Does it matter when the umbilical cord is cut? It’s a question many parents are asking, including couples who interview me, as a midwife, to attend the birth of their baby. They want to know if I routinely clamp and cut a newborn’s umbilical cord as soon as she is born, or if my unrushed approach toward normal childbirth includes non-interference during the third stage of labor—the time from the birth of the baby until the delivery of the placenta, or afterbirth.
Umbilical Cord Cutting: Understand the Difference Between Active and Expectant Management
In most hospitals in the United States and Europe, active management of the third stage of labor is standard practice. You will receive a drug that causes uterine contractions by IV or injection either the moment your baby’s first shoulder emerges or directly after delivery of the placenta. Your baby’s umbilical cord will be clamped and cut quickly, within about 30 seconds of birth, and the attendant will apply traction to the cord to get the placenta out. The rationale for active management has historically been the prevention of excessive maternal bleeding after birth. However, in a Cochrane review of 11 studies involving almost 3,000 women, researchers found that delayed cord clamping did not endanger mothers.
An alternative to active management is expectant, or physiological management, of the third stage of labor. Expectant management is a non-interventionist approach. The umbilical cord may be clamped and cut when it has stopped pulsing, on average between 10 and 20 minutes. Birth attendants wait patiently for signs of readiness and allow the spontaneous delivery of the placenta, aided by gravity, the mother’s pushing efforts, or the effects of early breastfeeding. Expectant management of third stage is popular in some northern European countries, and with some doctors and midwives in the United States and Canada. Many mothers also prefer it. In any case, delayed cord clamping may have important benefits for your baby.
Delay Umbilical Clamping: A Little Time Made a Big Difference For These Babies
According to a study of 358 full-term infants born in Mexico City, delaying cord clamping for even three minutes when a baby is born will provide her with higher blood hemoglobin, hematocrit and iron levels, and she will have a significantly lower risk of developing iron deficiency anemia in the first six months of life.
Since babies are born with iron stores that may be depleted by four to six months of age, the time when most pediatricians in the United States recommend supplemental iron, these findings seem remarkable. The beneficial effect was found to be even greater for infants of anemic mothers, infants who were breastfed exclusively for six months, and babies who weighed less than 6 pounds 10 ounces at birth.
In a study published in Acta Paediatrica in May of 2013, delayed cord clamping was even associated with improved neurodevelopment—specifically, higher scores in problem solving at four months of age.
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