We can't be bothered; Optimal Cord Clamping

I hear regularly from students and midwives that I meet on my travels that there remains a resistance in practice towards optimal cord clamping. Whilst I also want to recognise the exceptional work going on at some Trusts to include optimal cord clamping in all obstetric practice, from caesarean sections, to instrumental birth - its not just for midwifery led care! (blogs to follow soon)

Optimal cord clamping; the umbilical cord is not clamped or cut until after pulsations cease

The timing of cord clamping has an impact on initial and long-term outcomes for the mother and baby

Most guidelines suggest waiting at least 1-3 minutes, but the research says >5 minutes or until pulsations cease has the greatest advantages.

Advantages to the newborn

• The baby will receive up to 30% more of the fetal-placental blood than it would with immediate cord clamping.

• Increase in warm blood reduces the impact of newborn hypothermia alongside appropriate thermoregulatory care, drying neonate and a hat.

• Increase in blood volume promotes perfusion of the lungs and brain, reducing impact of issues of hypovolaemia and hypoxia of baby at birth.

• Increased haemoglobin levels improve oxygen and iron transportation around the body.

• Iron is important for long term neurodevelopment of baby, myelination of axons and development of white matter in the brain.

• Studies show improved fine motor function and social skills later in life.

• Immune promoting stem cells provide lifelong protection to baby.

• Keeps the mother-baby unit together facilitates neonatal benefits of skin to skin.

Significant neonatal benefits in preterm infants including;

• Improved transitional circulation.

• Better establishment of red blood cell volume.

• Decreased need for blood transfusion.

• Lower incidence of necrotizing enterocolitis and intraventricular haemorrhage.

Advantages to the mother

Photo Credit: Brie Zeltner; The Plan Dealer

Maternal bonding and attachment to neonate are facilitated by skin to skin contact - see @JennytheM

• Uninterrupted maternal-neonatal connection facilitates breastfeeding.