A mother’s impulse to immediately reach for her newborn to cradle him before the umbilical cord is clamped is natural. After childbirth, current guidelines suggest holding the newborn at the level of the placenta before clamping, or passing the baby to the mother, in order to boost iron levels. However, according to a recent study published in the journal The Lancet, holding the baby on the mother’s chest or abdomen can effectively reduce iron deficiency in infants when cord clamping is delayed for two minutes.

"Our study suggests that when umbilical cord clamping is delayed for two minutes, holding the baby on the mother's chest or abdomen is no worse than the currently recommended practice of holding the baby below this level," said Nestor Vain, lead author of the study from the Foundation for Maternal and Child Health in Buenos Aires, according to Medical Xpress. Typically, the infant is supposed to be held for more than a minute at the level of the vagina, based on the assumption that gravity affects the volume of placental transfusion. However, Vain and his colleagues believe the idea is cumbersome and might result in low compliance, interfering with immediate contact of the infant with the mother.

The Argentinean researchers sought to investigate whether the transfer of blood in delayed cord clamping procedures is affected by the position in which the baby is held immediately after birth by conducting a study in three university-affiliated hospitals in Argentina. The participants included 197 babies who were held in the currently recommended position and 194 who were instead immediately placed on the mother’s stomach or chest. The babies, who were born vaginally, were randomly assigned by computer-generated blocks in a 1-to-1 ratio to decipher who would be put in what position.

The babies’ weights were measured at the point of birth and immediately after the delayed clamping procedure. This allowed the researchers to measure the volume of blood which had transferred from the placenta to the child. Currently, more blood flow is thought to be received via placenta position.

The findings revealed there was no statistically significant difference between the two groups in the volume of blood transferred, suggesting that placing the baby on the mother’s chest or stomach is no less effective than placing the baby on the placenta in delayed cord clamping procedures. The babies in both groups had similar volumes of blood transferred from the mother’s placenta. "Because of the potential of enhanced bonding between mother and baby, increased success of breast-feeding and the compliance with the procedure, holding the infant by the mother immediately after birth should be strongly recommended," Vain said.

Iron deficiency in newborn babies and children continues to be a serious public health problem in low-income countries and also in countries from North America and Western Europe. The World Health Organization (WHO) recommends delayed cord clamping because it allows blood flow between the placenta and neonate to continue, which may lead to an improved iron status in the baby for up to six months after birth. This could be beneficial for underdeveloped countries who have less access to iron-rich foods.

Dr. Tonse Raju from the U.S. National Institute of Child Health and Human Development wrote an accompanying journal commentary to the recent study. He believes this study "should bring a sigh of relief from those trying to incorporate delayed umbilical cord clamping into practice," he wrote in his accompanying editorial. "The results are convincing and show that gravity did not have an effect on volume of placental transfusion."

Doctors like Dr. Mona Prasad, professor of obstetrics and gynecology, who specializes in high-risk cases at Ohio State's Wexner Medical Center, doesn’t wait two minutes before clamping the cord but believes this study could be beneficial for mothers, babies, and doctors alike. "I do not currently, routinely, wait 2 minutes before clamping the cord with the intent for placental transfusion," she told MedPage Today. “However, as we pay more and more attention to maternal bonding, and place babies on the maternal abdomen for immediate skin-to-skin contact, we likely approach 1 to 2 minutes before the cord is clamped."

The decision of whether to clamp or to delay clamping is one all parents should discuss with their OBGYN early on during pregnancy. The debate behind the duration of cord clamping is stirring up controversy years later, but in the end, Mom knows best.

 

Source: Alda MG, Berazategui JP, Gordillo JE, et al. Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trial. The Lancet. 2014.