In most hospital delivery rooms, doctors routinely clamp and sever the umbilical cord less than a minute after an infant’s birth, a practice thought to reduce the risk of maternal hemorrhaging.
But a new analysis has found that delaying clamping for at least a minute after birth, which allows more time for blood to move from the placenta, significantly improves iron stores and hemoglobin levels in newborns and does not increase the risks to mothers.
Doctors usually clamp the umbilical cord in two locations, near the infant’s navel and then farther along the cord, then cut it between the clamps. The timing of the procedure has been controversial for years, and the new analysis adds to a substantial body of evidence suggesting that clamping often occurs too quickly after delivery.
The new paper, published last week in The Cochrane Database of Systematic Reviews, may change minds, though perhaps not immediately.
“I suspect we’ll have more and more delayed cord clamping,” said Dr. Jeffrey Ecker, chairman of the committee on obstetrics practice for the American College of Obstetricians and Gynecologists.
Newborns with later clamping had higher hemoglobin levels 24 to 48 hours postpartum and were less likely to be iron-deficient three to six months after birth, compared with term babies who had early cord clamping, the analysis found. Birth weight also was significantly higher on average in the late clamping group, in part because babies received more blood from their mothers.
Delayed clamping did not increase the risk of severe postpartum hemorrhage, blood loss or reduced hemoglobin levels in mothers, the analysis found.
“It’s a persuasive finding,” Ecker said. “It’s tough not to think that delayed cord clamping, including better iron stores and more hemoglobin, is a good thing.”
The World Health Organization recommends clamping of the cord after one to three minutes, because it “improves the iron status of the infant.” Occasionally, delayed clamping can lead to jaundice in infants, caused by liver trouble or an excessive loss of red blood cells, and so the WHO advises that access to therapy for jaundice be taken into consideration.
By contrast, in December a committee opinion by the American College of Obstetricians and Gynecologists reviewed much of the same evidence as the new analysis but found it “insufficient to confirm or refute the potential for benefits from delayed umbilical cord clamping in term infants, especially in settings with rich resources.”
The new analysis did not include many women who had cesarean sections, some experts said.
