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The Placenta Part II: Delayed Cord Clamping and Cord Blood Banking

Posted on June 10, 2015 - 3:10pm
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Delayed Cord Clamping

This is the birth practice whereby the umbilical cord is not clamped or cut until pulsation of the umbilical cord has ceased. A three-minute cord delay allows approximately ninety percent of the blood remaining in the placenta to transfuse into the baby. This blood is a rich supply of stem and immune cells, and may decrease the risk of fetal anaemia in the first six months of life. The World Health Organisation recommends: “delayed cord clamping not earlier than one minute after birth and waiting until the cord has ceased pulsation for improved maternal and infant health and nutritional outcomes.” However, this is of course in the context that there are no complications. If your baby is at all compromised at birth or in need of resuscitation, immediate cord clamping and cutting will occur.

Umbilical Cord Blood and Tissue Banking

An option that you have post delivery is to have your baby’s cord blood and umbilical tissue collected and banked. The umbilical cord is rich in stem cells that are haematopoietic stem cells, similar to those found in the bone marrow. This blood and tissue can be used to generate red blood cells and cells for our immune system. These unique stem cells in your baby’s cord blood can therefore help in the treatment of blood disorders, cancers, and immune deficiency disease such as leukemia and anameia.

Collecting blood from the umbilical cord is both quick and painless for both mother and baby. In Australia, we have two options for cord blood banking: Private cord blood and tissue banking companies cryogenically preserve the blood and tissue for future use exclusively by you, for a fee. These products may be used in future for your baby or another family member, if the need arises. Alternatively, public cord blood banking in public hospitals enables you to freely donate your baby’s cord blood cells for life saving treatments for others in need.

The Third Stage of Labour.

The third stage of labour is the period after your baby is born through to the delivery of the placenta. The third stage of labour is critical in maintaining maternal health and avoiding excessive bleeding known as a post-partum haemorrhage (bleeding in excess of 500mL). The delivery of the placenta can be managed in two ways:

Active Management
Syntocinon, a synthetic form of the hormone oxytocin, is given as an intramuscular injection immediately after your baby is born, into either the thigh or arm. This promotes the delivery of the placenta. Following the injection, the umbilical cord is clamped and cut, (noting that delayed cord clamping can still occur with active management of the third stage). Once there are signs that the placenta is separating from the uterus, such as a small amount of vaginal bleeding and lengthening of the umbilical cord, gentle traction is placed on the cord. The placenta is delivered intact, usually with a uterine contraction. The third stage usually lasts between five and fifteen minutes and is generally completed by thirty minutes post birth.

Expectant Management (Physiological Third Stage)
The umbilical cord is left unclamped, contractions will continue and we wait for signs of placental separation. The contractions may intensify until there is an urge to push and the placenta can be delivered. Once this occurs, the cord is clamped and cut. This process can take up to sixty minutes.

Based on current evidence for best practice, active management of the third stage is recommended in our hospital delivery suites to reduce the risk of postpartum haemorrhage and shorten the third stage. Active management, in particular the injection of syntocinon, does not guarantee that a postpartum haemorrhage will not occur; however it greatly reduces the risk.

Can I delay cord clamping and also have cord blood banking done?

The simple answer to this frequently asked question is no. The research into ‘partial’ cord clamping, whereby there is a delay of approximately one minute, followed by clamping for the collection of cord blood, is inconclusive at present and very hard to measure. As you can imagine, each woman is different in terms of placental size and hence blood volume, and the rate at which her blood is pumped. Cord blood collection requires a certain volume of blood; therefore, delaying clamping, followed by collection of cord blood can risk the success of having an adequate volume. It is important to remember that immediate clamping and cutting of the umbilical cord is, and has been, commonplace practice. However, recent research has shown benefits of delaying this process. It is therefore a personal decision, which you and your family should decide based upon your particular circumstances.

What happens to the placenta after birth?

  1. The placenta is generally disposed of in ‘surgical waste’.
  2. If you have a complicated pregnancy and/or labour, the placenta may be sent for pathological examination.
  3. Provided there are no complications, you can opt to take your placenta home after birth. However, if you choose to do this, you must follow strict health guidelines, as provided by the hospital. Some people like to mark the birth of their baby by burying their placenta in the backyard under a plant or tree. Others choose to consume it for the health and wellbeing benefits. This is called Placentophagia and has been practiced for centuries.

 Placental Encapsulation

The placental encapsulation process is based on traditional Chinese medicine techniques where the placenta is dried and ground and put into gel or vegetable capsules by a certified professional. This process is undertaken within the first few days post birth and the capsules are consumed over a number of weeks within the post-partum period. Placental encapsulation is rising in popularity in Australia. It is claimed that consuming the placenta promotes good post-natal health, improved milk supply and help with post-natal depression.

If you have any questions regarding this information, please feel free to discuss during your next visit.

By Penny Stanbury
Midwife – Dr Morris Sydney Mother & Baby

 


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Topics
cord blood banking   delayed cord clamping   The placenta  
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