition to the fact that hyperbilirubinemia due to late clamping has not been demonstrated, there are other negative consequences of early clamping of the cord: babies slow to react, weak, planetary 'source' interrupted too early, stopping blood transfusion, which is related to the iron deficiency mentioned. On the contrary, the benefits:
If the blood that the placenta continues to pump is considered as a nutrient, it is evident that this in itself is a benefit, in addition the lungs will not be 'forced' and it is not necessary to cause crying, thus separating the baby from its mother.
These recommendations are also useful to follow when the baby has been delivered by cesarean section.
Picture - Tbsdy lives
Macarena, thanks for this post. But I think the advantage of late clamping is not so obvious. In fact, the WHO recommends it only in countries with a deficit of hygiene or nutrition. For civilized countries like ours, not cutting the cord until it stops beating could even be counterproductive. In certain cases it could cause the opposite effect to the desired one: That part of the baby's blood returns back to the placenta, thereby reducing the baby's total blood volume. There is also an increase in cases of children with polycythemia (exaggerated production of red blood cells) among cases of delayed clamping.
Delaying excessive cord clamping also prevents umbilical cord blood from being collected, thus preventing possible future use of stem cells. 80% of the cord blood enters the baby during the first minute after delivery. Therefore, this seems to be, according to the experts I have consulted, the ideal time to cut the umbilical cord, allowing the baby to receive the maximum amount of blood and at the same time, to collect what is still in the cord.
Hello Augustine, thank you for your comment. Look, according to the documentation we have reviewed, and regardless of the country we are talking about, it seems that the optimal time to clamp the cord could be between 1 and 3 minutes after birth.
For example, this post (http://apps.who.int/iris/bitstream/10665/120076/1/WHO_RHR_14.19_spa.pdf?ua=1) signed by 3 entities (including the WHO) reads as follows: «The World Health Organization recommends delayed clamping of the umbilical cord. Delayed clamping of the umbilical cord (performed between 1 and 3 minutes after delivery) is recommended for all deliveries, at the same time that simultaneous essential care of the newborn begins ”.
Or the following PAHO document: http://publications.paho.org/spanish/Capitulo_1_OT_195.pdf. From which I select the paragraph “Regardless of the particular reasons behind the change in the practice of delaying cord clamping, it is very clear that there is very little or, rather, no scientific evidence to justify early clamping as a practice of greater benefit for the newborn or its mother.
On the other hand, in an EPEN entry, he mentions a systematic review, which concludes that there is no evidence between late clamping and polycythemia (https://www.elpartoesnuestro.es/informacion/6-el-cordon-umbilical).
We would love that, if you consider it appropriate, you could provide us with useful links. Greetings 🙂