Historical perspectives on umbilical cord clamping and neonatal transition

Abstract

The timing of umbilical cord clamping is contested. Many textbooks imply that ‘early’ cord clamping (Table 1) is an inevitable and normal part of the third stage of labour.1 Indeed, it is widely practised and supported.2 The National Institute for Health and Clinical Excellence (NICE) recommended early clamping in their 2007 intrapartum care guideline.3 Yet, early umbilical cord clamping can be detrimental to the newborn, leading to an increased risk of anaemia and, in the premature infant, an increased risk of intraventricular haemorrhage and respiratory complications.4,5 Delaying clamping in preterm infants decreases the need for blood transfusion4 which has been associated with neonatal necrotizing enterocolitis and death.6 In the term infant, delayed clamping improves neonatal oxygen transport and red blood cell flow and in premature infants it is associated with fewer days on oxygen and ventilation.4 The mounting evidence for deferring clamping has prompted changes to recent guidelines. The World Health Organisation (WHO) has officially endorsed the practice of so-called ‘delayed’ cord clamping.5 The International Federation of Gynaecology and Obstetrics and the International Confederation of Midwives have also removed early cord clamping from active management guidelines.4 Table 1 Examples of variable definitions of ‘early’ and ‘late’ cord clamping (adapted from Ref 4) Despite the disadvantages, early cord clamping is still routine among maternity staff.2 When evidence for clinical practice is lacking, its history may enlighten.