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Umbilical Cord Clamping

June 2016

I'm back!! For the first time in my life, I was totally disconnected from my cell phone, FaceBook, email, and the internet. My husband and I took a long cruise to celebrate our 40th anniversary...and I was forced into disconnecting. Best thing EVER.

Let's talk, this week, about the timing of umbilical cord clamping. A new study has been published discussing immediate, short delay, and long delay clamping, and is a very good read for anyone interested in the physiology behind the infant transition from intrauterine to extra-uterine life.

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"The debate about when the umbilical cord should be clamped after birth has simply focused on the potential for a time-dependent net placental to infant blood transfusion. However, as there are many factors that influence blood flow in the umbilical arteries and veins immediately after birth, some infants may be a risk of losing blood volume. If clamping is to be delayed, there is now very good evidence demonstrating that the timing of the clamping should be based on the infant's physiology, rather than on a stopwatch" (Hooper, S. B., Binder-Heschl, C., Polglase, G. R., Gill, A. W., Kluckow, M., Wallace, E. M., Blank, D., and te Pas, A. B., 2016).

This journal article detailss:

1. History surrounding umbilical cord clamping (UCC), such as debates dating back to the time of Aristotle in 300 BC.

2. The complex interplay of physiological factors that control blood flow in the umbilical arteries and veins.

3. Infant cardiovascular transition at birth and the effect of UCC before and after lung aeration.

4. Cardiovascular physiology related to the rapid increase in pulmonary blood flow and peripheral vascular resistance.

5. The effects of gravity, and findings "...which found that placing an infant at the same height or above the introitus does not effect placental to infant blood transfusion...".

6. The effects of uterine contractions on placental to infant blood transfusion.

One of the closing statements made by the authors reads, "While a time-based approach is much easier and convenient for the caregiver, ignoring the infant's physiology during delayed UCC can potentially be counter-productive for the infant" (Hooper, et al., 2016).

Just a quick note here...if you have not accessed BioMed Central, I'd encourage you to do so. This is an open access portal to thousands of full journal articles, allowing you to request the journals and topics in which you are most interested. The notifications for each article are then sent directly to your email inbox. A truly valuable resource for evidence-based practice. www.biomedcentral.com



Kathy Parkes, MSN-Ed, BSPsy, RN, IBCLC, RLC, FILCA
Professional Development Educator, Step2Education International



Hooper, S.B., Binder-Heschl, C., Polglase, G.R. Gill, A.W., Kluckow, M., Wallace, E.M., Blank, D., and te Pas, A.B.  The timing of umbilical cord clamping at birth: physiological considerations.  Maternal Health, Neonatology, and Perinatology. 2016;2:4.  DOI: 10.1186/s40748-016-0032-y

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