Premature clamping and cutting of the umbilical cord can be highly traumatic
Studies show that premature cord clamping can cause:
- significant blood loss for the baby (loss of 15 to 30%, and up to 40% -50% in more extreme cases of fetal distress and cord compression prior to clamping) (1)
- loss of red blood cells (up to 50%) (2)
- loss of stem cells (2)
- loss of support from placental circulation, to receive oxygen and transfer accumulated acids, before the lungs are functioning adequately (3)
- anaemia and iron-deficiency (4)
- interference with clearing of fluid from the lungs (2).
This last point is important, because suctioning of fluid can be traumatic for the baby too.
Many people believe all babies require suctioning at birth – and there is a good chance this ‘need’ is partly due to the effects of immediate cord clamping.
This is because the normal increase in blood volume in the minutes or so after birth (without cord clamping) has a role in the baby’s lung transitioning from a small, fluid filled organ to the ‘dry’ organ of efficient respiratory exchange (2).
After a baby is born, the blood vessels in the air sacs of the lungs are filled for the first time. This increased blood supply though the lungs is an important mechanism for fluid to be drawn out of the lungs (into the baby’s circulation) (2).
Suctioning can be trauma
Routine suctioning of the baby – the oropharynx and stomach – was adopted without evidence in the same manner as immediate cord clamping (2).
Suctioning at birth has been performed on a vast number of babies and is still routinely done by some providers/ institutions.
Studies that have examined this practice (after it was already routine) found no differences in lung function between the groups of babies that were suctioned versus the group not suctioned (2). Instead, the studies found risks associated with bradycardia (slowed heart rate) and cardiac rhythm disturbances (2). Suctioning can also be painful and interfere with breastfeeding. (6)
In the video below you can see a baby that is already crying and vigorous at birth being suctioned, and you can clearly see the baby gag and cry in distress.
How to avoid trauma
To protect your baby from unnecessary trauma, please give careful consideration to how you can protect your baby’s umbilical cord and normal placental transfusion.
Your baby is a placental-mammal and as such, is designed to transition from placental circulation to pulmonary circulation (5) – without the need for clamping, suctioning, painful rubbing with towels and separation of mother and baby.
Delayed clamping, gentle handling, even a gentle approach to neonatal resuscitation is possible – parents need to be aware of their options to increase the likelihood their baby will avoid immediate cord clamping(6).
Delayed clamping (or ‘cord milking’) with no suctioning or separation is achievable in more than just natural birth. It can also be possible in:
- medicated birth,
- induced or augmented birth,
- after forceps or vacuum birth,
- after shoulder dystocia and other forms of temporarily constricted cord (like tight nuchal cord),
- twin birth,
- cesarean section birth.
It is important to learn about the physiology of the third stage of labour, discuss your preferences with your care providers, and communicate your choices in very clear terms.
For example, “refusing to consent to the umbilical cord being touched, clamped or cut without verbal consent” (state in writing too) is likely to be much more effective than “asking for delayed cord cutting”.
It is important to be aware how use of equipment in the birthing space can lead to unwanted and premature clamping of the cord.
Planning ahead and discussing birth without clamping with your providers may improve your chances of the cord being intact for assessment, support and perhaps even resuscitation. (This PDF regarding the B.A.S.I.C.S. trolley provides further explanation about bedside neonatal support)
Worse than premature cord clamping?
In some instances, pre-birth and premature cord clamping can be fatal.
The immediate clamping of a volume-deplete and compromised infant can inflict a catastrophic hemorrhage, resulting in global developmental delay, cerebral palsy or death . (Please refer to the references in this article)
There are other rare complications and accidents that can be associated with untimely clamping the cord at birth, for example:
- Failure to clamp the cord that is cut before natural cord closure, resulting in the baby bleeding out from the cord
- Clamping too close to the baby and pinching the skin or portion of the gut which may be in the cord – see video below
Supportive birth practices
There are many routine practices that are disruptive and harmful to the mother and baby at the time of birth. Parents may need to be very clear in negotiating supportive birth practices for their babies. (6)
Supportive birth practices can include:
- allowing time for the baby’s shoulders to rotate during birth (without applying traction),
- somersault manoeuvre if cord is tight around the neck,
- allowing fluids to clear without suctioning,
- leaving the cord intact and not clamping,
- using gravity to assist with placental transfusion if necessary,
- resuscitating with the cord intact or milking the cord before clamping (6).
While a provider may argue some of these practices are not based on outcomes from random controlled trials, neither is traction for rapid delivery of the shoulders, immediate cord clamping, routine suctioning, or the routine and premature amputation of pre-term, full term, vigorous or depressed newborns from the placenta prior to full transition to pulmonary circulation!
Supportive birth practices protect and preserve the normal anatomy and physiology of birth
The more parents demand this type of care, the less infants will experience unnecessary shock, trauma, blood loss and mother-baby separation at birth.
Video showing birth without harmful clamping
Jamie shared her video with this site a few months ago, which compares her experience of natural ‘Bradley’ style birth to a hospital birth where her baby had instant cord clamping. The Bradley style birth is very safe and gentle, but please be aware this video contains distressing scenes of immediate cord clamping, significant infant blood loss and suctioning.
(1) Yao, A.C., Moinian, M., & Lind, J. (1969). Distribution of blood between infant and placenta after birth. Lancet 2 (7626):871-873
(2) Mercer, J., Skovgaard, R., & Erickson-Owens, D. (2008). Fetal to neonatal transition: first, do no harm. In Downe, S. (Ed.) Normal Birth: Evidence and Debate (pp. 149-174). Elsevier Limited
(3) Farrar, D., Airey, R., Law, G. R., Tuffnell, D., Cattle, B., & Duley, L. (2011). Measuring placental transfusion for term births: weighing babies with cord intact. BJOG : an international journal of obstetrics and gynaecology, 118(1), 70-75. doi: 10.1111/j.1471-0528.2010.02781.x
(4) Chaparro, C. M. (2011). Timing of umbilical cord clamping: effect on iron endowment of the newborn and later iron status. Nutrition reviews, 69 Suppl 1, S30-36. doi: 10.1111/j.1753-4887.2011.00430.x
(5) Hutchon, D. J. (2010). Why do obstetricians and midwives still rush to clamp the cord? BMJ, 341, c5447. doi: 10.1136/bmj.c5447
(6) Mercer, J., & Erickson-Owens, D. (2010). Evidence for Neonatal Transition and the First Hour of Life. In Walsh, D., & Downe, S. (Eds.) Essential Midwifery Practice: Intrapartum Care (pp. 81-104). United Kingdom: Blackwell PublishingPlease note this page does not constitute medical advice.
This site is for information sharing and discussion only – the web host assumes no responsibility for any loss/injury/damage arising related to any use of the content contained in, or linked to this website. It is up to the individual, in collaboration with their clinical care provider, to determine the appropriate course of action, treatment and management.