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Delayed cord clamping in the compromised baby

02 February 2015
11 min read
Volume 23 · Issue 2

Abstract

Compromised babies are routinely immediately separated from the umbilical cord in order to be resuscitated. The benefits of delayed cord clamping are numerous and apply as much, if not more, to the non-breathing baby, thus it is important to ask ‘does early cord clamping cause harm?’ The evidence suggests that early cord clamping can cause bradycardia in the baby and create the need for resuscitation. Invasive measures such as drugs and volume expanders are not required as frequently when delayed cord clamping is practised. Allowing the placenta to perform its role in the resuscitation means that oxygen supply continues, despite the failure to achieve effective respiration immediately. There appears to be no adverse psychological affects for the mother and birth partner if adequate midwifery support is provided. As midwives we must use the best available evidence to support our practice and improve outcomes.

When a baby is born it begins its adaption to extra-uterine life. Delayed cord clamping is a normal part of gentle transition (Mercer and Erikson-Owens, 2010) and has been widely advocated as a means of preventing iron deficiency in babies (World Health Organization (WHO), 2012). Compromised babies are routinely separated from the umbilical cord immediately after birth, and rushed to a Resuscitaire, a more comfortable environment for the health practitioner, and the place deemed most appropriate by paediatricians. New guidance from the National Institute for Health and Care Excellence (NICE) (2014) recommends leaving the cord intact for at least 1 minute in active management, unless the baby has a heartbeat of less than 60 beats per minute that is not getting faster. It is estimated that 5–10% of newborns in the developed world require some form of resuscitation, although the majority of these only need stimulation, and just 1% require assisted ventilation (Castle, 2009). The logical action is to provide support to the baby by the perineum, ensuring the non-breathing child remains attached to its only source of oxygen (Mercer and Erikson-Owens, 2010).

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