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Expert urges to wait before clamping cord after birth

UK obstetrician recommends a few minutes’ delay before cutting the cord

Louise Prime

Thursday, 11 November 2010

The National Institute for Health and Clinical Excellence (NICE) should advise UK doctors and midwives to follow World Health Organization advice and delay cord clamping until a few minutes after birth to avoid harming the newborn baby, a UK obstetrician has urged on bmj.com today.

In a personal view, retired consultant obstetrician Dr David Hutchon from Memorial Hospital in Darlington points out that rushing to clamp the cord immediately – regarded as normal procedure in Britain – goes against advice from both WHO and the International Federation of Gynaecology and Obstetrics. Waiting allows time for the baby to transfer from placental to pulmonary respiration, and vasospasm occurs naturally.

Dr Hutchon is concerned that newborn babies’ wellbeing could be compromised by very early clamping, as they could, for example, experience severe blood loss (hypovolaemia).

NICE continues to recommend early clamping in its guideline on intrapartum care – despite repeated calls from experts that it should advise delayed clamping to reflect the evidence.

Dr Hutchon suggests that one reason for doctors’ and midwives’ apparent resistance to change practice to fit with the evidence is that cord clamping “has become the accepted norm so much so that delaying clamping is generally considered a new or unproved intervention” – even though, as he argues, “applying a clamp to the cord is clearly an intervention, having the greatest effect when it is done quickly after birth”.

Dr Hutchon points out that two well-known lay pregnancy books explain to parents the advantages of delayed clamping, and he argues that if the need for early cord clamping was removed from NICE’s guideline, “there could be an overnight change in practice”.

He concludes: “Clamping the functioning umbilical cord at birth is an unproven intervention. Lack of awareness of current evidence, pragmatism, and conflicting guidelines are all preventing change. To prevent further injury to babies we would be better to rush to change.”

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