Delayed Cord Clamping and Breastfeeding, Brain Bleeds, Blood Infections, and More

One of the most frequent questions I am asked in my childbirth classes is about delayed cord clamping.  

If we go back to the "normal" and "natural", perhaps the question should be about early cord clamping.  Before physicians started clamping the cord almost immediately after delivery as part of their routine procedures, the cord would simply stop pulsating a couple of minutes after delivery.  

Dr. Nicholas Fogelson presented a grand rounds on this topic and did a great job, in my opinion.

The conclusions?

Early cord clamping robs the baby of about 40% of the blood s/he would have received if it were delayed until the cord stops pulsing.  

Clamping at about a minute gives the baby about one-half of the 40%.

Delayed cord clamping improved the amount of iron stores in the baby's body.  This decreases the chance of iron deficiency anemia in breast fed babies and babies on formula not fortified by iron.  Remember that iron in breast milk is better absorbed than similar amounts in formula.  This is why formula has larger amounts of iron - -  and this can lead to an increase in G.I. related illnesses.

Iron is important in the development of the myelin sheath (the insulation material around neurons).  Good iron stores in infancy help with proper central nervous system development for the lifetime.

Delayed cord clamping in preterm babies born less than 32 weeks gestation decreased their risk of intraventricular hemorrhage -- especially Grade 2 -- and late onset sepsis (brain bleeds and blood infections).

There was no increase in clinically significant jaundice, or polycythemia (overabundance of red blood cells) -- in other words, no more babies became sick from these issues than did early cord clamped babies.

As long as the baby's position was 20 centimeters or less in relation to the placenta, the blood transfer was about the same.  Babies placed on mom's abdomen or at her side (if some stimulation or resuscitation procedures which could be done while the baby is connected to the cord needs to be done) are well within this 20 cms above or below the placenta.

Small babies seem to benefit more from delayed cord clamping.

Babies continue to receive oxygen via the cord as they begin to breathe.  There is no rush for baby to breathe quickly.  The transition is easier.  Slow to get started babies are supported by the oxygen coming through the umbilical cord.  This may decrease the effects of an insult to the brain, etc.

Babies receive their full supply of umbilical cord stem cells.  It is thought that some of these can grow into cells to replace damaged cells of various types in the babies body.  This benefit could be life long.

Dr. Fogelson made some good points.  "Why rob the baby of 40% of it's blood supply unnecessarily?"  "The burden of proof is on the intervention versus the natural" (paraphrased).  "Why phlebotimize the baby of 40% of it's blood supply? (i.e. a MAJOR blood draw or "blood letting" as it was known hundreds and  thousands of years ago).

He also shows videos of animal births and the type of attention paid to the cord immediately post birth.  He does discuss the "evolution" to delayed cord clamping.  Going from better to less beneficial is arguably not "evolution".  Again, God's design is perfect.

Click on the following to hear the entire grand round presentation.  Also, Penny Simkin has a nice visual demonstration.

Grand Rounds Part 1
Grand Rounds Part 2
Grand Rounds Part 3
Grand Rounds Part 4

More and more physicians and midwives are allowing the cord to stop pulsating before clamping.  Talk with your physician or midwife about this topic.  This is something you would probably want noted on your birth plan.