For many years now, the standard care during the delivery of the placenta has been to clamp the cord immediately at birth and just follow the regular umbilical cord care tips.
There are increasing amounts of literature supporting delayed cord clamping as a method for improving neonatal outcomes.
This delay can be anywhere from:
- Delayed cord clamping: waiting until the cord has stopped pulsating before clamping, Cochrane definition is waiting at least 30 seconds; right up to
- Lotus birth: where the cord remains uncut and the baby remains attached to the placenta until the cord naturally separates at the umbilicus some 3-10 days post delivery.
Another option is “umbilical cord milking” (UCM) which means the caregiver holds the cord and squeezes blood down the cord into the baby.
A recent JAMA study looked at umbilical cord milking as a method to improve neonatal outcomes.
It reviewed 7 RCTs involving >500 infants (infants with a gestational age of less than 33 weeks allocated to UCM).
It found no difference in the risk for mortality, hypotension, need for inotropic support, and found that UCM resulted in higher levels of haemoglobin/ haematocrit, reduced risk for oxygen requirement at 36 weeks, and reduced risk for intraventicular haemorrhage.
They conclude that “UCM is associated with some benefits and no adverse effects in the immediate postnatal period in preterm infants (gestational age <33 weeks)". Some feedback would be that:
- Similar results are found for delayed cord clamping, so if this is possible, UCM may not be providing any additional benefit;
- However, UCM may be useful when delayed cord clamping is not possible;
- This study concentrates on outcomes in infants <33 weeks and therefore the results may not be applicable to all infants.
Al-Wassia H, Shah PS. Efficacy and Safety of Umbilical Cord Milking at Birth: A Systematic Review and Meta-analysis. JAMA Pediatr. 2015 Jan 1;169(1):18-25.