US updates guidelines on delayed cord clamping to benefit more babies

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The American College of Obstetricians and Gynecologists (ACOG) has just released new guidelines regarding cord clamping after birth.

These new recommendations advise delaying umbilical cord clamping for all healthy infants for at least 30-60 seconds after birth.

Instead of clamping a baby's umbilical cord straight after birth, it means delaying the process to allow the blood that's still pulsating in the cord to transfuse into your baby, as midwife Amanda Bude, from Groovy Babies, describes.

Amanda says delaying clamping can increase your baby's blood volume by approximately 30 per cent. This can then lead to a reduced need for blood transfusion after birth, providing your baby with "four to six months of iron [reserves]".

Obstetrician, gynaecologist and fertility specialist Dr Joseph Sgroi, fellow of the Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG), agrees.

He says there are many health benefits associated with delayed cord clamping - and these benefits can vary in babies born prematurely, and those born at term.

In preterm babies, benefits include a decreased risk of necrotising entercolitis (an intestinal problem) and intraventricular haemorrhage (bleeding in the brain).

In full-term infants, he says the improvements mainly lie in the increased iron reserves and haemoglobin levels. That's important because low iron levels in children may impair neurodevelopment. He says adequate levels of iron therefore impact "cognitive, motor and behavioural development".

While the benefits of delayed cord clamping seem clear, our current  Australian guidelines don't reflect this.

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The guidelines were developed by the Women's Health Committee and approved by the RANZCOG Board and Council in 2010, and were most recently updated in 2014.

These current guidelines note there are benefits to delayed cord clamping for both preterm and term infants, but say: "At present, there is no clear evidence to guide practitioners regarding delayed cord clamping in term infants".

Despite this, Dr Sgroi says the practice is widespread in Australia.

"Most - if not all - obstetricians and midwives delay cord clamping in babies born in a healthy condition."

While our guidelines currently lag behind current practices, this may soon change.

That is, if we follow in America's footsteps and update our guidelines as they just did.

While Amanda applauds the American update, she thinks the timing recommended requires further consideration.

Instead of waiting "at least 30 to 60 seconds" to clamp (as per their guidelines), she likes to delay clamping by "at least two to five minutes".

"Or until the cord has completely stopped pulsating ... and looks like pale calamari," she adds.

Dr Sgroi also prefers to wait for the cord to stop pulsing before he clamps it, saying, "This is always after one minute [after] birth and hence over 75 per cent of placental blood is given as a transfusion to baby."

While the process of delayed cord clamping sounds clearly beneficial, there are some potential drawbacks.

Dr Sgroi explains that the increase in blood in term infants can lead to jaundice, due to the breakdown product of red blood cells, bilirubin.

If this happens, he says babies sometimes require time under special lights to help clear the jaundice.

There are also times when delayed cord clamping isn't recommended, because of health concerns regarding either the mother or baby. For instance, if the mother is bleeding heavily, or if the baby requires immediate resuscitation, the cord may need to be clamped early.

But in most cases, delayed cord clamping is commonly practiced here. And with good reason, says Dr Sgroi, who emphasises that the practice "seems to provide benefits to baby without any major risk".

Dr Sgroi says the Australian guidelines are due to be reviewed again in July 2017.

At that time, Amanda hopes new guidelines will make clear recommendations about waiting before clamping the cord.

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