Neonatal resuscitation: ‘room side to motherside’

02 November 2019
22 min read
Volume 27 · Issue 11

Abstract

Delayed clamping of the neonatal umbilical cord is considered beneficial to the transition to extrauterine life in a term, uncomplicated birth. However, some neonates require resuscitation and the ability to perform this is a fundamental aspect of midwifery practice. The decision to clamp and cut the umbilical cord often precludes any resuscitative attempt, but the reasoning for this action is unclear. This article explores the purpose and place of leaving the umbilical cord intact during neonatal resuscitation. It considers the physiological basis for delaying cord clamping as well as the psychological benefits to baby, mother and family of leaving the cord intact until resuscitation is complete.

From the moment of birth, around 90% of neonates initiate spontaneous respiration within 30 seconds (Resuscitation Council UK, 2016). For approximately 10% of neonates, this process takes a little longer and a degree of support is needed to achieve cardiopulmonary stability (Ersdal and Singhal, 2013). Current guidelines advise clamping and cutting the umbilical cord when resuscitation is required (Resuscitation Council UK, 2016), and the neonate is swiftly removed from the mother's bedside to the resuscitaire for assessment and stabilisation (Yoxall et al, 2015). The anticipation of positive pressure ventilation is the primary reason for this decision; however, this is only required in 3% of cases (Resuscitation Council UK, 2016). Consequently, neonates are denied the benefits of delayed cord clamping (DCC) (Hutchon and Burleigh, 2013), when requiring nothing more than stabilisation which can be provided at the mother's bedside. While the potential harm of immediate cord clamping (ICC) is widely recognised (World Health Organization [WHO], 2012; Hooper et al, 2015; Leslie, 2015; Royal College of Obstetricians and Gynaecologists [RCOG], 2015), this risk is imposed on compromised neonates (Bhatt et al, 2013), those it could be argued would benefit from DCC more than uncompromised neonates.

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