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Despite recommendations from the World Health Organization (WHO) which state that cord clamping should be delayed from one to three minutes after birth, early cord clamping (ECC) still remains the standard of care within the vast majority of American hospitals. The practice of ECC, which typically occurs within one minute of birth, was initially recommended as a means to reduce maternal hemorrhage rates, yet data has indicated that no correlation exists between the amount of time which elapses between birth and clamping of the umbilical cord and said such rates. ECC is, however, associated with an increase in newborn anemia rates as well as delayed cognitive and motor function, with extreme cases resulting in brain damage or neonatal demise.
Role of the Umbilical Cord and Placenta Immediately After Birth
After a baby is born, the placenta continues to supply the newborn with oxygen until the lungs expand with air and the heart begins to circulate the oxygen which is absorbed through the lungs for the first time. Blood continues to flow from the placenta as a result of gravity and/or uterine contractions while the placenta remains attached to the mother. The volume of blood contained within the placenta can amount to up to 50 percent of the infant's total blood volume; when ECC is practiced, this blood is not able to enter the bloodstream of the newborn and can lead to hypovolemia (an insufficient blood volume), hypotension (low blood pressure), anemia and other serious conditions. Delayed cord clamping (DCC) allows placental blood, along with precious iron stores, to be transferred to the newborn in sufficient quantity to last for up to the first four months of the child's life.
Acknowledged Benefits of DCC
According to sources including the WHO, DCC provides newborns with numerous benefits, including:
- A 61 percent reduction in blood transfusions required when infants develop anemia as a result of insufficient iron stores;
- A significant drop in infant hypotension rates resulting in 52 percent fewer blood transfusions;
- Intraventricular hemorrhage (bleeding into the fluid-filled areas of the brain) rates which drop by 59 percent;
- A 29 percent reduction in neonatal sepsis (bacterial blood stream infection) rates in preterm infants;
- 62 percent fewer cases of necrotizing enterocolitis (death of intestinal tissue) in preterm infants.
While these numbers are striking in and of themselves, there may be many more benefits of DCC, including a reduced risk of brain damage which can lead to disorders such as cerebral palsy and even death if the infant is already compromised at birth.
Does ECC Provide Any Benefit to the Mother or Child?
Despite evidence which has been readily available for numerous years dispelling the myth that ECC reduces the risk of maternal postpartum hemorrhage, the practice remains common place. Some medical professionals site concerns related to an increase in jaundice rates when DCC is practiced, but ECC has been shown to only nominally increase this risk; furthermore, jaundice is easily treated in healthy newborns with exposure to artificial light and/or sunshine, and the condition is rarely life threatening. Conversely, depriving the newborn of up to half his or her blood volume and a significant amount of iron stores and oxygen has been shown to have much more dire consequences, some of which may not appear until the child reaches his or her school age years.
What About Cord Blood Sampling?
In practice, ECC may continue to be utilized in the belief that the practice is required to obtain a reliable sample to test for blood gas levels and pH. Research indicates otherwise, as blood samples can be obtained directly through the intact umbilical cord or from the newborn scalp or heel with a negligible impact on validity. Practitioners concerned with the legal implications of DCC should shift to heel or scalp blood collection methods to determine the oxygenation status of the baby at birth.
Can Neonatal Care and Resuscitation Be Completed With an Intact Umbilical Cord?
The WHO recommends that initial neonatal care be performed with the umbilical cord intact. They also state the importance of performing resuscitation techniques, if needed, with an intact cord, as five minute Apgar scores and long term outcomes show a significant improvement when placental blood continues to flow to the infant while resuscitation techniques are completed. ECC is only recommended if the inexperience of a technician prevents them from performing any required resuscitation techniques in conjunction with DCC.
How Long Should Cord Clamping be Delayed?
According to WHO, DCC should occur between one and three minutes after birth, although some experts recommend waiting significantly longer (up to 20 minutes or more in certain cases). The gold standard is related to the level of pulsation detected in the cord; clamping would ideally be delayed until all pulsations have ceased. Parents can ensure that medical providers abide by their wishes to practice DCC by obtaining an informed consent document which states that the cord will not be clamped until the infant is pink and breathing on their own and no cord pulsations are present.
Is a Physician Liable for Damage Resulting From ECC?
Dr. George Malcolm Morley, who worked as a highly respected OB/GYN until his retirement in 1999, stated that any physician who continues to utilize the outdated practice of ECC can and should be held liable for any resulting injuries to the child. Considering the complexity of medical malpractice cases, it is highly recommended to contact a professional attorney if you believe your child was injured as a result of ECC.
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