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Feed Your Stash Friday: July 2-8, 2010

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Delayed Cord Clamping/Cutting

Umbilical cord blood is a baby’s life blood until birth. It contains many wonderfully precious cells, like stem cells, red blood cells, and more recently scientists have discovered that umbilical cord blood contains cancer-fighting T-cells.

Yet common practice is to cut this source of valuable cells off from the baby at the moment of birth, due to unsubstantiated claims that it can cause complications. Not only that, a new line of business has been set up to store this precious cord blood for you, which all sounds great in theory, but why deprive a baby of those super cells at birth and then give them back on the very small chance that a problem has appeared later in life? Could there be a link to not having those super cells at birth and those illnesses? Storing cord blood is not only extremely expensive but it is also worth finding out exactly what they have been successful on helping and how common those conditions really are.

How likely is it that my baby will need stored stem cells?

According to Dr Sarah Buckley, in her well researched book ‘Gentle Birth, Gentle Mothering’ (2005):

• The likelihood of low-risk children needing their own stored cells has been estimated at 1 in 20,000
• Cord blood donations are likely to be ineffective for the treatment of adults, because the number of stem cells are too small
• Cord blood may contain pre-leukemic changes and may increase the risk of relapse
• Autologous cord blood is only suitable for children who develop solid tumours, lymphomas or auto-immune disorders
• All other uses are speculative

And this from the Choice website:

“The most common reason for transplantation in childhood is for leukemia, but a donor’s own cord blood is unlikely to be used. The most appropriate source of stem cells is another person, either a family member or an anonymous stem cell donor.”

Collection is also very lucrative for the collector (midwives get offered training in this too, some decline but some do it). Collectors get paid hundreds for doing the procedure.

Timing of cord clamping

There have been an increasing number of studies published with regards to the timing of cord clamping, including a recent 16-month study which was published in 2006 which you can read more about here. It was conducted at Hospital de Gineco Obstetrica in Mexico City, where over 350 mother/baby pairs were part of the study.

This study, as well as several others, have provided solid evidence of the benefits of delayed clamping. The main benefits being:

• Increased levels of iron
• Lower risk of anaemia
• Less transfusions and
• Less incidence of intraventricular haemorrhage

A two-minute delay in cord clamping increased the child’s iron reserve by 27-47 mg of iron, which is equivalent to 1-2 months of an infants iron requirements. This could help to prevent iron deficiency from developing before 6 months of age.

Another study has been released in 2007 from the University of Granada which has similar findings, you can read it here.

While delayed clamping is beneficial for babies across the board, the studies found that the impact of delayed clamping is particularly significant for infants who have low birth weights, are born to iron-deficient mothers, are premature, or those who do not receive baby formula or iron-fortified milk. Given that mother nature provided breastmilk for babies and not formulas, you would think she also supplied that valuable source of iron for a reason too. You may have noticed that formula companies promote iron deficiency rates to sell their products.

The studies have suggested that delayed clamping, for as little as two minutes, should be implemented as standard practice, however this is yet to happen at many hospitals. Some couples choose to leave the cord unclamped until it has stopped pulsating, which could take a few minutes or it could take around twenty – either way, the baby is able to have his or her supply of placental blood.

Delayed Cord Clamping & Donating/Storing Cord Blood

Delayed cord clamping is not compatible with cord blood donation. The reason being is that in order for them to collect that blood, they need to cut the cord so that blood can be used for storage or donation. So if you would like your baby to have it’s full supply of cord blood, you may need to reconsider you plans to donate or store cord blood.

Delayed Cord Clamping & Jaundice

You may be told that delayed clamping causes jaundice in babies by your carer or hospital. This is not true.

Babies are no more likely to become jaundiced by delaying cord clamping and there is no relation to jaundice and the time of the cord being clamped. In the studies, the bilirubin levels were within normal range no matter when the cord was clamped. (Excess bilirubin levels are what is associated with jaundice).

Here are some statements from recent studies to back this claim:

“There were no significant differences for other secondary outcome measures: plasma bilirubin levels at 24 to 48 hours, neonatal morbidity (respiratory distress, tachypnea, grunting, jaundice, seizures, sepsis, necrotizing enterocolitis), mortality (none), neonatal intensive care unit admission, length of hospital stay, disease up to 1 month of age, weight or rate of breast-feeding at 1 month, maternal postpartum blood-loss volume, and maternal hematocrit level at 24 hours postpartum.”

AND

“Plasma bilirubin values as well as hyperbilirubinemia rates were similar in the 3 groups, which goes along with other authors’ observations.”

AND

from the recent study at the University of Granada

”...the clamping of the umbilical cord of newborns from full-term pregnancies, two minutes after the infant is expelled from the womb, makes no difference to hematocrit or hemoglobin levels of the umbilical cord vein compared to clamping the cord within 20 seconds. Thus, the study shows that early clamping (which is widely performed) is not justified.”

Further to this, Dr. Sarah Buckley’s well-researched article, A Natural Approach to the Third Stage of Labour’ states:

“Some studies have shown an increased risk of polycythemia (more red blood cells in the blood) and jaundice when the cord is clamped later. Polycythemia may be beneficial, in that more red cells means more oxygen being delivered to the tissues. The risk that polycythemia will cause the blood to become too thick (hyperviscosity syndrome), which is often used as an argument against delayed cord clamping, seems to be negligible in healthy babies. (Morley 1998)

Jaundice is almost certain when a baby gets his or her full quota of blood, and is caused by the breakdown of the normal excess of blood to produce bilirubin, the pigment that causes the yellow appearance of a jaundiced baby. There is, however, no evidence of adverse effects from this. (Morley 1998). One author has proposed that jaundice, which is present in almost all human infants to some extent, and which is often prolonged by breastfeeding, may actually be beneficial because of the anti-oxidant properties of bilirubin. (Gartner 1998)”

Delayed Cord Clamping & Blood Volume

You may also hear of concerns over the increase in blood volume and red blood cell volumes, overloading the heart and causing respiratory difficulties, as a result of delayed clamping. Again, this is not substantiated.

According to an article from the World Health Organisation, they state: “These effects have not, however, been demonstrated. In fact, there is probably a self-regulatory mechanism in the infant which limits the extent of placental transfusion. Moreover, there is evidence that the circulatory system of the newborn is capable of rapid adjustment to an increase in blood volume and viscosity by increased fluid extravasation and dilation of blood vessels.”

Delayed Cord Clamping & Maternal Haemorrhage

Again, another unsubstantiated claim. As per the earlier studies, there was no significant maternal postpartum blood-loss volume which is echoed in the World Health Organisation article:

“Although there was some evidence that early clamping reduces the duration of the third stage of labour, there was no significant effect on the incidence of postpartum haemorrhage”.

Something important to note

Just after you have given birth, the last thing you are paying attention to is the umbilical cord! So if after reading this article you have decided not to have the cord clamped immediately, make sure you make it well known with your caregiver and at the hospital that you want to delay clamping of the cord, so your baby can have it’s full store of blood.

There are some circumstances where the cord will need to be clamped immediately, including if you choose to have the third stage injection of syntocinon to expel the placenta faster – obviously the cord will need to be cut right away in this managed form of third stage. You can chose a normal physiological third stage if you haven’t had syntocinon during your labour (for inductions, augmentations or third stage).

Finally…

All this leaves one question. Why isn’t delayed cord clamping standard practice if it means healthier babies and has no adverse effects? The answer is very clear – most obstetricians are reluctant to take up this practice.

According to THIS survey on the ‘Attitude of obstetricians towards delayed cord clamping’ as published in the Journal of Obstetrics and Gynaecology (sent out to obstetricians all over the world), the results came back glaringly stating that the reason the obstetricians who haven’t changed over to delayed cord clamping is ‘difficulty implementing it into practice’, which I find to be a big cop out really. Why are many obstetricians REALLY so reluctant to implement a simple process which benefits mother and baby? Why can’t the midwife clamp the cord later if the obstetrician is too busy? It’s yet another sensible and very healthy process that was practiced decades ago, before obstetrics even began and took over with a surgical approach.

The Royal College of Obstetricians and Gynaecologists MUST and SHOULD produce guidelines for delayed cord clamping in obstetric practice for healthier mothers and babies.

Summary

Don’t be embarrassed or afraid to speak up if you feel your baby could benefit from delayed cord clamping. Print off this article as well as these studies and present them to your carer if you would like to discuss delayed cord clamping with them.

Useful Websites and References:

Dr. Stuart Fischbein: Delayed Cord Clamping (GREAT YouTube clip) Third Stage of Labour: A Natural Approach
Don’t Cut The Cord
Five Good Reasons To Delay Cord Clamping
Birth Injuries Related To Umbilical Cord Clamping
Early or Late Clamping?
Early Clamping of the Umbilical Cord
Risks of Premature Cutting of the Umbilical Cord

Copied from http://www.bellybelly.com.au/articles/birth/cord-clamping-delaying-cord-clamping