It's time to let the baby decide

Let me rephrase this; Any form of delaying cord clamping is better then early cord clamping. In all the things that we not yet know about improving birth, there is a wide consensus that early cord clamping causes harm (Rabe et al. 2019). Clamping the umbilical cord is the intervention, cutting off the supply of oxygen rich blood to the newborn baby.

The importance of delaying cord clamping has been recently confirmed by the release of the 2021 ERC guidelines on newborn life support (NLS) (Madar et al. 2021). The ideal timing of cord clamping, especially for newborns in need of support, is being debated in the scientific community, still requiring more evidence. Nevertheless, in it’s 2021 NLS guidelines, ERC is taking a first step, by underlining that cord clamping is ideally delayed until breathing has commenced:

This new guideline is based on scientific evidence on the physiology of transition, showing the importance of a baby’s first breaths during transition (Hooper et al. 2015). Lung aeration is the master switch; by filling it’s lungs with air, the newborn baby lowers its pulmonary vascular resistance and triggers its pulmonary blood flow. If the supply of oxygen rich blood from the placenta is cut off before the baby establishes pulmonary blood flow, its heart, and consequently its organs, are deprived of sufficient oxygen rich blood, as the cardiac input, and subsequently, the cardiac output is compromised. If the supply of oxygen rich blood from the placenta is maintained while the baby is taking its first breaths, cardiac output is maintained and the baby’s transition is more (haematological and circulatory) stable.

This process is about the baby, and the time it needs to make the transition. We know that this is different for every newborn baby. Timing cord clamping, in seconds, seems arbitrary and illogical. Waiting with clamping the cord until the baby is ready, giving the baby its own required time to adjust, with or without support, should be the next logical step. A “shock-free” birth for every baby.

If you are interested in learning more about the science behind umbilical cord management at birth and why you should wait with clamping the cord until the baby is ready, I recommend you to have a look at the great educational Concord Talk by physiology professor Stuart Hooper, accessible via: https://concordneonatal.com/concord-talk/

Rianne Rotink

This blogpost is written by Rianne Rotink, CEO of Concord Neonatal. In her blogposts, Rianne will be sharing her latest personal insights and knowledge about stabilization with intact cord and physiological based cord clamping.