OB-GYN Group Issues Major New Cord Clamping Recommendation

By | March 22, 2016

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More and more research has said there are benefits to keeping the umbilical cord attached for several minutes after childbirth ― a practice known as “delayed cord clamping.” But the American College of Obstetricians and Gynecologists has held off from endorsing the practice, saying there was insufficient evidence to support it universally.

This week ACOG issued new guidelines changing its stance. In the first policy opinion on the topic issued since 2012, the group now recommends that doctors and midwives hold off on clamping all healthy newborns’ cords for at least 30 to 60 seconds.

“While there are various recommendations regarding optimal timing for delayed umbilical cord clamping, there has been increased evidence that shows that the practice in and of itself has clear health benefits for both [all] infants,” Dr. Maria Mascola, lead author of the new ACOG opinion, wrote in a press release. “And, in most cases, this does not interfere with early care, including drying and stimulating for the first breath and immediate skin-to-skin contact.”

The change may not seem significant ― it is, after all, a delay of only a few seconds or minutes ― but the timing of cord clamping has been a major source of debate within the childbirth community. 

For decades, doctors cut the umbilical cord (or encouraged enthusiastic partners to do so) immediately after birth, thinking it reduced the risk of maternal hemorrhage. But research has not supported the idea that delaying cord clamping put moms at risk in any way.

Instead, studies have found numerous benefits to waiting for a minute or two, particularly for vulnerable pre-term babies. It can cut their risk of brain hemorrhage in half, allowing blood to flow from the placenta to the baby. For full-term babies, delayed cord clamping has been linked to longterm neuro-developmental benefits and improved iron levels

“Blood carries more than just red blood cells; it also includes important nutrients, iron, antibodies, and clot-making factors,” Dr. Heather Smith, an attending physician and OB-GYN with the Montefiore Health System, told HuffPost.  

When extenuating medical circumstances make it impossible to delay cord clamping, it is possible to try “umbilical cord milking,” Smith said, which involves squeezing the cord to push the blood in it back up to the baby. However, in the new statement ACOG said there was not enough evidence to support or refute any potential benefits of cord milking this time. 

Ultimately, the new statement is more a reflection of ACOG catching up with the times rather than fundamentally changing best practices. The World Health Organization already recommends it and many hospitals and midwifery practices across the country already practice routine delayed cord clamping. However, ACOG holds a lot of sway over obstetric practices in this country, with nearly 60,000 members.

“The biggest differences that a mom might notice right after vaginal delivery is that we won’t immediately ask the support person to cut the cord,” Smith said. “The baby will be placed on her chest with the cord still attached from the baby to the placenta that’s still inside the uterus.”

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