What is Baby's Golden Minute?
It gives babies the oxygen they need immediately at birth and the iron they need for growth.
It gives babies the red, white and stem cells they need for optimal health.
It's leaving the umbilical cord connected and unclamped for at least 90 seconds.
At the moment of birth, about 2/3 of the baby’s blood (the fetal circulation) is in the baby. The remaining third is still in the umbilical cord and placenta. During the third stage of labor, which lasts from the delivery of the baby to the delivery of the placenta, the cord actively pumps iron-rich, oxygen-rich, stem-cell-rich blood into the baby.
Immediate cord clamping is an active medical intervention with unproven benefit.
The World Health Organization (WHO) does not recommend immediate cord clamping.
Studies continue to find that delayed cord clamping has signifcant benefits for newborns. Just a few are included below on this page.
Early cord clamping deprives the baby of 54-160 mL of blood, which represents up to half of a baby's total blood volume at birth. "Clamping the cord before the infant's first breath results in blood being sacrificed from other organs to establish pulmonary perfusion [blood supply to the lungs]. Fatality may result if the child is already hypovolemic [low in blood volume]." -Morley, G. (1998, July).
At 4 months of age, infants subjected to delayed cord clamping have 45% higher mean ferritin concentration and a lower prevalence of iron deficiency. Iron deficiency even without anemia has been associated with impaired development among infants. Delayed cord clamping improves iron status and decreases the risk for iron deficiency at 4 months of age among infants born at term in a country with a low prevalence of iron deficiency anaemia. Delayed clamping is not associated with neonatal jaundice or other adverse effects.1
Dr. Alan Greene at TEDxBrussels - 90 seconds to change the world
Dr. Stuart Fischbein shares his thoughts on delayed cord clamping.
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Studies were conducted to determine the effects of early cord clamping compared with late cord clamping after birth on maternal and neonatal outcomes. 15 trials involving a total of 3911 women and infant pairs were reported in the Cochrane Library - "Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes" published July 11, 2013
Neonatal outcomes: Mean birthweight was significantly higher in the late, compared with early, cord clamping (101 g increase 95% CI 45 to 157, random-effects model, 12 trials, 3139 infants, I2 62%). Haemoglobin concentration in infants at 24 to 48 hours was significantly lower in the early cord clamping group (MD -1.49 g/dL, 95% CI -1.78 to -1.21; 884 infants, I2 59%). This difference in haemoglobin concentration was not seen at subsequent assessments. However, improvement in iron stores appeared to persist, with infants in the early cord clamping over twice as likely to be iron deficient at three to six months compared with infants whose cord clamping was delayed (RR 2.65 95% CI 1.04 to 6.73, five trials, 1152 infants, I2 82%).
Maternal outcomes: There were no significant differences between early versus late cord clamping groups for the primary outcome of severe postpartum haemorrhage (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.65 to 1.65; five trials with data for 2066 women with a late clamping event rate (LCER) of ˜3.5%, I2 0%) or for postpartum haemorrhage of 500 mL or more (RR 1.17 95% CI 0.94 to 1.44; five trials, 2260 women with a LCER of ˜12%, I2 0%). There were no significant differences between subgroups depending on the use of uterotonic drugs. Mean blood loss was reported in only two trials with data for 1345 women, with no significant differences seen between groups; or for maternal haemoglobin values (mean difference (MD) -0.12 g/dL; 95% CI -0.30 to 0.06, I2 0%) at 24 to 72 hours after the birth in three trials.
Authors' conclusions: A more liberal approach to delaying clamping of the umbilical cord in healthy term infants appears to be warranted, particularly in light of growing evidence that delayed cord clamping increases early haemoglobin concentrations and iron stores in infants. Delayed cord clamping is likely to be beneficial as long as access to treatment for jaundice requiring phototherapy is available.
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The potential for developing hyperbilirubinemia is issue of concern regularly expressed on the issue of cord clamping. In their systematic review, using data from 1009 infants, Hutton and Hassan2 found no significant difference in mean serum bilirubin levels nor an increased risk of neonatal jaundice within the first 24 hours of life associated with late clamping (RR, 1.35; 95% CI, 1.00–1.81). One of their included studies reported a mean bilirubin level of 192.8 mmol/L in the late clamping group versus 175.7 mmol/L in the early clamping group. Another trial found a mean bilirubin of 99.18 mmol/L in the late clamping group and 104.31 mmol/L in the early clamping group. They also report no significant difference between the groups in risk of
jaundice at 3 to 14 days after birth nor in the percentage of infants with bilirubin levels exceeding 256.5 mmol/L (15 g/dL) requiring phototherapy (RR, 1.27; 95% CI, 0.76–2.10; 1 trial; n = 332).[2] Furthermore, using 3 RCTs (n = 111), Rabe et al. found that none of the neonates with elevated bilirubin levels required phototherapy treatment or exchange transfusions.
- Morley, G. (1998, July). Cord closure: Can hasty clamping injure the newborn? OBG Mgmnt: 29-36.Early clamping has been linked with an extra risk of anemia in infancy.
- Grajeda, R. et al. (1997).Delayed clamping of the umbilical cord improves hematologic status of Guatemalan infants at 2 mo. of age.
- Am J Clin Nutr 65:425-431.Premature babies who experienced delayed cord clamping--the delay was only 30 seconds--showed a reduced need for transfusion, less severe breathing problems, better oxygen levels, and indications of probable improved long-term outcomes compared with those whose cords were clamped immediately.
- Kinmond, S. et al. (1993). Umbilical cord clamping and preterm infants: A randomized trial. BMJ 306(6871): 172-175.Some studies have shown an increased risk of polycythemia (more red blood cells in the blood) and jaundice when the cord is clamped later. Polycythemia may be beneficial in that more red cells mean more oxygen being delivered to the tissues. The risk that polycythemia will cause the blood to become too thick (hyperviscosity syndrome), which is often used as an argument against delayed cord clamping, seems to be negligible in healthy babies.
- Morley, ibid.Some evidence shows that the practice of clamping the cord, which is not practiced by indigenous cultures, contributes both to postpartum hemorrhage and retained placenta by trapping extra blood (about 100 mL) within the placenta. This increases placental bulk, which the uterus cannot contract efficiently against and which is more difficult to expel.
- Walsh, S. (1968, May 11). Maternal effects of early and late clamping of the umbilical cord. The Lancet: 997.Clamping the cord, especially at an early stage, may also cause the extra blood trapped within the placenta to be forced back through the placenta into the mother's blood supply during the third stage contractions. This feto-maternal transfusion increases the chance of future blood group incompatibility problems, which occur when the current baby's blood enters the mother's bloodstream and causes an immune reaction that can be reactivated in a subsequent pregnancy, destroying the baby's blood cells and causing anemia or even death.
- Doolittle, J. & Moritz, C. (1966). Obstet Gynecol 27:529 and Lapido, O. (1971, March 18). Management of the third state of labour with particular reference to reduction of feto-maternal transfusion. BMJ 721-3.
Part of the above is an excerpt from Sarah Buckley's "A Natural Approach to the Third Stage of Labour," Midwifery Today Issue 59. Other studies are quoted/cited as well.
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Delayed vs Early Cord Clamping
Baby's
Golden
Minute
