I'm really excited about today's post. Delayed cord clamping after birth is a really crucial topic for midwives.
It's all about whether it's best to clamp a baby's cord right after birth, or leave it until it's stopped pulsating. It's an issue I've struggled with and you've probably heard the debate raging.
However, there's a stunning bit of research which I hope will stick in your mind about delayed cord clamping! I've also found my favourite new evidence resource. I'll share both below.
For those of you just joining in, every week I publish a 'Midwife Motivation Monday'. These are inspirational posts to keep your chin up as a midwife, or midwife in the making! I write them to help us keep enthusiastic and proud about the crucial job we do.
But, as you may have noticed, something has gone wrong with Midwife Motivation Monday this week. It's Tuesday! How did that happen! I've had a hell of a week of mixed night and day shifts. You'll be happy to hear I kept it together while practising, but my beloved blog took a hammering. All I seemed to be able to do yesterday was recover, drink red wine and watch QI.
I hope you haven't been similarly trampled by either working as a midwife, or working towards being a midwife this week! But if you have, remember to treat yourself kindly. It's not selfish to let that pile of ironing get a bit higher or leave the washing up for another day. Get some sleep, watch some TV. Look after yourself so you can look after the women!
So back to the topic in question. We often clamp cords just after birth. This can be because the baby needs to be whisked away for resuscitation. It can also be because we've given oxytocin to control bleeding, so the cord needs to be clamped to stop the drug getting to the baby.
Sometimes we just do it out of habit, convenience, or a sense of urgency. Most midwives have a bit of adrenaline in their bloodstream when a baby is born, even in low risk situations!
For most midwives throughout history, the timing of cord clamping wasn't an issue. Basically you'd make a bit of a mess if you cut a cord that was still pulsing. There were no plastic cord clamps and if you cut a cord early, it was likely to spray like a writhing hosepipe!
The cord would be left to gently stop pulsing, and cotton or wool would be tied onto the stump after cutting.
Before I summarise this evidence, let me ask you a question:
How much blood do you think a baby gains if you delay cord clamping until the cord stops pulsating? It can't be that much, right, if most babies still do fine?
5% maybe? 10%? 20%?
Babies lose a whopping 40% of their 'destined' blood volume if delayed umbilical cord clamping after birth is not practiced.
(Usher et 1963) (Yao et al 1968) (yes I know this evidence is quite old, but the trials look to be well controlled, and this physiology is not likely to change much in 50 years!)
We're midwife vampires!
It's incredible that babies are so resilient. If we took this much blood away from an adult, they'd either die or go into shock. They're tough little monkeys!
So what effect does clamping the cord as soon as a baby is born actually have?
Some babies cope fine. But some definitely suffer:
- Anemia of various kinds (if mum's very iron deficient, delayed cord clamping can impressively up the iron count for these babies)
- More sepsis (in premature babies)
- More brain haemorrhage (in premature babies)
- Lower birth weight
We know that delayed cord clamping covers a baby's iron needs for 6 months. We also know that children with low iron levels have major problems from motor development to learning ability. Delayed cord clamping prevents anaemia, and can make children healthier and smarter, especially if they've got an iron deficient Mum.
(Cochrane review, McDonald et al 2013)
And we as midwives can help this natural process so easily. All we have to do is relax and put our scissors down.
Are there any bad side effects from delayed umbilical cord clamping?
The short answer appears to be 'not really'.
Babies can become a bit more contused, meaning full of blood in superficial areas. They may require a bit more phototherapy for jaundice (depending on which study you look at - some find no statistical difference between delayed and early clamping groups).
The main risk is delaying resuscitation. There is limited evidence at the moment, but delayed cord clamping might be dangerous in cases where babies have been born in an oxygen deprived state. Many argue that delayed cord clamping while resuscitating would be ideal - but there are issues with equipment and short cords to think about before we go making these changes....
Anyway, onto my new favourite resource. This post was inspired by one written a few years ago by Dr Nicholas Fogelson on delayed cord clamping.
His blog, Academic OBY/GN offers quite a lot of insight into American obstetric care. He also has a talent for picking interesting subjects and simplifying the research for readers. So into my blogroll he goes!
Do you approve of delayed cord clamping? Is it an art practiced by midwives for centuries that we lost as medical science came rampaging in? Is it just more pleasant for midwives and mothers to enjoy that few minutes after birth in a calm, gentle way without cutting the cord?
Regardless, I hope you have an excellent week as a midwife. If you're a midwife in the making, I hope this gave you an idea of the complex, fascinating issues you'll come across in your practice!
Wish me luck as I recover - supporting a nice, gentle birth with delayed cord clamping might be just what I need as well as any new baby!
If you enjoyed this post, please like it and share it around! And I'd love to hear any comments below.