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Don't Cut The Cord!

by Danette Preston

Clamping the umbilical cord immediately following birth is standard procedure in American hospitals. What much of the general population does not know is that there are very sound reasons for NOT clamping the umbilical cord immediately.

Early cord tying/clamping is a recent invention -- practiced routinely only in a few countries and only since the forties. It is neither natural, normal, evolutionary or historical. The debate on cord clamping dates back at least to 1801, when Erasmus Darwin noted that it would be "very injurious" to tie "the navel-string" too soon and urged that clamping be delayed until the infant has breathed repeatedly and all cord pulsation ceased.

Early cord clamping is an intervention in a natural process. There is NO evidence to support that early cord clamping is beneficial. Humans are the only placental mammals who routinely clamp the cord.  Many bite the cord and eat the placenta.

George M. Morley, MB., CH. B writes "If cord clamping is delayed to permit normal placental transfusion, the need for newborn transfusion often could be eliminated. The cord tie is viewed as insurance against blood loss after the vessels have closed. Fear of late clamping persists because physicians have been conditioned to believe that complications such as jaundice, plethora, hyperviscosity, and polycythemia are caused by placental over-transfusion.

In 1993, Kinmond and her colleagues noted that heterologous blood transfusion may be virtually avoided in preemies of 27 to 33 weeks by lowering the child 20 cm below the placenta for 30 seconds before clamping the cord. This gravity-enhanced method of placental transfusion produced healthier babies needing fewer blood draws and no heterologous transfusions. Kinmond et al. found no increase in these conditions using this method. The normal, term child routinely survives early clamping, but clamping the cord of a compromised child before ventilation is riskier.  At most high-risk deliveries, the cord is clamped as soon as possible to speed resuscitation and to obtain a cord pH. An increased incidence of hypovolemic complications would be anticipated in such newborns.  Besides the frequent use of blood transfusion in preemies, blood loss in other high-risk newborns was documented by Faxeliu. The problem may be largely avoided by resuscitating the child with the placental circulation intact. This maintains newborn placental oxygenation and provides blood volume to establish pulmonary circulation. If need be, a cord pH sample may be obtained without clamping by inserting a fine, sterile needle into a pulsating cord artery.

The logical way to resuscitate such newborns is to allow the massive placental transfusion of oxygenated blood to proceed while the airway is cleared and the lungs ventilated. Every effort should be made to reduce rather than clamp a cord around the neck." A normal blood volume at birth should aid recovery of a compromised child. Normal blood volume is not produced by a cord clamp. The newborn and placenta reach physiologic, hemodynamic equilibrium without interference, The placental transfusion is massive, silent, and invisible, but as
normal and physiologic as is crying at birth. An adequate blood volume is needed to perfuse the lungs, gut, kidneys, and skin that replace the placenta's respiratory, alimentary, excretory, and thermal functions. During the third stage of labor, a large portion of placental  blood is shifted to these organs, While the normal, term child tolerates immediate clamping, lack of placental transfusion increases morbidity in "at risk" births.

Many neonatal morbidities such as the hyperviscosity syndrome, infant respiratory distress syndrome, anemia, and hypovolemia correlate with early clamping. To avoid injury in all deliveries, especially those of neonates at risk, the cord should not be clamped until placental transfusion is complete.

The World Health Organization states (Care in Normal Birth: A Practical Guide) "Late clamping (or not clamping at all) is the physiological way of treating the cord, and early clamping is an intervention that needs justification."

Dr. M. Jeffrey Maisels says "If the cord is not clamped, the placenta gives the infant the equivalent of 20 cc of blood per kilogram of body weight within these first 3 minutes.  This placental transfusion in the normal infant is equivalent to the amount of blood given to an infant in profound shock. When cords are not clamped early, the third stage of labor is one-third shorter and the total mean blood loss after delivery is substantially less than when cords are clamped early. This might be because when cords are not clamped, the placenta is allowed to give up its volume of blood.  It thereby contracts and separates more easily from the uterine wall."

Newborns whose umbilical cords are clamped one minute after pulsation stops have much higher hematocrit levels than infants whose cords are clamped immediately after delivery. Dr. Rafaela Perez-Escamilla reported that 88% of infants with immediately clamped cords had hematocrit levels below 33 at the age of two months. In comparison, only 42% of infants whose cords were clamped after the one-minute delay exhibited iron deficiency anemia at two months of age.

There is much evidence to support delayed clamping, so why are physicians continuing a practice to the detriment of the newborns health?

• Belief that the oxygen deficit is what causes the baby to start breathing. In truth, nature designed a system for insuring a smooth transition from womb life to breathing.  The blood passing between the baby and the placenta carries oxygen to the newborn (possibly even after the placenta has detached and delivered!)  This system is especially useful to the distressed newborn.
• Belief that delayed clamping will cause placental over-transfusion. Read Kinmond's study above.
• Delayed clamping results in higher incidence of jaundice. Many midwives who delay clamping have found this is simply not true, and in fact see a dramatically lower incidence of jaundice when cord clamping is delayed. Medical people think that this goes against the physiology of jaundice.... but other experts believe that delayed clamping is precisely why the incidence is lower.
• Convenience. Whisking a baby away to be cleaned, weighed and 'checked' following most hospital practices is easier done when the baby is no longer attached to the mother.  A baby can be put on the mother's belly immediately following the birth or wrapped in a blanket and held by the mother providing the cord is long enough, until the placenta is delivered and the cord stops pulsating. The reality of this happening in a hospital birth is questionable.
• If a baby is having complications, a doctor can work on the baby easier by cutting the cord and resuscitating the child.  It is precisely in the most dire emergencies that cutting the cord is the worst of all possible things you can do.

What you can do:

If you are planning a hospital birth, discuss with your physician your wish of delayed clamping. Most medical practitioners are not educated about the function of the umbilical cord after birth, and you may end up having to do some education in order to see that your baby gets the best care. Regardless of their rules, you have absolute legal right to say what does and does not happen to your baby. Remind them shortly before the baby is born that you want the cord left intact and that you want the baby resuscitated with the cord intact if necessary (Hospital providers show a disturbing lack of imagination on this point) and then again right as the baby's born. You might even remind them to cover the umbilical scissors with a sterile cloth just to prevent any reflex reactions on their part.  Give your care providers an opportunity to use their brains to solve this puzzle!  An added complication is that most hospital protocols follow outdated research regarding the need to "visualize the vocal cords" of babies born with meconium.  The most recent research shows that doing this to vigorous babies causes more problems than it solves.  This is the most likely reason they'll give for "needing" to cut the cord.  You need to make your wishes clear and if your doctor is unwillingly to assist your needs, you may want to re-evaluate your choice of a physician.  This issue is easier to handle when having a home birth, but be sure to make your wishes clear to your midwife. Do not assume that the cord will not be immediately clamped. And of course if you are having an unassisted birth, you need only do what you choose!

Donna Young, an advocate for delayed cord cutting, is taking matters further and believes  the only way to stop this practice is to take civil action. Donna is trying to stop the practice of cord cutting, immediately, in her own town.  She is active in letter writing and searching for the truth of current practices and outcomes. You can contact Donna via e-mail at dyoung@pris.bc.ca

[All of the information in this article was obtained from the Midwife Archives http: and the Birthlove
web site: http:

[Originally printed in Nursing Family Magazine, March, 2001]