Dr. Nicholas Fogelson writes about delayed clamping and the shifting of thinking in Obstetrics- one of the slowest medical fields to "change" from ideologies they've carried around for decades.
"..For the majority of my career, I routinely clamped and cut the umbilical cord as soon as it was reasonable. Occasionally a patient would want me to wait to clamp and cut for some arbitrary amount of time, and I would wait, but in my mind this was just humoring the patient and keeping good relations. After all, I had seen all my attendings and upper level residents clamp and cut right away, so it must be the right thing, right?The latest study on Delayed Cord Clamping, as reported in the BBC news states that preterm babies who's umbilical cords were left intact for a longer amount of time had a positive impact on the health of the infants.
Later in my career I was exposed to enough other-thinking minds to consider that maybe this practice was not right. And after some research I found that there was some pretty compelling evidence that indeed, early clamping is harmful for the baby. So much evidence in fact, that I am a bit surprised that as a community, OBs in the US have not developed a culture of delayed routine cord clamping for neonatal benefit."
'Delay cord cutting aids babies'
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Waiting up to two minutes to cut the umbilical cord after a premature baby is born could reduce the risk of bleeding on the brain, say researchers. A team from Brighton and Sussex University Hospitals reviewed seven studies of 297 babies.
Delaying clamping 'allows babies to adapt to their surroundings'
Around half of units in the UK do wait, but others cut the cord as quickly as 10 or 15 seconds after birth.
The review is published by healthcare information group, the Cochrane Collaboration.
The seven studies which were reviewed measured blood pressure, red blood cell counts, blood volume, bleeding within the brain and the need for transfusions.
Between 60 and 80% of preterm infants less than 32 completed weeks' gestation require transfusion.
But premature babies often have trouble breathing, so doctors aim to move them to special care baby units where they are helped to breathe, which requires the umbilical cord to be clamped and cut quickly.
'A healthier start'
Medical staff ordinarily clamp the umbilical cord in two places after the baby is delivered, then cut the cord between the two clamps.
There are no formal guidelines for when the cord should be cut. The latest evidence showed 47% of units performed delayed cord clamping - anything between 30 seconds and two minutes after birth,
The researchers say reducing the chances of bleeding in the newborn's brain also cuts the need for transfusions.
They found the delay also reduces anaemia and increases blood pressure and blood volume, giving premature infants a healthier start in life.
Dr Heike Rabe, the neonatologist who carried out the review told BBC News Online: "A slight delay in cord clamping of preterm infants is good for their subsequent health.
"It is cheap, leading to no extra cost. The optimal timing is not known yet and needs to be assessed by further studies. Funding needs to be available to perform this clinical research."
She added: "If the cord is left unclamped for a short time after the birth, some of the baby's blood from the placenta passes to the baby to help the flow of blood to the baby's lungs," Rabe explains. "Delaying cord clamping for just a very short time helped the babies to adjust to their new surroundings better."