For approximately 50-60 years most birth attendants have clamped and cut the cord immediately the baby has been born, often before the baby has taken its first breath. There has never been any evidence to support this practice and recent national and international guidance recommends the umbilical cord should be left intact for at least one minute. Immediate cord clamping can deprive the baby of at least 30% of their intended blood volume and research shows that babies can gain up to 214g in the first five minutes following birth if the cord is left unclamped. (Farrar 2010) Further research shows that babies who have immediate cord clamping have a greater incidence of iron deficiency anaemia as valuable red cells are left behind and that out of this same group of babies some male babies have decreased fine motor and social skills at the age of four. (Andersson 2011) Cord blood also has a very high concentration of stem cells, important in development throughout the baby’s whole life.
New NICE guidance published in December 2014 recommends delaying cord clamping for at least one minute for all babies regardless of delivery unless the baby’s heart rate is less than 60bpm and not getting faster. This is an extremely rare occurrence. Some babies can be a little stunned at delivery but it is important to remember that the placenta and cord are still transferring oxygenated blood through to the baby as they did when baby was in the uterus and the majority of babies will spontaneously recover without any intervention when the cord is left intact. Your birth attendant will dry the baby to stimulate them and place the baby in skin to skin to help with transition, temperature control and bonding. Early feeding can help this process along and can also aid placental delivery and reduce blood loss immediately following delivery. All of this can be done with the cord intact.
When the cord has fully completed its function, it will stop pulsating. Your baby will have received all their intended blood volume and the cord will be empty and white. As this is the healthiest way for the baby to be delivered we are starting a campaign called #waitforwhite to raise awareness.
With informed choice it is a common practice to administer an oxytocic (hormone) drug by injection after the baby is born to help deliver the placenta and reduce the incidence of post-partum haemorrhage. Historically this injection is often given immediately after delivery but in uncomplicated births, ideally it should be given a few minutes after birth (or when the cord has stopped pulsating) and the cord clamped a few minutes after administration of the injection. This way the baby gets their full transfusion with no interference. Many birth units have adopted this method of managing the third stage of labour and it is called delayed active management.
Physiological third stage of labour.
After informed choice many parents are choosing to have no drugs to aid the delivery of the placenta and allow the placenta to deliver itself. The cord is left intact throughout the whole process. Normally the placenta delivers within the first 20-30 minutes, although some can take longer.
Some parents opt to leave the placenta and baby attached to each other until the cord dries out and separation occurs naturally. This takes a few days.
Amanda Burleigh has been in Midwifery practice for over 27 years.
Over ten years ago Amanda began to challenging the practice of immediate cord clamping after realising that this common routine practice had absolutely no evidence base and deprived babies of valuable stem cell enriched full blood. Amanda has campaigned for a change in practice from immediate cord clamping to delayed cord clamping and has seen all national and international guidelines change their guidance to recommend this. Amanda is a co-inventor of the award winning Basics/Lifestart trolley which enables vulnerable babies to be ventilated whilst the umbilical cord is kept intact to ensure they receive their full blood benefit. Amanda has written many articles and talked at numerous events about optimal cord clamping and changing practice and fully harnessed the power of social media by participating in an international network of midwives, doctors, birth-workers and parents who share and disseminate the latest in research and education regarding optimal cord clamping.
Amanda has been nominated and won several awards for her work in this area including Midwife of the Year 2015, British Journal of Midwifery and Midwife of the Year 2012, Yorkshire Evening Post. She works with and supports midwives in other countries to enable them to give informed choice and practical guidance in optimal cord clamping.
Hannah Tizard's Blood to Baby campaign is helping to raise awareness about delayed cord clamping, all the resources can be ordered and delivered free of charge from the website www.bloodtobaby.com. The campaign has global reach and has been shortlisted for the Royal College of Midwives Evidence into Practice Award 2016.