What Is Delayed Cord Clamping
The first thing you might think about when someone mentions delayed cord clamping (DCC) is “How do I make sure my newborn doesn’t suck up all of my breast milk?” But it goes beyond just making sure your infant isn’t hungry. If you’re a mother who has chosen DCC, there are many reasons why you would want to delay clamping the umbilical cord. The procedure can help lower infection rates and the risk of hemorrhage. It’s also said to reduce pain and stress on mothers during delivery. And while most women have heard of delayed bathing or delayed feeding, delayed umbilical cord clamping may be new to them.
Let’s start with what we mean by delayed cord clamping. Doctors typically clamp and sever the umbilical cord soon after birth. This is done so that the baby gets immediate access to oxygen-rich air. In fact, this is the standard practice worldwide — until recently, that is.
In recent years, more and more hospitals around the world are adopting delayed cord clamping procedures, which means allowing some amount of time between when the baby is born and when the umbilical cord is clamped and cut. While the exact length of time varies, anywhere from three to 10 minutes is common. During this period, the child receives an IV line, breathing tube and possibly other medical intervention like suction catheters.
As early as 1879, physicians started delaying the process of cutting off the umbilical cord because they observed that the babies were less irritable after being allowed to breath longer. They even called it “the great discovery” at the time. Over the past century, multiple studies have shown that delayed clamping reduces the rate of infections such as urinary tract infections, sepsis, pneumonia and meningitis. These infections occur due to the exposure of the immature gut lining, which allows bacteria to enter into the bloodstream. When the cord is clamped too quickly, the bacteria are not exposed yet and therefore remain protected.
Although delayed clamping is becoming increasingly popular among health care providers, the procedure is still relatively rare. Only 3 percent of births in New York City took place with DCC in 2013. However, the numbers are growing rapidly. According to 2014 data from the Centers for Disease Control and Prevention, 0.6 percent of births nationwide occurred with delayed clamping. So, if you’re interested in learning more about this option, read on to find out how it works.
Delaying the Process
When a doctor decides to delay clamping the cord, he or she will take several steps before doing so. First, the physician must decide whether to use intermittent compression to slow down the flow of blood through the cord. Second, he or she will assess the baby’s condition including heart rate, respiratory effort and response to stimuli. Finally, he or she will decide whether to give medications to relax the mother and/or the baby.
While these decisions vary from one hospital to another, here are some general guidelines for determining the best timing for clamping:
If a cesarean section was performed, the doctor should wait no less than two hours before clamping the cord.
If vacuum extraction was used, the cord should be clamped within 30 seconds.
For vaginal deliveries, the decision depends largely on the type of labor. For example, if the contractions are strong enough to push the baby out, DCC usually isn’t necessary. On the other hand, if the contractions aren’t very strong, then the doctor may choose to delay clamping the cord.
Once the decision is made to delay clamping the cord, the next step is preparing the baby for transport. That involves giving him or her an IV line, breathing tubes and warming blankets. Once those things are ready, the doctor takes the following additional steps:
Anesthetizes the mother and the baby
Gently cleans the area surrounding the cord
Tests fetal well-being
Administers Pitocin to increase the strength of uterine contractions
Calculates the amount of time needed to deliver the rest of the placenta and the afterbirth
Instructs nurses to monitor vital signs and keep the baby warm
Sends the baby to the nursery team
Clamps the cord
Removes the cord from the body
Keeps track of the time
Releases the clamp once the cord stops pulsating
Finally, removes the cords from the placentas and cuts them
During this whole process, the nurse monitors the baby closely and provides support as requested. She checks his or her skin color, temperature, pulse and respiration. He or she makes sure the baby is comfortable, eating and drinking. The doctor keeps the baby connected to monitoring equipment throughout the entire process.
So, now you know how delayed cord clamping actually works. But why bother waiting? Here are some possible benefits:
It helps prevent infection. As discussed earlier, research shows that delayed clamping leads to fewer cases of infection such as urinary tract infections, sepsis, pneumonia and meningitis. In addition, delayed clamping increases the amount of time the baby spends exposed to oxygen. Oxygenated blood travels through the placenta to the baby via the umbilical vein. Cutting the cord too soon deprives the baby of its supply of rich nutrients and blood.
It helps reduce bleeding. Some people believe that delayed clamping prevents excessive bleeding caused by manual pressure applied to the stump of the umbilical cord. Studies show that this is true only when the pressure is maintained for five minutes or less. After that point, the chances of postpartum hemorrhage are higher.
It reduces pain. A study published in 2011 found that delayed clamping reduced pain felt by both the woman and the baby during and after delivery. In addition, the researchers reported that infants experienced less anxiety during their stay in the neonatal intensive care unit.
It saves money. Hospitals spend millions of dollars each year treating complications associated with premature clamping.
According to the Society of Obstetricians and Gynecologists of Canada, delayed clamping is recommended for low-risk pregnancies involving vaginal births. The group says it could save hospitals money in the long run by reducing the number of admissions related to complications.
However, delayed clamping is controversial. Many experts disagree over whether it truly improves outcomes. Others feel that it exposes the baby to unnecessary risks. Read on to learn more about this topic.
Benefits of Delayed Clamp Clamping
Some obstetricians argue against delayed clamping on moral grounds. They say it is wrong to prolong life artificially. Proponents of delayed clamping claim that it is ethically acceptable since it does not interfere with the natural course of events.
Others question the science behind delayed clamping. One criticism is that it delays treatment of potentially serious conditions. For instance, if the baby needs resuscitation, it becomes harder to perform that task without having immediate access to an emergency department. Another argument against delayed clamping is that it increases the risk of hypovolemic shock. Hypovolemic shock occurs when the baby’s blood volume decreases rapidly. This happens when the cord is clamped sooner rather than later. The main concern is that rapid separation of the placenta from the wall of the womb causes blood loss.
To date, there hasn’t been any definitive scientific evidence proving either side of the debate. What is clear is that doctors continue to explore ways to improve health outcomes for mothers and babies.
One alternative to delayed clamping is antepartum cardiotomy, or the removal of part of the placenta prior to delivering the baby. This technique is performed mainly in high-income countries where delayed clamping is already widespread. An antepartum cardiotomy procedure is similar to open-heart surgery. It requires sedation and full anesthesia. The mother’s heart is stopped with medication, and a surgeon opens the abdomen and removes part of the placenta. Then, the heart is restarted, and the baby is removed through the vagina.
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