Terms of reference
“To investigate if the routine immediate clamping of the umbilical cord is still best practice.”
Method of procedure
The information in this report has been gathered from medical journals, World health Organisation recommendations, cited internet sources and current hospital practice guidelines. Primary research has also been gathered through interview.
Introduction
This study is being undertaken to determine if current obstetric practice of routine umbilical cord clamping within 30 seconds of birth has positive or negative neo natal outcomes. The current practice in some Irish maternity hospitals is the immediate clamping of the umbilical cord and actively managed third stage of labour. This practice has both positive and negative outcomes for mother and baby. The World Health organisation defines the actively managed third stage of labour as the use of uterotonic drug immediately following delivery of the fetus, controlled cord traction and early cord clamping and cutting. This practice has undoubtedly helped to reduce haemorrhagic morbidity for mothers worldwide.
Findings
Research shows that changing the timing of the cutting of the umbilical cord from 1 to 3 minutes after delivery of the baby improves the iron status of the infant. Delayed cord clamping specifically increases haemoglobin and hematocrit levels for the neonate with subsequent reduction in rates of anaemia that may extend into the infant period (Sabra Way MNIMH). A two minute delay in cord clamping increases the neo nates iron reserve by 27-47 mg of iron, which is equitant to 1-2 months of an infant’s iron requirements.
Potential adverse effects on the infant of delayed cord clamping and cutting may include jaundice requiring phototherapy(WHO).The difference between early clamping and natural cessation of blood flow has been established to result in the loss of 21% of the blood that would normally have transferred between mother and child(Heidi Stephenson).
Immediate cord clamping may adversely affect the neo nate. A baby that breathes within 2 minutes of birth usually survives. If the process is interrupted by cord clamping, which obstructs the placental circulation, survival can be compromised. If a baby that does not breathe within 2 minutes ,resuscitation commenced ,If this is after immediate cord clamping can it result in hypovolaemia, a condition that may not be treated for many hours. By this time, irreversible damage may have occurred, Hypovolaemia is an abnormal decrease in the volume of blood.
Conclusions
Delaying the cord clamping by 1 to 3 minutes appears to have positive neo natal outcomes with neo nates having increased levels of iron, lower risks of anaemia less need for blood transfusions as their blood volume levels are higher.
Research to show that neo nates suffer greater risk of jaundice from delayed cord clamping to this time line is inconclusive.
Immediate cord clamping shows to have negative effects to the neo nate and could potentially cause irreversible damage.
It is of upmost importance that delayed cord clamping is practiced with breastfed babies as they are at a higher risk of anaemia as they depend on the mother milk to transfer iron. Bottle fed babies have iron fortified into there diets.
Recommendations
A 1 to 3 minute delay of cord clamping should be routine in practice in maternity hospitals as reflected in current WHO guidelines.
The clients anatomy should be respected in regarded to her birth preferences and the cord should be left to stop pulsing before clamping if this is the desire of the client or has been stated in her birth plan.
Bibliography
What to expect when you’re expecting
Eisenberg, Murkoff ,Hathaway
2005
http://apps.who.int/rhl/pregnancy_childbirth/childbirth/3rd_stage/cd004074_abalose_com/en/index.html
http://apps.who.int/rhl/pregnancy_childbirth/childbirth/3rd_stage/cd004074_abalose_com/en/index.html
trying to be objective...
lol..
in my opinion cord should be left to stop pulsing...but very unlikely to become routine practice in cattle-mart hospital system..but every women has her right to birth how she wants...so if you dont want your baby snipped from your life giving source the second it pops out you need to speak out!!
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