Supporting Newborn Transition: Optimal Cord Management

During birth the compressive squeeze of the vaginal wall forces blood towards the fetal central circulation, to protect the brain, heart and lungs and reduces the impact of harm.

When the baby is born, the peripheral circulation opens, this sudden release of pressure on the newborn body in hypoperfusion resulting in low central circulation and blood pressure. Additionaly, any subsequent hypovolaemia is compounded by immediate cord clamping which causes a drop in blood volume.

Approximately one third of the newborn’s circulating blood remains in the placenta at birth and Immediate cord clamping after birth can cause significant bradycardia especially if the cord is cut before the infant has taken a breath.

Proponents of optimal cord management oppose the idea of any time-based cord clamping and favour a baby-led approach, where the timing of cord clamping is determined by the behaviour and onset of spontaneous breathing of the newborn as well as waiting for cord pulsations to stop therefore we propose to adhere to the WHO (2014) guidance of using a minimum interval of one minute for deferring cord clamping.

In addition to the benefits that come with adequate iron stores; newborn’s whose cords are physiologically managed have an increased total blood volume and this results in having a smoother cardiopulmonary transition at birth.

A further benefit is the addition of stem cells, which play an essential role in the development of the immune, respiratory, cardiovascular, and central nervous systems, among many other functions. The concentration of stem cells in fetal blood is higher than at any other time of life.

Resuscitation/ Additional supportive measures can take place with the cord still intact; unless the cord is compromised.

If the cord length is too short to undertake supportive measures for the baby, such as inflation breathes – then the Resuscitation of the baby takes priority over delayed cord clamping.

Resuscitation/ Additional supportive measures can take place with the cord still intact, where possible, however there must be no delay to supportive measures when indicated.