Delayed cord clamping: The new norm

I used to think that delayed (or ‘deferred’, as is now the preferred term, in order to avoid any suggestion of suboptimal care) cord clamping was a waste of time, and more likely to cause harm than good, but now I realise that I was wrong.

Readers of this journal will know that when cord clamping is deferred for a few minutes, the newborn baby receives an additional transfusion of blood from the placenta of 80–100 ml (Farrar et al, 2011). This is quite a significant volume, bearing in mind that a 3.5kg fetus (i.e. just before birth) has a blood volume of around 250 ml (Dawes, 1968; Farrar et al, 2011). And in the preterm baby, this proportional increase is greater, as a greater proportion is sequestered in the placenta. This has been shown to result in a reduced chance of iron deficiency (although no difference in haemoglobin concentration) at 3–6 months of age. It also results in an increase in the chance of jaundice in the first few days after birth, as the extra red blood cells are broken down, releasing bilirubin into the baby's circulation (McDonald et al, 2013). So my view was along the following lines: less iron deficiency but more jaundice seemed fairly evenly balanced, but delaying active management of the third stage would increase the risk of postpartum haemorrhage (PPH) in the mother, thereby increasing the risk to her with little net benefit to the baby. I had done much of my research in the prevention of PPH, and had worked and lectured regularly in India and Africa and witnessed first hand the terrible toll PPH can take.