A Doula’s Role: Delayed Cord Clamping

When I first started working as a labor and delivery nurse, delayed cord clamping was often scoffed at.  Women who wanted to have that done were “humored”, but seen as “one of those patients”.  If a baby did not cry instantly,  protocol or cultural practices still required the cord to be cut as quickly as possible.  Now, it is exciting to see how practice is changing, largely in part to quality research coming out detailing the benefits of delayed cord clamping.

Some of these benefits include:

1. increased oxygenation to the brain
2. decreased infection rate
3. increased iron status at birth and six months later

And that is just beginning to scratch the surface.  An increase incidence of jaundice, appears to be one draw back to delayed cord clamping.  But it does not appear to affect the health of the baby.

Role of the doula

A doula can help educate her clients by providing them with evidence based information or teaching them how to find it themselves.  They can also create handouts or print off information for their clients to bring with them to their medical providers to discuss the issue.  I always encourage the doula attend a prenatal visit.  This will provide an opportunity to help define roles and how the birth team can work together in order to ensure that the cord is clamped later if their client desires it.

For more information on how to find evidence based information check out our doula foundations course.  I’ve also included a few videos below that provide a good medical background on the case for delayed cord clamping.

References:

Mercer JS, Vohr BR, McGrath MM, Padbury JF, Wallach M, Oh W. Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial. Pediatrics 2006 Apr;117(4):1235-42.

Baenziger O, Stolkin F, Keel M, von Siebenthal K, Fauchere JC, Das Kundu S, et al. The influence of the timing of cord clamping on postnatal cerebral oxygenation in preterm neonates: a randomized, controlled trial. Pediatrics 2007 Mar;119(3):455-9.

Chaparro CM, Neufeld LM, Tena Alavez G, Eguia-Liz Cedillo R, Dewey KG. Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. Lancet 2006 Jun 17;367(9527):1997-2004.

Strauss RG, Mock DM, Johnson KJ, Cress GA, Burmeister LF, Zimmerman MB, et al. A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short-term clinical and laboratory endpoints. Transfusion 2008 Apr;48(4):658-65.

Chaparro, CM. Timing of umbilical cord clamping: effect on iron endowment of the newborn and later iron status. Nutrition Reviews. Volume 69, Issue Supplement s1, pages S30–S36, November 2011.

Ceriani Cernadas JM, Carroli G, Pellegrini L, et.al. The Effect of Timing of Cord Clamping on Neonatal Venous Hematocrit Values and Clinical Outcome at Term: A Randomized, Controlled Trial.Pediatrics. Vol. 117 No. 4 April 1, 2006 pp. e779 -e786 (2,3 8,9(doi: 10.1542/peds.2005-1156). Published online March 27, 2006.

McDonald SJ, Middleton P. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD004074. DOI:10.1002/14651858.CD004074.pub2.

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. British Medical Journal. 2011; 343: d7157. Published online 2011 November 15. doi:  10.1136/bmj.d7157

Ceriani Cernadas JM, Carroli G, Pellegrini L, et.al. The effect of early and delayed umbilical cord clamping on ferritin levels in term infants at six months of life: a randomized, control trial. Arch Argent Pediatr. 2010; 108:201-208.

Hutton EK, Hassan ES. Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA. 2007 Mar 21;297(11):1241-52.