Could delayed cord clamping at birth help your four-year-old’s social and fine motor skills?

The Umbilical Cord

The umbilical cord is the lifeline of a fetus in the womb.  It delivers oxygen, nutrients, and antibodies from the mother’s placenta to the baby.  It also removes waste and deoxygenated blood.^[1]http://www.nhs.uk/chq/pages/2299.aspx?categoryid=54

According to CNN, “At birth an estimated one-third of the baby’s blood is in the placenta. Red blood cells contain hemoglobin, a protein molecule, which carries oxygen to body tissues. At birth, the smallest amount of blood could have a big impact on specific aspects of an infant’s health..”^[2]http://www.cnn.com/2015/05/29/health/cut-the-cord/

Standard Cord Clamping Procedures

After a baby is born, a plastic clip is used to stop the flow in the umbilical cord and it is cut, usually within just 15-20 seconds after birth!  The American College of Obstetrician and Gynecologists (ACOG) recommends cord clamping happen 30-60 seconds after birth.^[3]http://www.cnn.com/2015/05/29/health/cut-the-cord/  This timeline could still be before the umbilical cord has naturally stopped working.

What is delayed cord clamping?

Defining delayed cord clamping varies.  Natural birth and midwifery advocates define it as allowing the umbilical cord to naturally stop pulsing before cutting the connection between infant and mother.  This usually takes between 3 to 5 minutes.  ACOG and the World Health Organization (WHO) define it as 1-3 minutes without mentioning the action in the umbilical cord.

You can visually see the umbilical cord pulsing after birth.  It is still functioning in its important role as the lifeline between mother and child.  One benefit of a home birth or midwife-assisted birth is delayed cord clamping.

The benefits of delayed cord clamping

Newborn benefits

Previous research has clearly found delayed cord clamping prevents iron deficiencies in newborns.

Allowing placental blood to flow into the neonate for 3 minutes, rather than cutting the umbilical cord within the first 10 seconds, as is common, increases blood volume sufficiently to elevate ferritin at 4 months, finds a study published online November 16 in the British Medical Journal.^[4]http://ecochildsplay.com/2011/11/17/more-benefits-of-delayed-cord-clamping-increased-iron-levels-at-4-months/

 ACOG touts even more immediate benefits of even waiting to clamp just 30 seconds after birth as “increased blood volume, reduced need for blood transfusion, decreased incidence of intracranial hemorrhage in preterm infants, and lower frequency of iron deficiency anemia in term infants”:

Neonatal Outcomes

Physiologic studies in term infants have shown that a transfer from the placenta of approximately 80 mL of blood occurs by 1 minute after birth, reaching approximately 100 mL at 3 minutes after birth (16, 31, 32). This additional blood can supply extra iron, amounting to 40–50 mg/kg of body weight. This extra iron, combined with body iron (approximately 75 mg/kg of body weight) present at birth in a full-term newborn, may help prevent iron deficiency during the first year of life (33).

Several systematic reviews have suggested that clamping the umbilical cord in all births should be delayed for at least 30–60 seconds, with the infant maintained at or below the level of the placenta because of the associated neonatal benefits (1, 21, 29, 33–35), including increased blood volume (2, 3, 13, 31, 36–40), reduced need for blood transfusion (17, 22, 41), decreased incidence of intracranial hemorrhage in preterm infants (10, 18, 29), and decreased frequency of iron deficiency anemia in term infants (7–9, 13, 24–26, 35–37, 40, 42).

In addition, a longer duration of placental transfusion after birth may be beneficial because this blood is enriched with immunoglobulins and stem cells, which provide the potential for improved organ repair and rebuilding after injury from disorders caused by preterm birth (39, 43). Although the magnitude of the benefits from enhanced placental stem cell transfusion has not been well studied, the other neonatal benefits have led investigators to consider revising umbilical cord clamping practice guidelines (4, 28, 40, 44–48).^[5]http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Timing-of-Umbilical-Cord-Clamping-After-Birth

These beneficial outcomes were found even when clamping occurred before the umbilical cord naturally stopped pulsing.

Why did the practice of immediate cord clamping start?  It was to prevent the anesthesia from “heavily medicated births” from entering the newborn’s bloodstream.

The ACOG identifies some risks of delayed cord clamping.  Dr. Mark Sloan refutes many of these concerns.  Research supports the benefits outweigh the risks.

Even with all of the benefits, the ACOG has not made any recommendations.  The World Health Organization does recommend delayed cord clamping, which it defines as 1 to 3 minutes after birth.

Late cord clamping (performed approximately 1–3 min after birth) is recommended for all births, while initiating simultaneous essential neonatal care.

Early umbilical cord clamping (less than 1 min after birth) is not recommended unless the neonate is asphyxiated and needs to be moved immediately for resuscitation.^[6]http://www.who.int/elena/titles/full_recommendations/cord_clamping/en/

The benefits 4 years later

New research finds the benefits of delayed cord clamping in four-year-0lds’ social and fine motor skills.  Published in the Journal of the American Medical Association, this Swedish study follows up with the same children involved in a delayed cord clamping study we wrote about five years ago.^[7]http://ecochildsplay.com/2011/11/17/more-benefits-of-delayed-cord-clamping-increased-iron-levels-at-4-months/.  The children involved in the original study were given the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) and Movement Assessment Battery for Children (Movement ABC), common tests given in educational settings.  Researchers found:

Conclusions and Relevance  Delayed CC compared with early CC improved scores in the fine-motor and social domains at 4 years of age, especially in boys, indicating that optimizing the time to CC may affect neurodevelopment in a low-risk population of children born in a high-income country.^[8]http://archpedi.jamanetwork.com/article.aspx?articleid=2296145

Social and fine motor skills are common deficiencies in young children, especially boys. It’s fascinating to find out that delayed cord clamping can address these issues from the start.

Researchers found no difference in overall IQ.

CNN explains:

Though the results are not dramatic, researchers involved with the study said this is an important step. “It’s incredible to see what a difference an extra three minutes and one-half cup of blood can have on the overall health of a child, especially four years later,” said Dr. Ola Andersson, lead author of the study and a pediatrician at the department of women and children’s health at Uppsala University in Sweden. “This is very promising, but larger studies are necessary,” said Andersson.^[9]http://www.cnn.com/2015/05/29/health/cut-the-cord/

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