Birth in South Africa Natural Birth Pregnancy and Birth Information by Marianne Littlejohn

Optimal Cord Clamping/Wait for White

Optimal Cord Clamping

The Key with optimal clamping of the umbilical cord is to “wait for white”, in other words, wait until the umbilical cord turns white before clamping and cutting. There is no need to rush to cut the umbilical cord after birth. Once the baby is born, the mother can even give birth to the placenta before the cord is cut. When the cord is left intact after birth, the cord goes white and then continues to dry out.

Optimal Cord Clamping

It is safe to cut the cord when it turns white after birth, because it signifies that all the blood in the placenta that belongs to the baby has transferred to the baby.  This is Optimal Cord Clamping.  Some parents choose to leave the cord intact until it dries and falls off at the navel spontaneously in 3-7 days. This is called Lotus Birth. The placenta is then often buried in the garden by the parents and a tree planted to commemorate  the important occasion. This way of waiting patiently for nature to complete the transition of birth is exhilarating for the parents as it shows how wonderful nature is.

Benefits of Optimal Cord Clamping

The following facts based on research indicate how important it is for your baby to receive the blood from the placenta after birth:

  • The baby will receive up to 30% more of the fetal-placental blood than it would with immediate cord clamping.1
  • The increase in warm blood reduces the impact of your baby getting cold (newborn hypothermia) alongside appropriate thermoregulatory care, such as, drying the baby and a hat.6,7
  • An increase in blood volume promotes perfusion of blood to the baby’s lungs and brain, reducing the impact of lack of blood (hypovolaemia) and lack of oxygen (hypoxia) at birth.4
  • Increased red blood cells (haemoglobin levels) improve oxygen and iron transportation around the baby’s body, this can reduce baby’s risk of anaemia in the first 12 months of life.8
  • Iron is important for the long-term neurodevelopment of baby, because it supports myelination of axons and development of white matter in the brain.9
  • Studies show improved fine motor function and social skills later in life. 8
  • Immune promoting stem cells provide lifelong protection to baby.10
  • Helps to keep the mother-baby together facilitates all the benefits of skin to skin for you and your baby.11

If Baby needs Help to Breathe

When a baby needs help to breathe (resuscitation), baby can be placed on a tray placed next to the mother, and the cord left intact. The blood flowing from the placenta to the baby’s heart and lungs will also help to resuscitate the baby and provide the much needed iron reserves to help baby recover. When the cord is left intact after birth, the baby is less likely to suffer from anaemia or low iron levels. Low iron levels affects the flow of oxygen to the brain and good iron levels ensures that the baby develops well and achieves appropriate growth milestones. Carolynn gave birth to Mabel and waited an hour after the birth to cut the cord. By this time, Mabel was breathing well, robust and pink.

Carolyn’s Birth

Carolyn gave birth to Mabel in the water supported by her husband. The cord was left intact with the placenta still inside the mother. Carolyn called her older children to meet their sister in the water and they greeted her delightedly during this precious undisturbed family gathering. When the mother and baby were ready, Carolyn left the cooling water, walked to the bed. We dried Carolyn and Mabel and they snuggled under the covers to warm up after the birth. After the birth, Carolyn pushed out the placenta and Marcel, her husband, cut the cord shortly thereafter.

Wait for White

  • It is advisable to leave the cord intact and ideal to wait until the cord turns white after birth , after the available blood in the cord and placenta has been transferred to the baby.
  • Once the cord has turned white, the birth attendant may cut the cord with sterile scissors or blade, and tie off the cord with sterile cord or clamp. 

Conclusion

Babies usually unfold beautifully after birth with little panic and minimal intervention. Waiting for white is a good directive for birth attendants. Waiting for the cord to turn white does no harm. The baby can be dried and the mother can lift the baby into her arms as she wishes, before the cord is cut. There is no need to rush and there is always a need to be calm.

A well perfused Mabel cord still intact!

References

  1. Yao A. Distribution of blood between infant and placenta after birth. The Lancet. 1969;294(7626):871-873. doi:10.1016/s0140-6736(69)92328-9
  2. WHO. Optimal timing of cord clamping for the prevention of iron deficiency anaemia in infants. World Health Organization. https://www.who.int/elena/titles/cord_clamping/en/. Published 2014. Accessed April 5, 2020.
  3. McDonald S, Middleton P, Dowswell T, Morris P. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews. 2013. doi:10.1002/14651858.cd004074.pub3
  4. Niermeyer S. A physiologic approach to cord clamping: Clinical issues. Matern Health Neonatol Perinatol. 2015;1(1). doi:10.1186/s40748-015-0022-5
  5. Vain N, Satragno D, Gorenstein A et al. Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trial. The Lancet. 2014;384(9939):235-240. doi:10.1016/s0140-6736(14)60197-5
  6. Oh W, Lind J. Body Temperature of the Newborn Infant in Relation to Placental Transfusion. Acta Paediatr. 1967;56(s173):137-145. doi:10.1111/j.1651-2227.1967.tb15289.x
  7. Wyllie J, Ainsworth S, Tinnion R. Resuscitation and support of transition of babies at birth. Resus.org.uk. https://www.resus.org.uk/resuscitation-guidelines/resuscitation-and-support-of-transition-of-babies-at-birth/. Published 2020. Accessed April 5, 2020.
  8. Andersson O, Hellstrom-Westas L, Andersson D, Domellof M. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial. BMJ. 2011;343(nov15 1):d7157-d7157. doi:10.1136/bmj.d7157
  9. Mercer J, Erickson-Owens D, Deoni S et al. Effects of Delayed Cord Clamping on 4-Month Ferritin Levels, Brain Myelin Content, and Neurodevelopment: A Randomized Controlled Trial. J Pediatr. 2018;203:266-272.e2. doi:10.1016/j.jpeds.2018.06.006
  10. Borlongan C, Lawton C, Acosta S et al. Enhancing endogenous stem cells in the newborn via delayed umbilical cord clamping. Neural Regen Res. 2015;10(9):1359. doi:10.4103/1673-5374.165218
  11. Moore E, Bergman N, Anderson G, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews. 2016. doi:10.1002/14651858.cd003519.pub4

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