Birth attendants usually separate the newborn from the placenta by clamping and cutting the umbilical cord, but the timing of this practice varies and has been the subject of on-going debate which have recently been revived. So what is the optimal time for clamping a newborns’ umbilical cord?
At the time of birth, the baby is still attached to the mother by the umbilical cord. Birth attendants usually separate the newborn from the placenta by clamping and cutting the umbilical cord, but the timing of this practice varies and has been the subject of on-going debate which have recently been revived. So what is the optimal time for clamping a newborns’ umbilical cord?Currently in most facilities – especially in high-income countries – clamping is usually performed less than a minute after birth. For a long time this was thought to reduce the risk of heavy bleeding after delivery (or postpartum haemorrhage) for the mother, however, recent research provides grounds to question this practice and its benefits.A study published in the Cochrane Library in July 2013 found that delaying cord clamping has a positive impact on newborn health. By giving more time for blood to move from the placenta to the newborn, it allows for higher weight at birth, higher haemoglobin levels after birth, as well as helping to reduce the probability of iron deficiency in the months following birth. Contrary to previous beliefs, this technique does not involve a higher risk of heavy bleeding post-delivery for the mother. However, a possible harmful outcome of delayed clamping highlighted by this study is an increased risk of jaundice in infants.These findings provide support for recently revised guidelines from the World Health Organisation and the International Federation of Gynecology and Obstetrics, which advise clamping the umbilical cord between one and three minutes after birth. These findings have a significant implication for clinical practice and make a strong case for promoting delayed cord clamping worldwide.Unfortunately, the findings have not generated consensus so far. According to a commentary in the New York Times on the Cochrane study findings, the debate on the optimal timing for cord clamping continues. Some still find that evidence remains insufficient to change longstanding practices, and insist that early clamping may be required in some situations such as if the newborn needs immediate care, like resuscitation. Others, on the contrary, feel that the Cochrane study provides a strong evidence base in favour of delayed clamping which should not be ignored.Are we clamping infants’ cord too early? It seems like there is a strong case for delaying clamping, but the optimal timing of the clamping depends on the context and situation of the delivery. In settings where treatment for jaundice is widely available, and when the health situation of the newborn allows for it, delaying cord clamping can have significant health benefits for the baby.