Why do Obstetricians Still Rush to Clamp the Cord?

By Dr. Mercola
December 02 2010
http://articles.mercola.com/sites/articles/archive/2010/12/02/obstetricians-immediate-cord-clamping-routine.aspx


For many years, the World Health Organization and the International Federation of Gynecology and Obstetrics have advised against early umbilical cord clamping. But obstetricians have been reluctant to change their habits.

Although no clamping occurs in nature, cord clamping has become such an accepted norm that delayed clamping is generally considered a new or unproved intervention.

Basic teaching of physiology could be a factor -- most textbooks state or imply that the cord circulation closes only because of the application of the cord clamp, which is not accurate.

Writing in the British Medical Journal, Dr. David Hutchon argues:

"Clamping the functioning umbilical cord at birth is an unproved intervention. Lack of awareness of current evidence, pragmatism, and conflicting guidelines are all preventing change. To prevent further injury to babies we would be better to rush to change."

"Many clinical studies have revealed that the delayed cord clamping elevates blood volume and hemoglobin and prevents anemia in infants.
 

 Moreover, since it was known that umbilical cord blood contains various valuable stem cells such as hematopoietic stem cells, endothelial cell precursors, mesenchymal progenitors and multipotent/pluripotent lineage stem cells, the merit of delayed cord clamping has been magnified."

Sources:

In U.S. hospitals, the clamping and cutting of the umbilical cord is typically performed within 30 seconds of birth, sometimes sooner. This is done because immediate cord clamping is generally believed to reduce the mother's risk of excess bleeding and the baby's risk of jaundice … but this practice may actually be detrimental to the baby's health.
 

When a baby is born it must transfer from receiving oxygen from the placenta to receiving oxygen from its lungs. For this to happen, the baby's lungs must first expand, and the burst of blood from the umbilical cord helps to get the newborn's lungs to expand properly.
 

Without the burst of blood from the placenta, the infant suffers a drop in blood pressure as its lungs fail to open as they should, creating a chain reaction of effects that can include brain damage and lung damage. Immediate cord clamping can cause hypotension, hypovolemia (decreased blood volume) and infant anemia, resulting in cognitive deficits.
 

Some have even theorized that the rise in autism could be linked at least in part to premature cord clamping.
 

World Health Organization, Extensive Research Supports Delayed Cord Clamping

In the United States there is absolutely no consensus about the optimal time to clamp the umbilical cord after birth, yet research is increasingly revealing that clamping the umbilical cord prematurely, before two or even three full minutes have elapsed, robs your baby of much-needed blood and oxygen.

 

The World Health Organization's (WHO) policy supports delayed cord clamping, stating:
 

"The optimal time to clamp the umbilical cord for all infants regardless of gestational age or fetal weight is when the circulation in the cord has ceased, and the cord is flat and pulseless (approximately 3 minutes or more after birth)."
 

They continue:
 

"Clamping the umbilical cord immediately (within the first 10 to 15 seconds after delivery) prevents the newborn from receiving adequate blood volume and consequently sufficient iron stores.
 

Immediate cord clamping has been shown to increase the incidence of iron deficiency and anemia during the first half of infancy, with lower birth weight infants and infants born to iron-deficient mothers being at particular risk …
 

Waiting to clamp the umbilical cord allows a physiological transfer of placental blood to the infant which provides sufficient iron reserves for the first 6 to 8 months of life, preventing or delaying the development of iron deficiency …
 

For premature and low birth weight infants, immediate cord clamping can also increase the risk of intraventricular hemorrhage and late-onset sepsis.13 In addition, immediate cord clamping in these infants increases the need for blood transfusions for anemia and low blood pressure."

 

Numerous research studies and experts are also confirming that waiting to clamp the cord offers significant benefits. Among them:

Andrew Weeks, senior lecturer in obstetrics, advises it's "better not to rush" umbilical cord clamping after birth.

In the Journal of Cellular and Molecular Medicine, researchers say delayed cord clamping is "mankind's first stem cell transfer and propose that it should be encouraged in normal births."

In a BMJ editorial, James Neilson, professor of obstetrics and gynecology, states that delayed clamping should be practiced.

Why is Immediate Cord Clamping Routine?

This is a question many experts are now seeking to answer, but it seems this is another example of an outdated medical practice that has become routine before anyone stopped to consider if it was actually beneficial.
 

As David Hutchon, retired consultant obstetrician, said in BMJ:
 

"Cord clamping has become the accepted norm so much so that delayed clamping is generally considered a new or unproved intervention.
 

Thus, showing that immediate or early cord clamping offers no advantage to the baby is not enough; it has to be proved beyond reasonable doubt that it is harmful. Other interventions such as routine episiotomy were quickly abandoned when it was shown that they gave no advantage."
 

Very often cords are now also clamped early to collect cord blood and cord stem cells to be used for various medical and commercial purposes. But the evidence is clearly emerging that the most beneficial use for cord blood may be to allow it to transfer to the baby immediately at birth.

 

While most full-term babies have enough blood to establish lung function and prevent brain damage from early clamping, the process often leaves them pale and weak. For premature babies, the process can be even more devastating. And no matter what, immediate cord clamping will cause some degree of asphyxia and loss of blood volume because it:

Completely cuts off the infant brain's oxygen supply from the placenta before lungs begin to function.

Stops placental transfusion -- the transfer of a large volume of blood (up to 50% increase in total blood volume) that is used mainly to establish circulation through the baby's lungs to start them functioning.
 

Keeping valuable oxygen and blood from an infant by clamping the umbilical cord prematurely increases the baby's risk of brain hemorrhage and breathing problems. It has also been implicated as a contributing factor to:

Autism

Cerebral Palsy

Anemia

Learning disorders and mental deficiency

Behavioral disorders

Respiratory distress

 

Remember, You Have a Choice

As with many areas of medical care it's easy to get swept up in the system once you enter a hospital setting. But if you are currently pregnant and weighing your birth options, it's important to know that you have a choice.
 

First and foremost, you can choose a practitioner, such as a midwife or holistically oriented obstetrician, who is aware of the benefits of delayed cord clamping and will work with you on your desire to have this during your birth.
 

Next, be sure and make it known to your practitioner both before you go into labor and again when you enter the hospital that you desire delayed cord clamping. If you choose to give birth at home you should discuss this choice with your practitioner in advance as well.
 

If your practitioner tells you that he or she will only perform immediate cord clamping, and this is not in line with your beliefs, it's time to find a new practitioner who will work with you on these potentially life-changing birth choices.

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