I remember my first hospital birth as a student midwife. My mentor guided me through and gave me strict instructions to follow. As soon as the baby was born she passed me a pair of scissors and a clamp and said, “clamp and cut it”. I got hold of the fat, pulsating cord and struggled to quickly put the clamp on stopping the blood flow from mum to baby and cut the cord. The baby was healthy, and the parents were overwhelmed with emotion but I couldn’t help feeling a bit guilty about stopping that blood flow. As time went on I found myself hesitating to clamp and cut cords so quickly at birth but because I was a student and my thoughts didn’t come from experience or research I thought I should just ignore my instincts and listen to my mentors.
“The topic of cord clamping affects every mother and every baby regardless of age, ethnicity or income”
Iron deficiency is the most common micronutrient deficiency in the world. It affects around 1.62 billion people and children under 4 are particularly susceptible. Iron deficiency can affect brain development in children by causing structural changes and function of the central nervous system (the spinal cord and brain) so there is a link between iron deficiency anaemia and poor cognitive development. We carry oxygen via red blood cells, so the body will prioritise the available iron to the red blood cells over other organs. In other words a baby needs blood to grow and develop properly.
Studies from infancy through to early adulthood suggest that socioemotional development is specifically vulnerable to iron deficiency anaemia and the effects of early iron deficiencies may be irreversible. So what can you do to help prevent your baby from becoming anaemic? Simply delay cord clamping at birth. All births should have delayed cord clamping of a very minimum of 1 minute, ideally longer. If you are planning on having cord blood banking, delaying cord clamping should not affect this or interrupt this.
Successful newborn transition is dependent on having enough blood volume for respiratory function and independence. In other words, your baby has been entirely reliant on the placenta for oxygen, nutrients and eliminating waste. Birth can be uncomfortable and daunting for babies. They now need do everything for themselves, regulate their own temperature, breathe and oxygenate their organs. When their last remaining connection to their mum is hurried to be cut it seems to be a bit of a harsh welcome to the world alongside the other long term problems that come with childhood anaemia already covered. I now have a body of research to back up my gut instincts back when I was a student.
RCM recommendations state a minimum delay of 1 minute but for the baby to receive the full adequate transfusion 3-5 minutes is preferable. This process should not be hurried. In mammalian birth there is always a rest period when the cord is left alone and it’s only in recent times that interference has crept in with human birth. Even if you have an emergency section, unless the baby needs cardiac compressions or there is concern over the cords integrity, clamping and cutting the cord should be challenged because the placenta is a resuscitative organ.