Wednesday, March 20, 2013

Why the wait? {Delayed Cord Clamping}

Delayed cord clamping is all the rage - but why?

Skin to Skin

Along with immediate skin to skin contact, the blood baby receives from the cord aids in stabilizing her temperature.  Furthermore, if baby is still attached to you, the chance of a nurse whisking her away to a warmer for typical newborn procedures is minimized.  Besides her blood, you may also want to let baby keep her vernix; avoid/delay the baby bath.  Like blood, vernix also can help regulate body temperature and has antibacterial properties, as well as being natures best moisturizer so it is best to rub this slimy cheese-like substance into the skin rather than wash it away.

Blood Flow

At 1 minute after birth approximately 80mL of blood is transferred from the placenta into baby.
At 3  minutes after birth that becomes approximately 100mL of blood according to the WHO.

Delayed cord clamping is defined by waiting about 3-5 minutes after birth or until the cord stops pulsating.

 Cord just after birth- still pulsating with blood.

Limp cord- blood fully delivered to baby.
Photo courtesy of Perfect Chance Photography

So why is this important?

Baby gets much needed iron supply.  According to Michelle Roberts, a BBC Health Reporter, iron deficient anemia is "a significant health problem because it can harm a child's brain development."  Allowing a child to receive the full potential of blood and iron stores meant for him ensures a good start; "babies with delayed cord clamping had better iron levels at four months of age." (Roberts, 2011)  This iron supply is especially important in premies who may have not had those last 8 weeks in utero to store up iron.

The brain is afforded some extra protection with this blood flow.  In babies with complicated births, especially a lack of oxygen, this layer of protection is crucial to the brain.  Oxygenated blood travels through the cord to the baby helping to prevent hypoxic injury and associated long term problems due to lack of oxygen.  
Elizabeth Perry describes a birth in which 
the baby was resuscitated physiologically through the intact, unclamped cord.
Perry, E. (2012). Redefining Normal. In N. Halseide (Ed.), Second Stage: The Pushing Phase of Labor, Midwifery Today, Inc. 
 -A highly recommended read from this Collection of  Articles from Midwifery Today Magazine.

The Count

A full-term newborn has an average of 120 ml of blood per kilogram of body weight, or an average of a total fetal-placental blood volume of about 480 ml (16.9 oz.) At any given time about 70 % of his blood is in his body and 30 % is in the placental/cord unit.
- Frye, A. (2004). Holistic midwifery. (Vol. 2). Portland: Labrys Press.

In premature babies and babies born to mothers with gestational diabetes these are very significant numbers. By receiving his full quota of blood, your baby is less likely to have low blood sugar and an increased count of white blood cells means better ability to fight off infection.

Q- Even in uncomplicated births and healthy babies, why not allow the baby the blood belonging to them? 
Jaundice is a commonly heard response, however studies show "no evidence of adverse affects from this."  Studies have shown that jaundice and polycythemia are not curbed by immediate cord clamping as there are other factors involved in their derivation.
A- Cord banking may be the only accurate answer to that question. More on this here.  The chances of a low-risk baby needing his stored stem cells is 1 in 20,000. 

To clamp or to delay clamp? That is the question.  One of the many decisions you'll make for your newborn on the Journey of Life.  What will you do?

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Jennifer Valencia | Labor & Postpartum Doula | 928.300.1337


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