Standard of Care Series Part Seven
Early Cord Clamping
For many years now, standard care has been to clamp the umbilical cord immediately following the birth of the baby. This practice is also known as early cord clamping, where the cord is clamped within 30-60 seconds after the birth of the baby. What some parents may not realize is that there is a difference between clamping and cutting the umbilical cord. We now know that when we immediately clamp the umbilical cord after birth, 30% of the baby’s blood is still in the placenta. “In contrast, if you leave the cord unclamped for a longer period of time, the baby will get 80% of their blood within 60 seconds, and 87% within 3 to 5 minutes” (Dekker, 2019, p 31).
The benefits of delayed cord clamping include increased blood volume, providing baby with blood rich in stem cells and iron (which is used to make hemoglobin), and helping the flow of blood to important organs like the lungs. Essentially, delayed cord clamping helps baby to transition to life outside the womb. The practice of delayed cord clamping has been found to be so beneficial, in fact, that some researchers feel there are ethical considerations before conducting any more randomized trials on this matter. Additionally, delayed cord clamping has not been found to be associated with an increased risk of maternal postpartum hemorrhage. Skin-to-skin care can still take place immediately after the birth with delayed cord clamping.
If you would like delayed cord clamping for your baby, having a conversation with your provider prenatally about delayed cord clamping is beneficial. Open communication allows everyone on the birth team to be on the same page. For some providers, delayed cord clamping means a minute or two, while some parents prefer to specify waiting to clamp the cord until the cord stops pulsing. The World Health Organization (WHO) recommends late cord clamping (performed 1-3 minutes after the birth) for all births (both vaginal and Cesarean and both term and preterm infants) while early umbilical cord clamping (less than 1 minute after birth) is not recommended for healthy newborns (both term and preterm infants) (2012).
You can find more information regarding WHO’s guidelines here.
Read more about delayed cord clamping here.
Separation from Baby
The Golden Hour is a term used to refer to the first hour immediately following the baby’s birth. It is a window of opportunity for bonding and establishing the breastfeeding relationship. Elevated levels of oxytocin following the birth, which are further elevated through skin-to-skin care, promote maternal/infant attachment, lower maternal and infant stress, and ease the newborn’s transition to life outside the womb. Immediate skin-to-skin is when the naked newborn is placed on the birthing person’s bare chest. A blanket may be placed over the baby and mother to keep the baby warm and dry, but having any clothing or blankets between the mother and the baby is not the same as skin-to-skin care. It is the actual skin contact between the baby and the mother that “allows hormones between the mom and baby to ‘communicate’ with each other” (Dekker, 2019, p 33).
The benefits of skin-to-skin care between a mother and her baby include maternal and infant lower stress levels, better success with breastfeeding, and more stable blood sugar, breathing, heart rate, body temperature, and oxygen levels for the baby. Separating babies from their mothers interferes with the breastfeeding relationship and causes distress and anxiety for both the mother and the newborn. This one to two hour window immediately following the birth is a very sensitive time for bonding between a mother and her baby. Immediate skin-to-skin care is a practice that can take place for healthy mothers and babies whether the birth was vaginal or Cesarean and regardless of feeding preferences. Studies have shown that mothers who were separated from their babies during this Golden Hour (or two) following the birth were less responsive towards their infants a year after the baby’s birth, while the babies were more irritable, impulsive and had a harder time self-regulating. In short, separating babies from their mothers during this critical time immediately following the birth is a harmful practice.
It is also important to note that skin-to-skin care can take place beyond the first hour or two after birth. The benefits of skin-to-skin care (or kangaroo care) mentioned above are still relevant during the fourth trimester. Additionally, skin-to-skin care between the baby and the partner of the birthing person can be practiced as well during this time.
Thankfully, more and more hospitals are adopting rooming-in policies where the baby is not separated from the mother throughout the hospital stay following the birth, and are encouraging skin-to-skin care during the Golden Hour.
More information about the short- and long-term health benefits of keeping mother and baby together can be found here.
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*Disclaimer: These posts are not intended to be construed as medical advice and are for educational purposes only. Each pregnancy and labor is unique. If you have questions or concerns, please consult your provider.