Midwives told to drop ‘30-second rule’ on cutting umbilical cord
A RADICAL change in the way babies are delivered will see midwives delay cutting the umbilical cord following evidence that it improves the health of newborns.
The Royal College of Midwives is preparing to update its guidance to recommend delayed clamping for most women who give birth in hospitals, which will affect about 90 per cent of all births.
Current guidance from the RCM and the National Institute for Health and Clinical Excellence is to cut and clamp the umbilical cord within 30 seconds to protect babies from too much exposure to a synthetic hormone given to mothers to speed up labour and deliver the placenta.
It was also thought to help prevent a baby getting jaundice, a condition that causes yellowing of the skin, and was encouraged because of the risk of bleeding in new mothers.
However, doctors have long been divided over the issue – and studies have now found that delaying the procedure by just a few minutes has significant health benefits.
It is thought being connected to the maternal blood supply for longer helps protect babies against iron deficiency and anaemia, and allows vital stem cells to be transferred.
Increasing numbers of women have also been asking midwives to delay cutting and clamping to allow more blood to drain from the placenta into the baby, and also simply so they are connected for longer.
The new guidance is being developed and will be announced at the College’s conference in November.
Mervi Jokinen, practice and standards development adviser at the RCM, said: ‘We are supporting the midwives not to clamp the cord immediately. We’ve not finalised the guidelines and in terms of how long it will recommend delaying clamping for, we don’t know.
‘Guidelines drawn up by different organisations vary from one to five minutes, and even up to ten.
‘Most midwives will have to use their judgment in terms of the clinical situation. It’s more likely to happen within three to five minutes.’
Mrs Jokinen added that the change was driven by the evidence from clinical studies, but also because women were increasingly asking for midwives to delay clamping.
‘The issue here was studies started to show that with early clamping you’re denying a baby a boost of blood and it was recognised that haemoglobin levels were much lower later on,’ she said.
‘It is said that babies who are healthy and well would benefit from greater haemoglobin levels. Women have also asked us to give their babies to them while they are attached.’
A study from Sweden found a delay of three minutes could reduce the risk of iron deficiency later in childhood as well as anaemia in
‘Delayed clamping clearly favours the child’
newborns, which can lead to poor brain development.
At four months, fewer than one per cent of infants who had delayed clamping were deficient in iron compared with six per cent of those clamped immediately.
There was no increase in jaundice or other complications thought to be linked to delayed clamping.
In an editorial published in the same journal as the study, Dr Patrick van Rheenen, a consultant paediatrician at Groningen University in the Netherlands, said: ‘Delayed clamping clearly favours the child.
‘How much evidence is needed to convince obstetricians and midwives that it is worthwhile to wait for three minutes to allow for placental transfusion?’
A major US study published in 2007, which involved more than 1,900 newborns, found a two-minute delay was enough to reduce the risk of anaemia by half and low iron levels in the blood by a third.
The World Health Organisation dropped early clamping from its guidelines in 2007 and best practice on the issue varies across Europe. Guidelines in the UK, drawn up by NICE, recommend early clamping although an update is due in 2014.
The Royal College of Obstetricians and Gynaecologists updated its guidance last year to recommend the cord ‘should not be clamped earlier than necessary, based on a clinical assessment of the situation’.
Although hospitals will still be able to decide their own birth protocols, it is likely that they will follow RCM policy.
David Hutchon, a retired consultant obstetrician and gynaecologist who has campaigned for years for a change in policy, said: ‘This is very welcome.
‘But whether doctors will take any notice is another issue.
‘There’s a lot of ignorance out there and people have just blindly followed guidance for years without questioning it.’