Delayed Cord Clamping

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Delayed Cord Clamping

Delayed Cord Clamping

You know those yucky brown iron-vitamin drops that pediatricians recommend for breast fed babies?  The stuff that stains everything it touches and makes your baby’s poop turn green?  I must confess that I’ve never been good at giving infant iron drops regularly, which is probably why all four of my children have had borderline anemia as infants.  Finally, we’ve found a better way to prevent neonatal anemia—delayed umbilical cord clamping.

Usually the umbilical cord is clamped within one minute of a baby’s birth, but it seems that waiting just 1-3 minutes after birth to clamp the cord allows the placenta to give a few more pulses of blood to the baby.  This extra blood from the placenta can be as much as 30-40% of the baby’s total blood volume.  And all that extra blood can prevent anemia in the first six months of life.  Waiting these extra few minutes before clamping the cord is referred to as “delayed cord clamping.”

This conclusion is supported by a new meta-analysis of years of research published in the July 11th issue of the Cochrane Database of Systematic Reviews.  This analysis included almost 4000 women and their babies.

It has long been thought that delaying cord clamping would increase a mother’s risk of post-partum blood loss or hemorrhage, but this study found no increase risk of hemorrhage from delayed cord clamping after vaginal birth.  There is still limited data regarding delayed cord clamping and risk of maternal blood loss after cesarean section.

But delaying cord clamping did make a difference to the health of the babies. Between one and two days after birth, their haemoglobin levels were higher; between three and six months after birth, they were less likely to be deficient in iron.

The research continues to show that delayed cord clamping can slightly increase an infant’s risk of jaundice, by about 2%.  This may increase a baby’s need for a repeat blood test for jaundice.  But even severe cases of jaundice are easily treated with a few days of phototherapy, especially in areas of the world with good access to medical care.  Jaundice is rarely dangerous when appropriately screened for and treated.  Anemia, on the other hand, is associated with poor cognitive development in infants and children, among a host of other problems.  Treatment and prevention of anemia is primarily with iron supplementation—those infamous brown drops.

Let’s be realistic about iron supplementation—how many breastfeeding parents really give the brown infant drops (often sold under the brand name poly-vi-sol)?  I’ve even had parents tell me they stopped breastfeeding just so that they wouldn’t have to give the poly-vi-sol anymore.  One of my own babies always spit them up within ten minutes, spewing greenish-brown partially digested breast milk all over our house and our clothes.  We had to rip up the carpets in our old house before we sold it because there were so many poly-vi-sol stains.  My husband flat-out refused to give it anymore.  I went to a pediatric lecture about the dangers of infant anemia and, feeling very guilty about my non-compliance with poly-vi-sol, asked all the pediatrician-parents I know how they got their babies to take the stuff and keep it down.  Most admitted that they stopped giving it after a few months…

All newborns need vitamin D supplementation, and breastfed infants do still need those iron drops starting at age 4 months if they have not yet started solid foods.  The AAP recommends starting your baby on solid foods including iron-fortified cereal at age 4-6 months, and once they do you don’t need to give the iron drops anymore unless your baby has anemia.

Now that we know the benefits of delayed cord clamping, hopefully my time with infant iron drops will be very limited.  And when my 5th baby is born in about 9 weeks, you can bet delayed cord clamping will be part of my birth plan.

Copyright 2013 Kathleen Berchelmann, M.D. 

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About Author

Kathleen M. Berchelmann, M.D., is a pediatrician at St. Louis Children’s Hospital and Assistant Professor of Pediatrics at Washington University School of Medicine. Kathleen is the director of ChildrensMD, a blog written by five dynamic mom-pediatricians who share their true confessions of trying to apply science and medicine to motherhood. Kathleen and her husband are raising five children. Connect with her at KathleenBerchelmannMD.com.

5 Comments

  1. Except in cases when anemia is not iron related, such as with hereditary spherocytosis, which may be more prevalent then we think and under diagnosed since the majority of cases are mild and aren’t recognized. If you are of Northern European decent you have a higher risk of having this autosomal dominant disorder. If you’ve been anemic your whole life listen up: I was force fed iron throughout my entire childhood and it was all in vain. All I had to show from iron supplementation was chest pain, constipation, and hemorrhoids, which were all totally unnecessary. If my doctors had paid attention to my RBC differentials, or ever ran an osmotic fragility test, and not ignored my enlarged spleen they might have been able to diagnose it a lot sooner. Instead it took my getting a degree in nursing, the birth of my son (typical immediate cord clamping) who was jaundice within hours (thanks to the aggressive Pitocin induction), before I was able to start piecing it together. However, it still took another 7 years before I was able to get them to order the right test to confirm that my son and I had hereditary spherocytosis and were NOT iron deficient. In fact giving us iron could cause irreversible damage, so I’d never allow supplementation with iron without first insisting upon a ferritin level to confirm that you are actually iron deficient. Case in point, when my 4th child had a low hemoglobin at 10 months the Pediatrician began to suggest iron and I suggested we first check the iron level (because we had done delayed cord clamping when she was born) and he agreed to run the osmotic fragility test at the same time. Her iron levels were well within normal and she did not need iron. Instead we supplement with folate to help her cope with the rapid blood cell generation that occurs with our kind of anemia.
    There’s many different reasons for anemia, and while it’s certainly true that most may be due to iron deficiency, don’t take iron long term unless you’re sure that’s the problem.
    And one more thing, if your looking for a better supplement for Vit D and you can’t take your baby outside for ten minutes a day, try Carlson Super D3 for babies. Administering this is so much easier and cleaner than that icky stuff.

    • In your experience, if there’s a chance that your baby will have Spherocytosis, is delayed cord clamping recommended?

      • I myself have h. Spherocytosis, and have done delayed clamping with 5 of my children (2 having confirmed spherocytosis), with no ill effects. My first born did not benefit from delayed cord clamping as he was born in a hospital, and subsequently required five days of bili-light therapy, ( which may or may not have been aggravated by his aggressive pitocin induction birth). Stress can increase our chances of going into hemolytic crisis. So going for a low stress birth is most optimal, IMHO.

  2. We did delayed cord clamping with both of our boys- at Hannibal Regional Hospital, it is policy to wait before clamping. I wish it would be policy at every hospital. Good luck and many blessings on your upcoming precious bundle!

  3. Pingback: Cord Blood Banking vs. Donation—What to do with Those Stem Cells | CatholicMom.com

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