Obstetricians have encouraged early, or even instant, cord clamping as part of the active management of the third level of labor to save you maternal hemorrhage. For term births, the timing of cord clamping does not have a clear impact on postpartum blood loss. but, immediate clamping reduces neonatal hemoglobin and neonatal jaundice. Although these effects are generally transient and well tolerated, reduced iron levels are seen at age 3–6 months, an effect associated with developmental delay. The WHO, the International Federation of Gynecology and Obstetrics, and the National Institute for Health and Care Excellence (NICE) in the UK now recommend deferring cord clamping.
The third of newborn babies are attending in birth by neonatal resuscitation staff. For most, all that happens is an assessment, stimulation, thermal care and easy airway management. Around 15% of babies receive active resuscitation at birth, such as mask ventilation, intubation, cardiac massage or drug administration.
When an infant requires assessment or stabilization and support at the start, a standard practice heretofore is to clamp and cut the wire immediately and then take the infant to a resuscitation platform, usually at the side of the room or in another room. This means that the period of transitional circulation is foreshortened. In addition, parents are often not able to see or touch their baby at birth. Evidence from other areas of adult and child resuscitation has shown that family presence is preferred by relatives and by staff9–13 and is now standard in these settings. This issue has not been explored for care after birth, and to date, newborn resuscitation has always been away from the woman and her partner.
The need for instant neonatal care and support will increase with increasing prematurity. For preterm infants, deferred cord clamping is associated with decreased transfusion for anemia, reduced low blood stress requiring inotropic support and less low-grade intraventricular hemorrhage in comparison with immediate clamping. There is an increase in jaundice, but the long-term effects are unclear. A systematic review suggests that strategies for increased placental transfusion after birth may improve neonatal mortality rate in very premature babies, but it is uncertain whether any benefits would be negated by delayed resuscitation. Very preterm babies are those most likely to experience these major morbidities and, potentially, might benefit from deferred clamping.
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