Cord clamping guidance

Abstract

British Journal of Midwifery • September 2012 • Vol 20, No 9 New guidance by the Royal College of Midwives (RCM) on the timing of cord clamping is expected to be unveiled at the RCM conference in November. The new guidance will recommend delaying clamping the cord until after it has stopped pulsating—sometime between 3 and 5 minutes. Delaying cord clamping is thought to protect babies against iron deficiency and anaemia, and allows vital stem cells to be transferred. Currently, midwives are advised to clamp the cord within 30 seconds of birth (National Institute for Health and Clinical Excellence (NICE), 2007). It was previously thought that cutting the cord within 30 seconds protects babies from exposure to hormones given to speed up labour and deliver the placenta and could also prevent jaundice. The change in guidance follows a growing number of studies highlighting the benefits of delayed cord clamping. For example, in a Swedish study that looked at the outcomes of 400 babies born after a low-risk pregnancy, where some had their umbilical cords clamped after at least 3 minutes and others were clamped in less than 10 seconds after delivery, Andersson et al (2011) found that babies with delayed clamping had better iron levels at 4 months of age and were far less likely to suffer newborn anaemia. Hutton and Hassan (2007) compared the potential benefits and harms of late vs early cord clamping in term infants. They found that delaying cord clamping by 2 minutes could half the risk of anaemia. The benefits of delayed cord clamping have been known for sometime—Hutton and Hassan’s meta-analysis was over 5 years ago. The World Health Organization (WHO) dropped early clamping from its guidelines some years ago as anaemia is a big problem in the developing world (WHO, 2009). The Royal College of Obstetricians and Gynaecologists (RCOG) also updated its guidelines in 2009 to state that: ‘the cord should not be clamped earlier than is necessary, based on clinical assessment of the situation. Evidence suggests that delayed cord clamping (more than 30 seconds) may benefit the neonate in reducing anaemia, and particularly the preterm neonate by allowing time for transfusion of placental blood to the newborn infant,which can provide an additional 30% blood volume. In the preterm infant (less than 37+0 weeks of gestation), this may reduce the need for transfusion and reduce intraventricular haemorrhage. Delayed cord clamping does not appear to increase the risk of postpartum haemorrhage’ (RCOG, 2009). The change in guidelines is definitely welcome, but the question has to be asked why has it taken so long for us to catch up? BJM