Monday August 20 2007
Wait a few minutes before clamping?
On 17th August, The Independent and The Daily Telegraph, reported that early cutting of the umbilical cord after birth could be harmful to newborns. The Daily Mail took a more positive stance with the news that a short delay in cutting the cord could actually “improve a newborn’s health”.
The stories are based on an editorial written by a senior lecturer in obstetrics from the University of Liverpool.
The Daily Telegraph quoted the author, Dr Andrew Weeks, as saying, “There is now considerable evidence that early cord clamping does not benefit mothers or babies and may even be harmful."
The Daily Mail reported the author as saying that despite current UK practice to cut the umbilical cord at one minute to counter the risk of jaundice, “Waiting until three minutes would increase the child's iron levels and reduce the risk of anaemia.”
On the back of this interesting editorial, a systematic review of existing evidence would provide more robust evidence on harms and benefits associated with clamping the umbilical cord in healthy women undergoing normal deliveries.
Where did the story come from?
The story comes from an editorial written by Dr Andrew Weeks, a senior lecturer in obstetrics from the School of Reproductive and Developmental Medicine at the University of Liverpool. The editorial was published in the peer-reviewed medical journal the British Medical Journal.
What kind of scientific study was this?
The story is not based on an individual study, but on an editorial where the author has presented his personal narrative review of the evidence around cord clamping. He points out that the World Health Organisation and the International Federation of Gynecology and Obstetrics have dropped the recommendation for early cord clamping from their guidelines.
A recent review of policy across Europe has shown wide variation in practice, with only 17% of units in Denmark but about 90% of obstetric units in France promoting a policy of early cord clamping. This practice clearly needs further consideration in the UK.
What were the results of the study?
In his editorial, the author highlights various studies that support the claim that early clamping does not necessarily benefit the newborn. Early clamping also appears to have no benefit for the mother and trials have shown that it has no effect on the risk of postpartum haemorrhage or retained placenta.
He also cites research which shows that at the time of the first breath, blood is drawn into the lungs from the umbilical vein which can have benefits for iron status and haemoglobin levels in the newborn baby, and the author states that this has impact on the risk of anaemia.
What interpretations did the researchers draw from these results?
The author, Dr Andrew Weeks, concludes that based on the “considerable evidence that early cord clamping does not benefit mothers or babies and may even be harmful”, professionals should consider “incorporating delayed cord clamping into delivery routines.”
What does the NHS Knowledge Service make of this study?
This editorial raises some interesting points which will have an implication for current practice in the UK.
- The editorial is a narrative review of the evidence for and against early cord clamping. We have not appraised the research behind Dr Weeks’ opinions.
- The studies discussed certainly seem to support a review of practice in the policy of obstetric units towards cord clamping. One such study, a Cochrane review on early versus delayed clamping in pre-term infants, concludes that “delaying cord clamping [in pre-term infants] by 30 to 120 seconds, rather than early clamping, is associated with less need for transfusion and less intraventricular haemorrhage.”
- A systematic review of the evidence concerning this practice in near-term and full-term babies would enhance our understanding of the situation. Formal guidelines on best practice around cutting the cord could then be developed by professional bodies for implementation in routine postnatal care. These policies will also need to consider the optimal timing of cord clamping for growth-restricted babies, or those delivered by caesarean section, or in need of urgent resuscitation.
