November 11, 2010
Don’t Clamp Umbilical Cords Straight After Birth, Urges Expert
Personal view: Why do obstetricians and midwives still rush to clamp the cord?
Obstetricians and midwives should wait a few minutes before clamping the umbilical cords of newborn infants so that babies are not harmed by the procedure, argues Dr David Hutchon in an article published on bmj.com today.Hutchon, a retired consultant obstetrician from the Memorial Hospital in Darlington, says it's time for the UK to follow guidance from the World Health Organisation and the International Federation of Gynaecology and Obstetrics and refrain from early cord clamping.
Despite evidence for the benefit of delayed cord clamping, clinicians in the UK seem reluctant to change their practice, he says, and the UK National Institute for Health and Clinical Excellence (NICE) is not advising them to do so.
One explanation for the apparent resistance of clinicians to follow the evidence is that that cord clamping "has become the accepted norm so much so that delaying clamping is generally considered a new or unproved intervention," he writes.
Yet he argues that "applying a clamp to the cord is clearly an intervention, having the greatest effect when it is done quickly after birth." And he fears that babies might be injured by very early clamping, for example they could experience severe blood loss (hypovolaemia).
He adds that two popular pregnancy information books both imply that delayed cord clamping is the norm and explain the advantage to the baby of delayed clamping.
Hutchon believes that if the need for early cord clamping was removed from NICE's guideline, "there could be an overnight change in practice."
He concludes: "Clamping the functioning umbilical cord at birth is an unproven intervention. Lack of awareness of current evidence, pragmatism, and conflicting guidelines are all preventing change. To prevent further injury to babies we would be better to rush to change."
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