Most expecting parents anticipate having to decide who – whether it's a birthing partner or health-care professional – will cut the umbilical cord when their babies are born. But few consider the question of when to cut it.
The decision of how long to wait before clamping and severing the umbilical cord can have serious consequences for a newborn's health, according to Dr. David Hutchon, the past president of the North of England Obstetrical and Gynaecological Society. And in many cases, he says, physicians and midwives are doing it too soon, depriving babies of blood.
Doctors traditionally clamp the cord immediately, in the belief it can reduce the risk of neonatal jaundice and protect infants from drugs administered to the mother.
But Hutchon joins a growing chorus of experts who are promoting delayed clamping. Some health organizations, such as the International Liaison Committee on Resuscitation, recommend that clamping be delayed for at least one minute for healthy babies, and the World Health Organization also recognizes there is growing evidence to support delayed clamping. Meanwhile, a small fringe advocates not cutting the cord at all, allowing newborns to remain attached to the placenta for days, until the cord detaches on its own.
As media organizations such as the New York Post and the Daily Mail have recently reported, these so-called "lotus births" have become a trend in the United States. Parents who opt for lotus births typically keep the intact placenta wrapped in cloth until the cord breaks.
Hutchon, who does not have a strong view on lotus births, says the decision of when to clamp and sever the cord should depend not on a specified amount of time, but on when the baby has established his or her own breathing and no longer relies on the placenta. This can be determined when the umbilical cord is no longer turgid with blood and has ceased pulsating, which generally occurs three to five minutes after birth.
"If at birth, the cord is clamped quickly, a lot of blood can be trapped in the placenta," Hutchon says, noting that babies can lose significant blood volume, which could eventually lead to anemia, iron deficiency, and potentially, in rare cases, cerebral palsy.
A Swedish study published in 2011 found that four months after delivery, iron levels were 45 per cent higher in infants whose umbilical cords were clamped at least three minutes after they were born, compared with babies whose cords were clamped within 10 seconds.
Delayed cord-clamping is especially important when newborns are unable to breathe on their own and require resuscitation, since continued blood circulation through the placenta will ensure they get at least some oxygenated blood, as well as adequate blood volume and extra stem cells, which may be help repair any tissue damage, Hutchon says.
Nevertheless, clamping less than a minute after birth remains common practice, says Hutchon, explaining that it may be a holdover from the 1950s, when doctors sought to protect infants from drugs given to mothers to prevent postpartum hemorrhage.
But the need to immediately administer such drugs to the mother is "complete nonsense," Hutchon says. He says the drugs can be administered after the umbilical cord has quit pulsing and has been clamped and severed.
Carl Backes, a neonatal physician with the Nationwide Children's Hospital in Columbus, Ohio, adds that early clamping may also relate to anecdotal evidence that delayed clamping could increase the risk of jaundice in babies. He says, however, there is an "abundance of evidence" to support delayed clamping.
At the Society of Obstetricians and Gynaecologists of Canada (SOGC), chief executive Dr. Jennifer Blake says there are considerations for both early clamping and delayed clamping. She suggests parents should discuss with their obstetricians, doctors or midwives about the relative pros and cons and what is most appropriate option for them.
The SOGC's guidelines notes that for babies born at full term, the potential risk of neonatal jaundice "must be weighed against the physiological benefit of greater hemoglobin and iron levels up to six months of age conferred by delayed clamping."
Blake adds that parents who want to bank their babies' cord blood need to have their cords clamped early. Cord blood-banking stores the stem cell-rich blood taken from the umbilical cord for the possible future treatment of a variety of ailments, such as blood disorders and metabolic disorders.
While lotus births may be gaining more attention, Vancouver home birth attendant and midwifery educator Gloria Lemay has yet to see evidence that it is a growing trend in Canada. In the past 33 years, Lemay says she has only attended about 20 lotus births out of more than 1,000. "It takes very patient people to do it," she says, saying that while lotus births are safe, handling the baby and its attached placenta can be cumbersome.
"It's a small number of people who are interested in it, but they're devoted to it," says Lemay, who typically waits two hours after a home birth – allowing time to prepare food for the mother and letting the parents relax – before she inquires whether they want to cut the cord. "There's no rush."
Dr. Eileen Hutton, director of the midwifery education program at McMaster University, says she is not aware of any particular health benefits to leaving the umbilical cord intact longer than three to five minutes. At the same time, she says she is not aware of any health concerns about lotus births. "I don't think the practice is well studied, and thus we could only speculate on any risks," she said.
The London-based Royal College of Obstetricians and Gynaecologists issued a statement in 2008 that noted a lack of research regarding safety.
"No research exists on lotus births and there is currently no medical evidence that it is of benefit to the baby," it said, warning that infants should be monitored carefully for possible signs of infection that may be spread from the placenta.