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 Waiting a couple of minutes after a baby is born to
clamp and cut the umbilical cord is generally considered a good
idea, and some authorities have recommended holding the newborn
level with the vagina so gravity can help draw extra blood from the
placenta.
But babies held that way didn’t seem to get any more placental blood
than babies held in their mother’s arms instead, the new study
found.
“The fantasy that gravity plays a role was based on very old
studies,” Dr. Nestor E. Vain told Reuters Health.
Vain worked on the study at the Foundation for Maternal and Child
Health in Buenos Aires, Argentina.
The uterus continues to contract after the baby is born, and those
contractions are what push blood through the umbilical cord, not
gravity, he said.
Between 2011 and 2012, Vain and his team recruited about 400 women
in labor at three hospitals in Argentina. With hospital cooperation,
half of their babies were held at the level of the vagina after
birth and the other half were placed on their mother’s abdomen or
chest for two minutes before the umbilical cord was clamped.
The babies were weighed immediately after birth and again after the
cords were clamped.
Based on their weights, babies in both groups seemed to gain about
the same amount of blood regardless of where they were held,
according to results published in The Lancet. In the abdomen/chest
group, babies gained an average of 53 grams, or about a tenth of a
pound, compared to 56 grams in the vagina-level group.
“At any time during pregnancy in the last trimester, one third of
the fetal blood in the baby is circulating in the placenta, which is
where the baby’s blood goes to get oxygen and sugar from the
maternal blood and eliminate carbon dioxide like the kidney of an
adult,” Vain said.
That blood needs to get to the baby before the cord is clamped or
cut, he said. Waiting one to four minutes to clamp decreases the
baby’s risk of iron-deficiency anemia and neurodevelopmental
problems, which are a concern in Western as well as developing
countries, he said.
“In preterm infants, we know that more blood improves baby’s blood
pressure, reduces the need for blood transfusions, reduces the risk
for having intracranial bleeding, and helps in the smooth transition
between fetal and neonatal cardiovascular adaptation,” said Dr.
Tonse N.K. Raju.
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Raju, from the Eunice Kennedy Shriver National Institute of Child
Health and Human Development at the National Institutes of Health in
Bethesda, Maryland, wrote an editorial accompanying the study.Most doctors know that delaying clamping the cord is important,
but recommendations that a doctor or nurse hold the baby down low
for gravity’s sake mean it doesn’t always happen, Vain said.
“Two minutes, that’s a long time to stay holding a baby who is
kicking, screaming and slippery,” he said.
Hopefully delayed cord clamping will happen more often now that
researchers know giving the baby to its mother, which has other
benefits, is okay, he said.
“Many studies have shown that infant-and-mother attachment and
bonding improves by direct physical contact soon after birth between
mom and her infant,” Raju told Reuters Health in an email. “More
importantly, keeping the infant on mom’s chest helps the infant to
immediately begin to latch on to mom’s nipple, begin sucking, and
establish early on a successful pattern for breastfeeding,” he said.
Latching on helps release more of the hormone oxytocin, which can
help contract the now-empty uterus and deliver the placenta, he
added.
“Many believe that this is the evolutionary basis for a relatively
long umbilical cord,” Raju said. “That is, this enables the mom to
grab her newly born baby, put the baby on her chest to help the baby
to begin to suckle, which has a dual advantage of helping the
delivery of the placenta.”
SOURCE: http://bit.ly/1juRt2z and http://bit.ly/1kFkS8i The Lancet,
online April 17, 2014.
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