Delaying umbilical cord clamping better for baby: McMaster expert

It's a moment when time really flies — a baby is born, a nurse swoops in to clamp and cut the umbilical cord and often in under a minute, mom has baby in arms.

But if that process just took a little bit longer, baby could be healthier with no adverse affects to mom, says a new report from the Cochrane Collaboration, an international network of healthcare practitioners and policymakers.

Delaying umbilical cord clamping by as little as just a minute can increase the child's blood volume, and improves iron stores and hemoglobin levels, according to the report released Wednesday.

"There is a lot that happens in two to three minutes after the birth," said Eileen Hutton, associate dean of McMaster University's midwifery program and associate professor in obstetrics and gynecology, who is passionate about the benefits of delayed umbilical cord clamping.

This is what happens in those two to three minutes:

When the baby is in utero, the placenta does heavy respiration lifting, taking the carbon dioxide from the baby and exchanging it for oxygen, Hutton said.

At this point, the baby's lungs are not functioning at all, so blood flow to that organ is slim. Most of the blood — 40 to 50 per cent — stays in the placenta. This changes when the baby is born, and how much of that blood in the placenta that is transferred to the newly born baby is dependent on how long the umbilical cord is attached.

Canada leads the way

"When we leave the cord open for a few minutes, the blood flows from the placenta to the baby and provides about 40 per cent extra blood," Hutton said. "It's a very simple thing to think about. Allowing the blood that's required for proper perfusion of the lungs from the former organ of respiration to the new organ of respiration."

The Cochrane study, a meta-analysis of 15 trials with 3,911 women, says delaying cord clamping for as long as three minutes increases increases blood volume, and therefore red blood cell count and iron storage capacity. Hutton teaches her midwifery students to delay clamping, period.

"Midwifery is more natural," she said. "It follows a more natural processes."

Hutton herself has done a number of studies on delayed cord clamping, including a meta-analysis with similar findings in 2007, the first study that pulled research together. As a result, Canada is leading the way with this initiative, she said. A recent survey of practitioners she conducted at the end of last year showed 60 per cent are delaying cord clamping.

The long-standing procedure, Hutton said, came about as really a matter of convenience — "active management to get the baby out of the way. It's more coincidental to the process than an active part of treatment."

Age-old debate

And the debate about what delayed cord clamping can do is almost as old as the procedure itself. Hutton has found reports from the late 1800s about umbilical cord clamping.

This is a medical policy area that parents can influence, she said.

"Because the parent is beside the practitioner, they can say, 'remember, I want to delay the cord clamping,'" she said.

And it's a simple change in medical policy that can make a world of a difference in those two to three minutes.

"We're looking at a 40-per cent increase in the baby's blood volume by delaying clamping by two minutes for an intervention that costs nothing and has no downsides," Hutton said. "It's so beneficial to babies that we really need to take it seriously and make the change."