Apr 6, 2017

Interview Transcript

Dr. Jones: When should you cut the cord? I'm not talking about making your adolescents independent, but that's a good topic. But when should you cut the umbilical cord after the birth of a baby? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health, and this is The Seven Domains of Women's Health on The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: When a baby is just born it is attached by the umbilical to the placenta which is still attached to the mother's uterus. Of course after the birth of a baby we want to get the baby dried off, and warm, and in the arms of the mom, skin to skin if possible. But when do you cut the cord? This has actually been of some debate over the years, cut immediately, cut in a minute, cut in five minutes, why does it matter? And what's best for the baby?

First of all, the placenta is two pools of blood in it, pumped by two hearts. The reason of placenta is there for all of us mammals is to provide oxygen and nutrients from the mom to the baby. The mom pumps her blood through her side of the placenta and the baby's hearts pumps blood through its side of the placenta. The blood isn't directly mixed but goodies are exchanged.

Immediately after the baby is born, before its starts to take its first breath and really get his lungs going, the blood is still pumping on the baby's side of the placenta. Eventually, some of the blood on the baby's side comes back to the baby about 80 to 100 cc or three ounces. Then the umbilical cord stops pulsing and clamps down. This happens to babies born all over the world without a birth attendant, without a clamp and some scissors, and it happens in other mammals, in dogs and cats.

That extra blood that goes back to the baby does makes the baby's blood a little thicker, a little higher count than is found in babies a month later, but that blood also serves as extra iron stores for the baby to make its red blood cells while it's nursing, as breast milk is low in iron. So most OBs were trained to deliver the baby and clamp and cut the cord right away. This was as much habit as anything, but there was some data that babies that had delayed cord cutting might be at higher risks of bilirubin problems -- having a little jaundice after birth as a result of the extra blood.

So until a couple years ago, it was habit to clamp and cut the cord right away. However, moms and midwives we're fighting back from what they saw as a more natural approach to cutting the cord, wait a minute or two, or three, or at least until the cord stops pulsing. So there were some randomized trials, healthy term babies were randomized to having the cord cut right away versus waiting a minute or so. And although there was a slight increase in the rate of jaundice in the baby's with later clamping, the babies had less anemia several months later.

They also did the same study with babies that were somewhat premature and these babies did better also. The preemie babies who were stable enough to delay cord clamping a little while had less needs for transfusion in the intensive care unit and a lower risk of some of the serious problems of prematurity.

For term babies the concern is iron deficiency anemia which isn't common but can happen in more than 5% of term newborns. Iron deficiency and anemia in young babies may also be associated with some developmental and cognitive problems later. It's important to know that the vast majority of babies with early cord clamping did not get anemic but there was slightly less of chance of anemia in babies with later cord clamping.

Many babies in the U.S. get vitamins and minerals, but this certainly isn't true of all babies in the U.S. and definitely isn't true for babies around the world. So, in January of 2017, the American College of Obstetrics and Gynecology along with the American Academy of Pediatrics and the American College of Nurse Midwives put out a practice bulletin that recommends waiting 30 seconds to a minute before clamping the cord after the birth of the baby. Incidentally the British Royal College of OB/GYN recommends at least two minutes and the American College of Nurse Midwives recommends two to five.

Originally it will thought that the baby had to held below the mom's abdomen to let the blood rundown to the baby, but a study -- all that science -- comparing having the baby held below the uterus made no difference compared to a baby place on mom's tummy or chest to be dried and warm. In healthy babies, the extra couple of minutes don't make a difference one way or the other, but OB's are often delivering babies in trouble. Very premature babies or babies with low heart rates or distress, for those babies no more than 30 seconds, which can feel like an eternity for an OB delivering a baby in trouble, would be advised. And in some cases is very important to hand the baby off to a pediatrician for immediate care.

Some conditions affecting the mom would be if the mom has hemorrhaging and the placenta needs to be removed immediately or if the placenta has prematurely separated during delivery. Sometimes the cord is wrapped very tightly around the baby's neck and needs to be cut to allow the baby to be delivered. These are not so common in general, it's a reasonable thing the wait a little bit if the baby and the mom are not in danger.

Another reason to consider immediate cord clamping is the case where the parents have planned umbilical cord banking either for this child or to help another child. Delayed cord clamping means more blood goes to the newborn and less is available for collecting for the cord blood bank. If the cord blood banking is a critical issue for this baby or another child, then the cord might best be clamped immediately.

Now in the case of adolescents, I don't know when the time is right to cut the cord. But I think we now have some really good evidence and guidance for delaying cord clamping newborns. And this is what we have been doing at the University Hospital for some time now. Good luck with your newborn and with your adolescents and thank you for joining us on The Scope.

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