Most recent evidence favoring a return to nature's wisdom:
. . . . .
van Rheenen P, de Moor L, Eschbach S, de Grooth H, Brabin B. Delayed cord
clamping and haemoglobin levels in infancy: a randomised controlled trial in term
babies. Trop Med Int Health. 2007 May;12(5):603-16.
"In traditional African home deliveries the umbilical cord is cut after placental descent into the vagina
(Lefeber & Voorhoeve 1997), but in hospital deliveries in resource poor settings immediate cord clamping
(ICC) is the routine standard of care." p603
"Like in other parts of Zambia, over 50% of women deliver at home (Stekelenburg et al. 2004). Especially
nulliparous and grand multiparous women, and women with a prior caesarean section, are advised to
deliver in hospital. Those who are able to pay the user fees and live in the vicinity are more likely to deliver
in hospital." p604
"Pregnant women were randomised to either DCC or ICC. ICC was the routine standard of care in
Mpongwe Mission Hospital at the time of the trial, and was usually completed within 20 s of delivery. In the
DCC group the umbilical cord was clamped after the cord stopped pulsating. The cord was palpated every
other 20 s for cessation of pulsations and clamped when pulsations were no longer observed. The exact
time was recorded by stopwatch." p604
"The decision to clamp after cessation of pulsations was based on the fact that in many delivery rooms in
resource-poor settings a clock is absent or not functioning (own observations)." p613
"Effective interventions are urgently needed to improve child survival in malaria-endemic areas. DCC is a
simple, cost-free and safe delivery procedure that might offer a sustainable strategy to reduce early infant
anaemia risk when other interventions are not yet feasible." p613
More recent discussion of the benefits of delayed cord clamping:
Oh W. Timing of umbilical cord clamping at birth in full-term infants. JAMA. 2007 Mar 21;
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;
Baenziger O, Stolkin F, Keel M, von Siebenthal K, Fauchere JC, Das Kundu S, Dietz V,
Bucher HU, Wolf M.The influence of the timing of cord clamping on postnatal cerebral
oxygenation in preterm neonates: a randomized, controlled trial. Pediatrics. 2007 Mar;
Ultee K, Swart J, van der Deure H, Lasham C, van Baar A. Delayed cord clamping in
preterm infants delivered at 34 to 36 weeks gestation: A randomized controlled trial.
Arch Dis Child Fetal Neonatal Ed. 2007 Feb 16; [Epub ahead of print]
Hutchon D, Ononeze B. Preterm birth: effect of corticosteroids or immediate cord
clamping? PLoS Med. 2006 Oct;3(10):e462. Letter in response to: Kapellou O et al.
Abnormal cortical development after premature birth shown by altered allometric
scaling of brain growth. PLoS Med. 2006 Aug;3(8):e265.
Levy T, Blickstein I.Timing of cord clamping revisited. J Perinat Med. 2006;34(4):293-7.
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;
Ceriani Cernadas JM, Carroli G, Pellegrini L, Otano L, Ferreira M, Ricci C, Casas O,
Giordano D, Lardizabal J. The effect of timing of cord clamping on neonatal venous
hematocrit values and clinical outcome at term: a randomized, controlled trial.
Pediatrics. 2006 Apr;117(4):e779-86.
Hutchon DJ.Epidemiology of preterm birth: delayed cord clamping used to be taught
and practised. BMJ. 2004 Nov 27;329(7477):1287; author reply 1287(adherence to
immediate clamping and pharmacological treatment).
Emhamed MO, van Rheenen P, Brabin BJ. The early effects of delayed cord clamping
in term infants born to Libyan mothers. Trop Doct. 2004 Oct;34(4):218-22.
Philip AGS, Saigal S (2004) When should we clamp the umbilical cord? NeoReviews Vol.
5 No.4 2004 e142, http://neoreviews.aappublications.org/cgi/reprint/5/4/e142. See also
e-letter responses at http://neoreviews.aappublications.org/cgi/eletters/neoreviews;
Baenziger et al. on better cerebral oxygenation in newborns with
60-90 second delay in clamping the umbilical cord:
Baenziger O, et al. The influence of the timing of cord clamping on postnatal cerebral
oxygenation in preterm neonates: a randomized, controlled trial. Pediatrics. 2007
Follow-up of 39 pre-term infants (24-32 weeks gestation), exceprts:
"The infants in the control group were delivered conventionally, with the cord
clamped in less than 20 seconds."
"Three infants subsequently died (2 because of complications from hyaline
membrane disease and 1 because of neonatal sepsis); all 3 were in the control
group." Hyaline membrane disease means the lungs did not inflate.
Average Apgar scores at one minute =5 (sd 2) in both groups, and at five minues =8
(sd 1.7). An Apgar score of 5 (or even 7) at one minute represents respiratory
depression, which can lead to impairment within the brainstem auditory pathway.
"Six infants from the experiment group and 12 infants from the control group needed
"...our results demonstrate that the delayed cord clamping had its effect on systemic
oxygen delivery to the tissues..." and "...clearly demonstrates a higher cerebral tissue
oxygenation in the experiment group." ... "Inadequate cerebral oxygenation is an
important factor in the development of neonatal brain injury." ... "reducing the risk of
inadequate tissue oxygenation by a simple technique, such as delayed cord
clamping, would be very advantageous."
"We conclude that delayed cord clamping increases cerebral oxygenation for the first
24 hours after birth."