Concerns about umbilical cord clamping

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There has been a tendency of late, for a number of reasons, to ignore this precept.  In the first place the widespread use of analgesic drugs in labor has resulted in a number of infants whose respiratory efforts are sluggish at birth and whom the obstetrician wishes to Turn over immediately to an assistant for aspiration of mucus and, if necessary, resuscitation.  This readily leads to the habit of clamping all cords promptly.  Secondly, there is the episiotomy wound to suture; and the quicker the repair is started, the shorter will be the duration of anesthesia, and the less the blood loss from the wound.  Finally,

modern management of the third stage, especially if ergonovine has been given with the birth of the anterior shoulder, calls for immediate attention to the uterus and furnishes another reason for handing the baby to an assistant or nurse as promptly as possible.   These three tendencies of modern obstetrics, then, notwithstanding their several merits, do militate against delayed clamping of the cord." – Eastman 1950, pp397-398 [55].

Efforts to minimize jaundice became another impetus for clamping the umbilical cord early, even after the cause of maternal-infant Rh-factor incompatibility was understood, and exchange-transfusion and RhoGam treatments available [27, 56].   Opinion, not evidence, appears to have led to recruitment of many adherents to this "school of thought" [7].

5.  Hypovolemic shock Waiting for the infant to cry is no doubt instinctive for most obstetricians and midwives before clamping the cord.  However, recently developed delivery-room protocols state that the cord should be clamped immediately [57].  This protocol has found its way into several recent textbooks [58-62].  If followed too literally, clamping of the cord before the first breath could not only obstruct the shift of placental blood to the lungs, but also leave the infant in a state of hypovolemic shock.  Reports on transfusions and blood volume expanders needed for infants in neonatal intensive care units indicate that hypovolemia may not be an infrequent problem [7, 63].

Posted: February 27, 2006 (a work in progress)

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