Clamping Down on Cutting the cord…

I wanted to write a post about the current method in 3rd stage labour of instantly clamping and cutting the cord when babies are born. There is so much evidence to suggest this is not the best idea, and the most advantageous thing for the baby is to wait (at least) 3 minutes until the cord stops pulsating and the blood has drained from the placenta.

If you are not aware of the benefits of prolonged clamping, or even know what it means (and don’t worry, you wont be the only one – the vast majority of women I have spoken to have never heard of this) you will probably be thinking:

1. What are you on about love?

2. Why should we wait? What are the benefits?

3. Don’t be silly, if the other way was better then why aren’t all doctors doing it?

So firstly what am I on about? Well the 3rd stage of labour is when your baby is born and it time to deliver the placenta (yippee! fun times!). There are 2 ways to deliver:

• A managed 3rd stage when your midwife gives you an injection to make your uterus (womb) contract. This speeds up delivery of the placenta. Your midwife may clamp the cord straight away.
• Natural, or physiological, third stage, when you are left to deliver the placenta without interference. Your midwife will wait to clamp the cord.

If you choose to have a managed 3rd stage the Current guidance from the RCM  and the National Institute for Health and Clinical Excellence is to cut and clamp the umbilical cord within  30 seconds to protect babies from too much exposure to a synthetic hormone given to mothers to speed up labour and deliver the placenta.

Now sorry to go off topic and have a pop (again.. lol) at the medical profession, but they do tend to push you to have a managed 3rd stage – i’ve even heard of some cases when they give the injection without even asking! When I booked into a birthing centre, rather than a delivery suite, even there they were “suggesting” that a managed one would be better… Better for who?! Remember me saying this if you are pregnant as they we give you all sorts of reasons – regardless of what they tell you, unless there is a SERIOUS medical reasons (such as you having complications in pregnancy or birth) you don’t have to have one.. Stick to your guns if you want a non managed stage!!! They will tell you its to lower risk of very heavy bleeding immediately after the birth.. But this is very rare. The main reason they try to get you not to have one is because they want you out of that bed quickly.

The hilarity of it is If you’ve had a managed third stage, there’s actually more of a chance then that you’ll need to return to hospital later because of bleeding. This may be due to fragments of placenta or membrane that have been left behind when your midwife eased out the placenta. The drugs which are used to narrow your blood vessels and stimulate contractions may unfortunately have side-effects. Ergometrine, when mixed with oxytocin to make up Syntometrine, may cause you to have:

• high blood pressure
• sickness and vomiting
• strong pains
• a greater need for pain relief

Many maternity units now use the single drug oxytocin because of this. Though this may cause fewer side effects than Syntometrine, it may be less effective at reducing blood loss. Your baby may have a lower birth weight after a managed third stage than he would after a natural third stage. This may be due to cutting the cord early.

Now back to the clamping issue the questions of benefits.. Are you aware that up to 30% of your baby’s blood is still in the cord/placenta? 30%!! How would you feel if someone was to say to you shortly after birth “Hello dear we are coming round and removing 30% of your baby’s blood for no reason” you’d tell them to jog on, right?! Now this blood isn’t just your regular blood it is oxygenated blood 60% higher in red blood cells – there has been recent evidence to suggest that Neonatal Anemia, a condition in which the body doesn’t have enough oxygen-carrying red blood cells, was associated with nearly eight times the risk a child would develop autism later in life.

Of course red blood cells are just the start – the blood is of course also very high in stem cells (the medical profession is only just starting the begin to find out all the amazing things stem cells have to offer us as human beings). A study from Sweden found a delay of three minutes could reduce the risk of iron deficiency later in childhood, which can lead to poor brain development. At four months, fewer than one per cent of infants who had delayed clamping were deficient in iron compared with six per cent of those clamped immediately. We also know that delaying clamping improves the health of premature babies. So let’s just get run down on all the (researched) benefits here:

• 30% more blood volume and 60% more red blood cells
• 50% less need for blood transfusion to infant (from 8% down to 4%)
• fewer units of blood transfused per patient
• significantly lower risk of hypovolemia and shock
• improved Oxygenation
• much less anemia, more iron, and >50% higher levels of the protein that transports iron (ferritin)
• much lower rate of late onset sepsis (a serious infection – 8% compared with almost 0%)
• 50% lower risk of intra-ventricular haemorrhage (a common and important type of brain bleed)
• 50% reduction in encephalopathy (brain damage – (due to shock, low Oxygen, or both)
• lower risk of necrotizing enterocolitis
• less need for mechanical ventilation

You are well within your rights to ask them not to cut and clamp – tell them you want them to wait! Also depending on your hospital’s policy if you have even had a managed third stage, your midwife may hold off cord clamping for two to three minutes or even longer. Some hospitals will even delay for at least a minute if you have had a caesarean or if your newborn needs support.

Now can I just say that I was lucky enough to be told by my NCT teacher about prolonged clamping a few weeks before I gave birth.. I was actually looking into donating my cord and the blood because as far as I was aware it was a useless waste product that was dumped in the bin (more or less what the NHS promotional material for donating in the hospital tells you) some doctors will tell you delaying clamping will increase chances of jaundice in babies – this is an unproven point and research has proved this to not be factual.

What seems to be the standard in this country is that there are very old fashioned ways of doing things and they stay like that as “that’s the way they have always been. Good news though – In November 2012 The Royal College of Midwives was preparing to update its guidance  to recommend delayed clamping  for most women who give birth in hospitals, which will affect about  90 per cent of all births. Mervi Jokinen, practice and standards development adviser at the RCM, says:

“We are supporting the midwives not to clamp the cord immediately. We’ve not finalised the guidelines and in terms of how long it will recommend delaying clamping for, we don’t know… Guidelines drawn up by different organisations vary from one to five minutes, and even up to ten. Most midwives will have to use  their judgment in terms of the clinical situation. It’s more likely to happen within three to five minutes. The issue here was studies started to show that with early clamping you’re denying a baby a boost of blood and it was recognised that haemoglobin levels were much lower later on,’ she said. It is said that babies who are healthy and well would benefit  from greater haemoglobin levels. Women have also asked us to give their babies to them while they  are attached.”

Dr Patrick van Rheenen, a consultant paediatrician at Groningen University in the Netherlands, said: ‘Delayed clamping clearly favours the child. How much evidence is needed to convince obstetricians and midwives that it is worthwhile to wait for three minutes to allow for placental transfusion?’

The World Health Organisation dropped early clamping from its guidelines in 2007 and best practice on the issue varies across Europe. Guidelines in the UK, drawn up by NICE, recommend early clamping although an update is due in 2014.

David Hutchon, a retired consultant obstetrician and gynaecologist  who has campaigned for years for a change in policy, said: ‘This is very welcome. “But whether doctors will take any notice is another issue. There’s a lot of ignorance out  there and people have just blindly  followed guidance for years without questioning it.”

So did you have a delayed clamping? Did anyone in the medical profession ever discuss this option with you before you gave birth?