Why What Doctors Don't Know About Cord Clamps Puts Every Newborn at Risk

The cutting of a newborn baby's umbilical cord is a highly significant event and the job is considered a high honor in many families. There's a definite sense of pride in the words, "I cut the baby's cord." But far too many parents are unaware of the biological significance of severing the amazing umbilical cord, or, more importantly, the clamping of it.

Why is cord clamping significant? In the majority of medically managed births, the umbilical cord clamp is the intervention that suddenly separates a newly born infant from their source of blood, nutrients and oxygen. It has been proposed that this one seemingly routine and insignificant act could be the cause of damage to the brain, heart and/or lungs of the child before it even takes its first breath. Most Western doctors routinely clamp the umbilical cord before it stops pulsing, effectively amputating a live organ and performing instant surgery on the most fragile of human beings. At this point many people think, "So what? They're doctors, they know what they're doing." Unfortunately, according to the majority of the research and to the newly revised ACOG guidelines, they don't. What follows are several reasons why you might want to consider telling your doctor to delay clamping your newborn's umbilical cord and some of the research available to back you up when you do.

"The placental blood normally belongs to the infant, and his/her failure to get this blood is equivalent to submitting the newborn to a severe hemorrhage at birth." ₍₁₎

When a baby is born it needs to begin breathing oxygen into its lungs in order to survive. However, it would be foolish to imagine that a baby's first breath contains their body's first experience of life-giving oxygen. Oxygen is provided for the fetus throughout the entire pregnancy by the mother, through the placenta. Following birth the placenta continues to provide oxygen for approximately 5 minutes while blood pumps, back and forth, through the umbilical cord. This is part of Nature's ingenious plan that allows the newborn time to "unfold" their lungs and to gently switch from underwater living to dependence on breathing air. Remember, the infant is not receiving "placental" blood or even the mother's blood through the umbilical cord. The baby is retrieving its own blood supply from one of its own functioning organs that just happens to be inside its mother's body.

When the process is given time to function naturally, the placenta and umbilical cord will shut down, essentially dying, as the baby begins to breathe by itself. The blood vessels in the baby's cord close, the placenta separates from the uterine wall and is soon expelled, its function completed. With a simple cord tie and sterile cutting tools, the umbilical cord can be safely severed at this point. The baby is typically breathing well, turning pink and perhaps even nursing away contentedly in a reasonably calm mood. Of course, baby's first surgical procedure doesn't really need to be done immediately following birth or, even, at all. In times past when infections were more common and sterile tools were less common, our ancestors would frequently wrap the placenta in a diaper and swaddle it in with the baby until the cord dried out and the placenta fell off by itself, a few days after the birth.

But that's probably not what happened to your baby, if s/he was born at a typical Westernized hospital. Most OBs and even CNMs are trained to clamp the cord during or immediately following birth. If you suggest the idea of waiting until the cord has stopped pulsing you will probably be confronted with at least one of two prevailing medical attitudes:

#1 ~ It's far too dangerous for me to allow the cord to continue to pulse. You would be putting your baby at risk of: (one or more of the following) jaundice, plethora, hyperviscosity, or polycythemia.

and/or

#2 ~ What is all this touchy-feely stuff about the umbilical cord? Early clamping does no harm.

The research shows that neither of these extremely common responses are based in fact.

A study in 1993 "... found no increased jaundice, plethora, hyperviscosity, or polycythemia using this method. Yet fear of late clamping persists because physicians have been conditioned to believe that these complications are caused by placental over-transfusion. Cord stripping (allowing the baby to retrieve its own blood supply) has become tantamount to malpractice."₍₂₎

It makes perfect sense to me; nature's plan to ensure that humans survive their births would not, by and of itself, cause such dire consequences. I would need to see an extremely convincing study of several thousand births suggesting that such things were happening to otherwise healthy infants of healthy mothers before I would believe it.

Mothering Magazine has this to say about jaundice. "Among other drugs, Pitocin inductions and epidurals have been conclusively linked with nonphysiological neonatal jaundice (this is not normal, breastfed jaundice). Any drug administered to mother or baby must be viewed with a 'jaundiced' eye, for it is likely to compete with bilirubin sites on blood protein, causing more bilirubin to be free to contribute to jaundice.

"In an all-out effort to prevent the possibility of jaundice, obstetric practitioners have reasoned against delayed cord clamping, since it increases the volume of red blood cells , which, in breaking down, will produce increased levels of bilirubin. True, hyperbilirubinemia may be prevented in premature and "medicated" infants by early clamping; however, in a normal delivery of a full-term, unmedicated infant, there are untold advantages to delaying cord clamping until after the placenta has delivered itself." (emphasis mine)

When I published the first draft of this article, I received a comment from a woman who was told that her doctor needed to clamp the cord early because she was diabetic and her baby was at risk of developing polycythemia (a thick blood disease) if the cord was not clamped early enough. I did some research and came to the conclusion that this is merely an obstetric myth. There are babies who develop polycythemia and some of them are born to diabetic mothers. However, late cord clamping does not appear to be a deciding factor for transmission of this condition.

In fact, it seems that the practice of early cord clamping began during the days of heavily medicated births. Doctors deliberately stopped the blood flow to keep the newborns from retaining too much of the anesthesia their mothers were under. One would certainly hope that being able to dole out drugs to laboring women isn't more important to doctors than preventing the various problems related to early cord clamping in newborn babies. However, while the drugs used during births have advanced and become less problematic, the old practices remain. Most doctors today have no idea that the reasons they were taught to clamp the cord in med school were merely excuses used by the past generation of doctors to justify questionable practices, long since abandoned.

Regarding argument #2, that cord preservation is merely "touchy-feely, pseudo-science." Early cord clamping has been shown to cause: newborn anemia, respiratory distress leading to brain damage, inadequate blood supply resulting in a need for transfusion, possible heart defects resulting from problems closing off the hole in the heart valves following birth and/or death (rare, yes, but there is no question that it does happen). The mother may suffer an increase in the length of the 3rd stage as well as increasing her blood loss following birth when her baby's umbilical cord is clamped early. There are even a few doctors now theorizing that the rise in autism is due to brain damage caused by early cord clamping. More medical studies are needed with large control groups of babies whose cords are not clamped until all pulsations have ceased, but there is already ample evidence that early clamping is a violent, uncontrolled experiment that's failed and needs to be abandoned.

"Deprivation of placental blood results in a relatively large loss of iron to the infant." ₍₁₎

"The time of cord clamping may be involved in the pathogenesis of idiopathic respiratory distress syndrome (the earlier clamped, the more respiratory distress)."₍₃₎

"Placental blood acts as a source of nourishment that protects infants against the breakdown of body protein."₍₁₎

"Studies have shown that immediate cord clamping prolongs the average duration of the third stage and greatly increases maternal blood loss."₍₄₎

"In order to give the newborn the blood that it need(s), physiologically cord clamping should be performed not immediately after birth. One should wait ... until the umbilical vein has been empty and is collapsed."₍₅₎

"Normal blood volume is not produced by a cord clamp ... 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."₍₆₎

In fact, due to an overwhelming number of studies like the ones quoted above, the American College of Obstetricians and Gynecologists has officially abandoned the experiment. Unfortunately for babies, they did it in such a way that most practicing Obstetricians don't know about it.

On a back page of the February 2002 edition of Obstetrics & Gynecology (361), the ACOG quietly withdrew Educational Bulletin 216, the bulletin that instructs OBs to clamp the still pulsing cord in order to obtain samples of PH blood gases. In other words, the ACOG no longer sanctions the practice. However, due to fear, rational or not, of parents whose children have been injured by a cord clamp seeking compensation for those iatrogenic injuries there have been no announcements beyond this. So unless your doctor carefully reads and researches every last word printed in every issue of their O&G journal, they may have no idea that the ACOG will no longer stand behind them if they injure a baby with a cord clamp.

Of course, there are some cases where the newborn is severely compromised at birth. In most of these cases, the cord is instantly severed so the birth attendants can whisk the baby off to the warmer. These are the very babies who need their blood the most! The premature, the distressed and those babies born by Cesarean sections may suffer needless interventions due to the practice of early cord clamping. Make sure that your birth attendant is made aware that you do not authorize early cord clamping long before you give birth. It isn't time to argue the point once you are already in labor.

If your attendant does not indicate willingness to wait for the cord to stop pulsing, especially in an emergency, it may be time to consider firing them and having your baby in a safer environment. The first rule of medicine is supposed to be, "Do no harm." More and more doctors, midwives of every stripe, researchers and parents believe that routine early cord clamping violates that oath. If your birth attendant doesn't recognize this, it is your baby's best interests for you to find one who does. Delaying cord clamping is not nonsense, it is the safest and healthiest way to give birth.

Research Cited:

1) De Marsh, QB, et al "The Effect of Depriving the Infant of its Placental Blood", JOUR AMA ? 7 June 1941

2) Kinmond S et al. Umbilical Cord Clamping and Preterm Infants: a Randomized Trial. BMJ 1993; 306: 172-175

3) Saigat, Saroj, et al. "Placental Transfusion and Hyperbilirubinemia in the Premature" PEDS 49:3 - March 1972

4) Walsh, S. Zoe "Maternal Effects of Early and Late Clamping of the Umbilical Cord" LANCET - 11 May 1968

5) Z Geburtshilfe "Cord clamping at birth - considerations for choosing the right time" Perinatol 1982 Apr-May;186(2):59-64

6) Morley, George M., MB., CH. B "Cord Closure: Can Hasty Clamping Injure the Newborn?", OBG Management - July 1998