Sunday, July 15, 2007

The Umbilical Cord-Don't Rush to Cut

If you or someone you know is pregnant, a recent study from JAMA is something you should know about. It has to do with when to cut the umbilical cord. That is probably something you never thought about, right?

The placenta and umbilical cord contain up to 60% of the fetal blood red cells and this blood is rich in stem cells. We are just learning how important these precious stem cells are in preventing blood disorders and diseases later in life. There has been controversy among obstetricians about the optimal time to clamp the umbilical cord in a normal childbirth. Early clamping is considered up to one minute after delivery. Late clamping is leaving the cord attached with blood flowing from placenta to infant for at least 2 minutes.

The researchers carefully reviewed all of the world's literature on this subject and compared studies. They found that delaying clamping of the umbilical cord for at least 2 minutes after birth consistently improved both the short- and long-term blood and iron status of full term infants and this benefit lasted for months. This benefit would be even more important in developing countries where the mothers are often anemic and infant anemia is widespread.

If you think about childbirth in nature, there would not be a rush to cut the cord. The infant is tethered to the mother for several minutes during birth and there is likely a selection advantage for this. We are entering a new era in medicine as we study best practices and use this evidence in care of patients. This is called "evidenced-based" medicine, as opposed to much of how we care for patients which is anecdotal and varies depending on where the physician is trained. Any time we can know what the current evidence shows and use that evidence to practice in the best way, patients all over the world benefit.

The evidence is clear...don't clamp the umbilical cord for at least 2 minutes so the infant can receive all of the important blood components from the placenta and cord.


Brad Cohn, MD said...

Good article. Not new. Pulsation of the cord lasts at least 2 minutes and on ending is a good measure of when to cut. An exception to the two minute wait is maternofetal blood incompatibility (Rh or ABO) where you want to reduce the transfusion of sensitized cells pursuant to less hyperbilirubinemia and
no erythroblastosis. Brad Cohn, MD

Rich said...

Can you say that in English Brad?

K said...

My understanding of what Brad wrote was that it's better to cut the cord earlier rather than later if the mother's blood type is incompatible with the baby's. Because of the problems that occur when someone receives incompatible blood, and also because babies are kinda delicate when first born, it's best to limit their exposure to their mother's blood.

Unfortunately all I could do to help with what hyperbilirubinemia and erythroblastosis are would be to google them for you. I do remember bilirubin and blastocysts from biological anthropology class, though. Basically, though, the things he mentions are blood disorders.

Toni Brayer MD said...

K, it looks like you were listening in anthroplogy! That college tuition was worth it. Now you can interpret health blogs. You translated Brad very well.
Erythroblastosis is too many red cells and hyperbiliruinemia is too much bilirubin. Newborns with excess bilirubin can have serious complications. We know ahead when there is the rare case of maternal-fetal incompatibiity so in all other cases...let that cord blood flow.

Anonymous said...

Unless you are a midwife you don't really specialize in birthing, and most doctors have never witnessed a truly intervention free birth before they are allowed to deliver a baby. SO..that should tell you that what they say and do is what they were told in medical school not from what they learn by watching women give birth naturally! said...

It cannot have effect in actual fact, that is exactly what I think.

Wilfrid said...

It won't really have effect, I consider like this.
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