When the cord is surgically clamped at birth, the volume of blood within the newborn baby is fixed.
While the healthy, full term baby routinely survives early cord clamping, some babies are born prematurely or with a dangerously low blood volume. A low blood volume (hypovolemia) can be caused by compression on the cord, a tight nuchal cord (cord around neck), a large baby that is a very tight squeeze and shoulder dystocia.
It is routine in hospitals to immediately clamp the cord of compromised infants to transfer them to a warmer and/or flat surface to commence resuscitation. But since immediate clamping leaves the baby with the low blood volume, the consequence of clamping can be fatal.
If the baby survives, the low blood volume can mean blood flow has to be sacrificed from other organs in order to to sustain the lungs – multiple organ damage can be the result (including mild to severe brain damage).
The compromised infant – shoulder dystocia
Shoulder dystocia is a serious complication of birth and a scary situation for all involved .
Shoulder dystocia occurs after the baby’s head is born but the anterior shoulder cannot pass the mother’s pelvic bones (the pubic symphysis).
In Cardiac asystole at birth: Is hypovolemic shock the cause?, Mercer, Erickson-Owens and Skovgaard (2008) write about immediate cord clamping and shoulder dystocia:
”In cases of shoulder dystocia, infants shift blood to the placenta due to the tight squeeze of the birth canal and thereby are born hypovolemic. At birth, the sudden release of pressure results in hypoperfusion and low blood pressure. Severe hypovolemic shock from these effects can result in sudden cardiac arrest. Immediate cord clamping maintains the hypovolemic state and delays treatment until volume expanders can be given artiﬁcially through an umbilical catheter instead of using physiologic and readily available placental blood. Blood loss sets off an inﬂammatory cascade which can result in seizures, HIE and later brain damage. To prevent these conditions, the infant must obtain the blood volume lost with the squeeze. Recommended countermeasures for research are: (1) resuscitation at the perineum with intact cord; or (2) milking the cord before clamping; or (3) autologous transfusion of placenta blood after the birth; or (4) rapid transfusion of O negative blood.”
This YouTube video provides a visual description of this type of birth and response.
The video shows a medical birth with a vacuum-assisted delivery. Once the head is born there is an attempt to immediately rotate the baby and deliver the shoulders. There is a delay (the footage is momentarily turned off) before the baby is born extremely pale and unresponsive.
The doctor responds to the baby’s condition by gently shaking the baby and immediately clamping and cutting the cord. The baby is moved away from the mother and CPR is commenced.
The parents wrote that when the baby’s shoulders became stuck the circulation got cut off and the baby’s heart stopped. While the parents are grateful the medical staff were able to revive him, according to Mercer’s hypothesis the baby’s condition was made much more grave by the immediate cord clamping.
Parents need to be aware of the importance of blood volume so they can advocate for their baby’s safety at birth – until such time as practice improves and immediate cord clamping ceases.
Please be aware the video does not allow embedding so please click to watch on YouTube. The video does include graphic images of an vacuum-assisted birth with a compromised infant and immediate cord cutting.