How Many Times Do We Have To Learn That We Should Delay Cord Cutting?!

Every time I read some new article about the benefit of delayed cord cutting at birth, I feel like I’m having déjà vu.  I’m kind of frustrated that even though researchers are consistently finding that delaying cord cutting is healthier for our babies, most hospitals in the United States STILL don’t delay cord cutting as standard procedure.

Here’s the latest article I found that reports on a new analysis. The actual analysis was published Wednesday and can be found in the Cochrane Library.  Authors of the review explained how they looked at 15 randomized trials. In these FIFTEEN trials, there was no real difference in postpartum hemorrhage rates when you compared early cord clamping and delayed cord clamping.  Authors went on to say, “There were, however, some potentially important advantages of delayed cord clamping in healthy term infants, such as higher birthweight, early haemoglobin concentration, and increased iron reserves up to six months after birth. These need to be balanced against a small additional risk of jaundice in newborns that requires phototherapy.”

Is Jaundice the Real Concern?

So, if we realize that there is no longer a need to worry about an increased risk of maternal hemorrhage, are we seriously going to then blame our cord cutting habits on jaundice? Are we to really weigh higher birth weight, hemoglobin concentration, and decreased chances of anemia against the risk of jaundice requiring phototherapy?

Why are we dragging our feet so much on this? The authors concluded, “Delayed cord clamping is likely to be beneficial as long as access to treatment for jaundice requiring phototherapy is available.”

So, where ever there is sunlight available, we should delay cord clamping.

Now, one may say, “Whoa, whoa, whoa…. The author didn’t say, ‘sunlight.’ The author said PHOTOTHERAPY.”

Sunlight vs Phototherapy Devices

Except that, sunlight can be almost 6.5 times more effective than a phototherapy unit depending on where on earth you live.  In fact, sunlight can still be more effective  than modern phototherapy during the winter. Researchers learned that well over a decade ago.   When my son (who’s cord was cut right away, for the record) got jaundice, his pediatrician told me to just put him in a sunny window for a little bit every couple of hours… Which worked perfectly.

Even when compared to the new developments in modern phototherapy, the sun still rocks our socks off: The University of Michigan, way up here in the less-sunny north, admits that the strength of light form the biliblanket is about the same as you would get in the shade on a sunny day. Of course, when using the sun, we do have to be careful of sunburns, but not so much in the shade. Also not as much when you consider that phototherapy is done on average for around 24 hours and if the sun is around 6 times more effective, you might possibly be looking at only around 4 hours of sunlight required. Plus, it’s not like phototherapy devices are without risks themselves.

That’s not really the point though. And that certainly wasn’t medical advice.

I’m trying to question why  typical US hospitals still have not adopted a delayed cord cutting policy. Realistically, wouldn’t those same speedy cord cutters also have access to a phototherapy machine or biliblanket?

So, what’s the hold up?


The Hold Up

The American College of Obstetricians and Gynecologists reviewed many of the same studies but found the results “insufficient to confirm or refute the potential for benefits from delayed umbilical cord clamping in term infants, especially in settings with rich resources.”

One reason that is given by many doctors to explain immediate cord cutting is that if a baby needs resuscitation they would need to have the cord cut, but if that’s the concern, why do they let fathers try to clumsily cut the umbilical cord?  No one is asking for it to be standard procedure to ignore an emergency to wait for the cord to stop pulsing. We are only asking for it under normal conditions. 

NY Times reported that Dr. Eileen Hutton, a midwife who teaches obstetrics at McMaster University in Ontario, mentioned that by not waiting a few minutes to cut the umbilical cord, we are depriving babies of 30-40 percent of their blood at birth.

Apparently though there are a couple of studies in progress that indicate a potential long-term neurological benefit of not cutting the cord immediately after birth. So, maybe those studies will someday finally invoke change in our delivery rooms. Until that day finally arrives though, women planning to deliver in a hospital will continue to have to specify their wishes to wait until the cord has stopped pulsing.

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