DELAYING CORD CLAMPING

Early cord clamping, immediately after birth and prior to cessation of pulsation of the cord, is performed routinely in many hospitals as part of managed third stage. Women planning to give birth in Birth Centres or at home will often be aware of the advantages to the baby of delayed cord clamping, or not clamping or cutting the cord, and request physiological 'unmanaged' third stage. This is the usual practice for many independent homebirth midwives.

An article in yesteday's Sunday Age, 'Trial to test benefit of delayed cord cutting' brought the welcome news that research is being undertaken - "leaving the cord unclamped for 60 seconds, holding the baby below the placenta and allowing gravity to let blood from the placenta enter the baby." The trial focuses on babies born more than 10 weeks early - the vulnerable, premature babies, who would not be likely to survive without expert neonatal specialist care.

In a normal birth setting - that is, a baby at term, spontaneous onset and progress of labour without stimulation, and spontaneous cephalic birth of a healthy baby - the mother herself is able to take her baby into her arms when she is ready. This may be immediately after the birth, or may be minutes later. There should be no need to put times and restrictions on the position of the baby.

The ICM/FIGO joint statement on active management of third stage is the 'evidence based' protocol followed in many major maternity hospitals.
"Active management of the third stage of labour consists of interventions designed to facilitate the delivery of the placenta by increasing uterine contractions and to prevent PPH by averting uterine atony. The usual components include:
· Administration of uterotonic agents
· Controlled cord traction
· Uterine massage after delivery of the placenta, as appropriate."

This protocol requires "Clamp the cord close to the perineum (once pulsation stops in a healthy newborn) and hold in one hand."

Waiting for pulsation to cease can be a precious time for the mother, in touching and observing her newly born child. A pulsating cord usually means the baby is OK. Even in the highly complex birthing situations a baby born with a pulse is likely to be fine.

I have observed many instances of actively 'managed' third stage in which the clamping of the cord is immediate, allowing a baby to be whisked away from the mother so that medical personnel can perform their ritual 'lifesaving' acts. This must have a profound impact on both mother and baby, interfering with bonding and increasing fear in both. Many mothers accept the interventions uncritically, believing that they were performed in the best interests of the child.

Professionals and parents need to critically examine the evidence around these serious interventions. Many lay people who read a blog such as this one may feel overwhelmed by the huge differences between holistic midwifery practice, and the highly interventionist obsteric services that are provided for the majority of women. As an immediate action that anyone who is concerned that their baby's umbilical cord may be clamped prior to cessation of pulsation, should discuss with their care providers and ask what is their usual practice.

Any midwife or doctor who is willing to clamp a pulsing cord should, in my opinion, be challenged.
Joy Johnston