Monday, August 26, 2013

Cord clamping: to delay or not to delay?

It seems the questions facing pregnant women on what they should eat, how they should behave and what should happen in the delivery room never end.

One day caffeine is the root of all evil in pregnancy and the next who knows if it has an effect. Some doctors say to avoid sushi others say use your judgment. And don’t even get me started on the whole where to have your baby and with what pain management options debates.

So I have to admit I groaned, loudly, when I saw headlines that weighed in on when the cord should be clamped in the delivery room? My third trimester brain is too flooded with details I don’t really want to be considering about delivery and now I need to ask my doc when she plans to cut the cord? Really?
Apparently it’s not as new a discussion as the recent headlines would have you believe.

Early versus delayed umbilical cord clamping has been a source of controversy and debate in the OBGYN field for many years, said Dr. Sheri Puffer, an OB/GYN on the medical staff at Texas Health Arlington Memorial Hospital. A quick primer on umbilical cords: at the time of birth, the infant is attached to the mother via the umbilical cord which is part of the placenta. Separation of mom and baby happens when the cord is clamped and cut. Dr. Puffer – who’s also pregnant with her first child – said there are no guidelines currently stating if early (less than 60 seconds after birth) or delayed (greater than 1 min after birth) cord clamping is superior. The timing is up to your provider and their clinical practice.

And that brings us to the recent headlines describing the effects of timing of umbilical cord clamping in term (>37 weeks) infants. The conclusions from this review of the available data showed that there was an increase in hemoglobin concentration and iron stores up to six months of age when there is a delay in clamping the cord. The only disadvantage found was that there was an increase in infant jaundice requiring phototherapy. This study found no difference in early or delayed cord clamping to maternal bleeding at birth. This is an important finding as maternal bleeding during or after childbirth is the leading cause of maternal mortality worldwide, Dr. Puffer said.

Now when it comes to preterm infants the benefits are even more clear, when the baby is not born in any type of respiratory distress requiring immediate treatments. The American College of Obstetricians and Gynecologists published a recent committee opinion in December 2012 regarding this topic as well. Studies have shown that the neonate receives an increase in blood volume, reduced need for blood transfusions and a 50% decreased incidence of intracranial hemorrhage.

Dr. Sheri Puffer, OB/GYN
“I try to delay clamping when there is little to no risk to Mom or baby, taking each case individually,” Dr. Puffer said. “I am finding more of my patients are asking about this as an option and it is a conversation I’m happy to have in the months of office visits leading up to delivery. In fact, I plan to delay the clamping during the delivery of my own baby boy.”

As for me, I’ll probably add the question to the list I take to each OB appointment. After all, while I’ve put the details of my daughter’s delivery in the fully capable hands of my OB, it doesn’t hurt to ask.

Jennifer Erickson is a Sr. Communications Specialist with Texas Health Resources who is 33 weeks pregnant with a baby girl.

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