What does the evidence tell us? Revisiting optimal cord management at the time of birth

Abstract

A newborn who receives a placental transfusion at birth from delayed cord clamping (DCC) obtains about 30% more blood volume than those with immediate cord clamping (ICC). Benefits for term neonates include higher hemoglobin levels, less iron deficiency in infancy, improved myelination out to 12 months, and better motor and social development at 4 years of age especially in boys. For preterm infants, benefits include less intraventricular hemorrhage, fewer gastrointestinal issues, lower transfusion requirements, and less mortality in the neonatal intensive care unit by 30%. Ventilation before clamping the umbilical cord can reduce large swings in cardiovascular function and help to stabilize the neonate. Hypovolemia, often associated with nuchal cord or shoulder dystocia, may lead to an inflammatory cascade and subsequent ischemic injury. A sudden unexpected neonatal asystole at birth may occur from severe hypovolemia. The restoration of blood volume is an important action to protect the hearts and brains of neonates. Currently, protocols for resuscitation call for ICC. However, receiving an adequate blood volume via placental transfusion may be protective for distressed neonates as it prevents hypovolemia and supports optimal perfusion to all organs. Bringing the resuscitation to the mother’s bedside is a novel concept and supports an intact umbilical cord. When one cannot wait, cord milking several times can be done quickly within the resuscitation guidelines. Cord blood gases can be collected with optimal cord management. Conclusion: Adopting a policy for resuscitation with an intact cord in a hospital setting takes a coordinated effort and requires teamwork by obstetrics, pediatrics, midwifery, and nursing. What is Known:• Placental transfusion through optimal cord management benefits morbidity and mortality of newborn infants.• The World Health Organisation has recommended placental transfusion in their guidance. What is New:• Improved understanding of transitioning to extrauterine life has been described.• Resuscitation of newborn infants whilst the umbilical cord remains intact could improve the postpartum adaptation.

Women and maternity care providers experiences of planned home birth in Northern Ireland: A descriptive survey

“…Delayed cord clamping results in a baby receiving 30 % more blood than a baby whose cord is clamped at birth [33,34]. In this study, the majority of women reported that the umbilical cord was clamped and cut in line with the evidence base.…”

Neonatal resuscitation after birth – Swedish midwives’ experiences of, and perceptions about, separation between mothers and their newborn babies

“…To justify separation at birth by highlighting the need for resuscitation should no longer be accepted. A growing body of evidence reports that intact cord resuscitation supports the process of physiologic neonatal transition and is beneficial for non-vigorous newborn infants 22 , 23 . If motherside resuscitation cannot be practiced for maternal reasons, specially designed equipment or trolleys can facilitate resuscitation, in the same room, with the placental and cord circulation intact 18 .…”

Cardiac Asystole at Birth Re-Visited: Effects of Acute Hypovolemic Shock

“…The effect of blood loss at birth from ICC can be quite subtle or acute [53]. In a study examining the effects of a severe acute hemorrhage on late-term fetal sheep, Meyers and Rudolph (1991) found life-threatening effects following the removal of 40% of the fetal blood volume [54].…”