Delayed Cord Clamping Gives Babies a Healthier Start in Life

Submitted by Liz Zehner, RN

When a baby takes its first breath outside the womb, with that breath comes a rush of 80 milliliters of blood through the umbilical cord. The second breath can mean up to 100 milliliters of blood and higher iron levels for newborns.

In the past, the umbilical cord was clamped and cut as soon as the baby is delivered. This meant valuable blood was lost.

By delaying the process of clamping and cutting the umbilical cord between mother and child, this extra force of blood is able to reach the baby, similar to a blood transfusion. 

Increasing evidence has emerged suggesting that it is favorable to delay umbilical cord clamping (DCC) for at least one minute after birth or until the cord stops pulsating in uncomplicated full-term births. 

Delayed cord clamping means a healthier baby.

Documented benefits include:

  • Increased blood volume, including valuable stem cells
  • Reduction in blood transfusions
  • Decrease in bleeding in the brain in preterm infants
  • Decrease in iron deficiency anemia in full-term infants

According the American College of Obstetricians and Gynecologists (ACOG, 2012), the reduction in bleeding in the brain is the most important clinical benefit of delayed cord clamping for preterm infants.

Additional suggested benefits of DCC include improved APGAR scores. The APGAR test is a quick overview of the baby performed at one and five minutes after birth to determine the general health of the baby. Evidence has shown that by allowing the extra burst of blood through the umbilical cord, babies have better temperature stability at birth and a decrease in heart murmurs.

One component of the APGAR scoring is the color of the newborn. With DCC the color of the newborn should be pinker in response to the extra circulating blood. 

The DCC initiative was recently adapted into practice at Beebe Healthcare in large part due to the collaborative efforts of the nursing staff. Several Beebe colleagues were introduced to this practice concept at the national conference for the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN).  Upon returning from the conference, the team was inspired and convinced that this clinical practice change could be implemented.  With the support of the leadership team, the physicians and nurses were educated and coached to perform DCC in the delivery room.  Initially, DCC was performed for vaginal deliveries, but once the providers were comfortable with the practice, the practice was translated into the operating room for Cesarean deliveries.

Beebe has been collecting data for the past three months since starting the initiative and the data has shown 98 percent of the APGAR one-minute scores are greater than 7 and 100 percent of the five-minute scores are nine or 10 (the highest score possible).  There has been no increase in jaundice or polycythemia, a condition where the baby has too many red blood cells, which can cause birth complications.

The exact best time to clamp the umbilical cord is still being researched. The success of DCC at Beebe Healthcare is a model for the collaboration of nurses, physicians, and leadership to translate research into practice, while keeping the patient at the center.  At Beebe Healthcare, the data shows that our babies are benefitting from this new evidence.

Liz Zehner, RN, has worked at Beebe Healthcare for six years. Beebe Healthcare serves women of all ages with comprehensive and integrated care. For more information, go to www.beebehealthcare.org.

 

Tags: