Question of the Quarter

Question:

What are my options with regard to the timing of cutting the umbilical cord?

Answer:

There are four main approaches to cord cutting.

  1. Immediate cord clamping (now sometimes called ‘premature’ cord clamping): This entails clamping and cutting the cord immediately after the baby is born, before the cord has stopped pulsing. This practice became popular in the 1940’s and has remained standard amongst many physicians, sometimes out of concern that delaying cord clamping might increase the risk of newborn jaundice, and sometimes simply out of habit. This approach is now falling out of favour amongst many practitioners, since it has been discovered that it puts babies at increased risk for anaemia, and prevents the absorption of approximately one third of baby’s total blood volume. One remaining reason for early cord clamping is to extract stem cells for storage in a stem cell bank. If you wish to extract and save your baby’s cord blood for future use, you can choose either a private cord-blood bank or a public one. Either way it has to be arranged prior to the birth.
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  3. Delayed cord cutting (now sometimes called ‘physiological’ cord cutting): Another option is to give the cord the chance to stop pulsating before it is cut. This allows all the nutrients, blood and oxygen time to complete their transfer from the placenta to the baby. Some researchers argue that this gives the baby the opportunity to gently transition from cord to lung breathing rather than being shocked by the sudden deprivation of oxygen caused by immediate cord cutting. Another argument is that babies do better if they receive all the stem cells right at birth, rather than cold-storing them for potential need later in life. Once the cord has stopped pulsating, the transfer of blood and oxygen to the baby is complete. This takes about 5 minutes.
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  5. Waiting for the placenta to be delivered: Yet another choice is to delay cutting the cord until after the placenta is born. This is what most other mammals do and likely what humans did once upon a time. Some people believe that cutting the cord any time prior to the birth of the placenta interferes in a natural process, while others believe that there is no reason to wait longer than when the cord stops pulsating. Waiting for the placenta to be born can take between 15 minutes and 2 hours.
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  7. Lotus birth: The final option at the far end of the spectrum of choices is to leave the cord intact until it falls off by itself. This is called a ‘Lotus Birth’ and it is by no means a common choice. It involves carrying the placenta around alongside the baby until the cord has sufficiently dried up that it literally falls away from the baby’s navel with no interference. This takes a week or more, and involves salting and wrapping the placenta, as well as carrying it everywhere mum & baby go.

 

As you can see, there is reason to think carefully about your choices and discuss these issues with your caregiver before the birth of your baby. No matter what you choose, we encourage you to research your options and, in consultation with your caregiver, arrive at the decision that is best for you and your baby.

 

The World Health Organization’s position is that, “late clamping (or not clamping at all) is the physiological way of treating the cord, and early clamping is an intervention that needs justification” (Care in Normal Birth: A Practical Guide).

 

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