McMaster University

McMaster University

Faculty of
Health Sciences

Wait two minutes before cutting the cord

By Sue Johnston

Published: March 20, 2007
Nancy Pollock
Eileen Hutton, assistant dean of midwifery at McMaster University.

Doctors and midwives should think twice about when exactly to cut the umbilical cord following childbirth.

Although the tendency in western countries is to clamp and cut the cord immediately after a baby is delivered, a study published in today’s Journal of the American Medical Association (JAMA) indicates that delaying the procedure for a minimum of two minutes provides health benefits for full-term newborns.

"The results of our study clearly show that later cord clamping reduces the incidence of anemia and improves iron stores in newborns," said Eileen Hutton, lead author of the paper and assistant dean of midwifery at McMaster University. "And, more importantly, these benefits extend beyond the early neonatal period."

The results are from a systematic review of 15 earlier controlled trials on cord clamping that involved 1,912 newborns in 11 countries on five continents. About half had immediate cord clamping, while the others had their cords clamped between two and three minutes after birth.

Clamping and cutting the umbilical cord is the oldest and most prevalent medical intervention in humans, but the timing of the procedure has been controversial for decades, and there are no formal practice guidelines. Before birth, the fetal blood circulates through the umbilical cord and placenta. Earlier studies have shown that somewhere between 25 and 60 per cent of fetal blood is in the cord and placenta. Delaying clamping of the cord allows an increase in blood volume in the newborn of up to 30 per cent, by allowing the blood in the placenta to flow through the cord to the baby, bringing with it potentially healthy benefits.

Hutton and research partner Eman Hassan at the University of British Columbia combined and analysed the results of the earlier studies looking for data on both benefits and harms of early and late cord clamping, such as the development of jaundice, abnormally high or low volume of blood being circulated, rapid or irregular breathing, risk of anemia, improved iron stores and healthy blood functioning.

Their analysis showed that delaying clamping of the cord for at least two minutes after birth consistently improved healthy blood function and iron status in newborns. As well, the risk of anemia in these babies decreased by nearly 50 per cent and the risk of low iron stores was reduced by one-third at three months of age.

"Late clamping of the umbilical cord is a physiological and inexpensive means of enhancing hematologic status, preventing anemia over the first three months of life and enriching iron stores for as long as six months," stated the paper in JAMA. "Although this is of particular importance for developing countries in which anemia during infancy and childbirth is highly prevalent, it is likely to have an important impact on all newborns, regardless of birth setting."

While cord clamping is part of the active management of the third stage of labour and recognized as a means to minimize blood loss by the mother, delaying the procedure is not expected to have any adverse effect on the mother. In fact, the JAMA paper states that a joint statement from the International Federation of Gynecology and Obstetrics and the International Confederation of Midwives recommends that delayed clamping be incorporated as part of the active management of delivering the placenta.

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