Cord Clamping – Why we need to Wait for White, with Amanda Burleigh

Cord clamping is something that you might not even think to consider when it comes to your birth plan, but let me tell that it most definitely is. In today's podcast I want to help you to undersrtand why delayed cord clamping should be an important non-negotiable aspect of the birth of your baby, whether you have a vaginal or c-section birth.

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Today I'm chatting to Amanda Burleigh, who is a well-known UK midwife. I say well-known, because Amanda is a bit of an activist and is very outspoken on this particular topic. She has been campaigning for delayed cord clamping for over ten years and it is in thanks to her efforts that health policies are changing. She is a true hero!

Amanda first started to consider the impact of cutting the cord when she was wondering why so many boys (her sons included) had behavioural issues.

"After talking to teachers who were concerned at the numbers of children with behavioural, learning and medical problems and noticing the same in my friends and colleagues children. The numbers were too high to be ignored and this got me thinking and looking for a common denominator. Informally I looked at many potential causes, caffeine, tobacco, alcohol, sugar consumption etc eventually (in 2005)  I reflected on our own practice as midwives and realised that although we were taught to clamp and cut the umbilical cord immediately, there was absolutely no evidence to support this practice. The cord for 50-60 years and common practice now) is to cut the cord before the baby has even breathed and I quickly realised that this couldn't be good practice. I looked for evidence and found work by George Morley who stated that immediate clamping was the reason for the increase in autistic spectrum disorders and other problems, cerebral palsy. In 2005 there was little evidence to look at to support delaying cord clamping but there has never been any evidence to support immediate cord clamping at all. All the available evidence did point out that immediate cord clamping deprives the baby of at least 30% of their intended blood volume.

I started my campaign from then really and increased as I realised that implementing change (despite it being evidence based change) is really hard to influence.

I did change practice slightly in my own hospital and was then asked to be quiet (in 2012) and then I decided to get louder and I started the facebook page to inform parents and carers and I got a petition up to try and influence NICE (UK guidance) to change practice . This attracted 5.500 signatures from over 44 different countries. I also had articles in the paper."

Delayed Cord Clamping - The Benefits

Delayed cord clamping or optimal cord clamping is associated with:

Increased neonatal iron stores in the neonatal period.

Increased organ perfusion and subsequent cardiopulmonary adjustment.

Increased duration of early breast feeding.

Decreased risk of  feral-maternal transfusion

Decreased umbilical infections

Increased white cells-infection prevention

Less blood splatter-HIV protection

May benefit neurodevelopmental outcomes, particularly in males

One thing that Amanda talked about was the Golden Hour after birth. Here's what se means by that;

Safe environment - warmth, privacy, dignity, respect, quiet and undisturbed

Slow, gentle and peaceful - Less problematic third stage

Raised Oxytocin

Decreased Adrenaline.

Optimal Cord Clamping –ideally the cord should be empty

Immediate Skin to Skin

Breastfeeding

Time alone to bond

Resources and research

Judith Mercer - Rethinking placental transfusion

bloodtobaby.com

Andersson, O., Domellöf, M., Andersson, D. and Hellström-Westas, L. (2014). Effect of Delayed vs Early Umbilical Cord Clamping on Iron Status and Neurodevelopment at Age 12 Months. JAMA Pediatrics, 168(6), p.547.

Andersson, O., Lindquist, B., Lindgren, M., Stjernqvist, K., Domellöf, M. and Hellström-Westas,