In previous subjects we have presented some studies and medical opinions about the moment of the clamping and cutting of the cord. Studies continue to progress but today the highest authority in medicine in the world, the World Health OrganizationIt has a clear position: the cord should not be clamped if there are no very clear medical reasons. Together with this, WHO recommends that the rates of caesarean sections in countries like Spain be drastically reduced and that the application of synthetic oxytocin is only carried out if there are real causes that justify it, early clamping or non-clamping are the best practices that should be implemented and parents inform us about them to request them.
In the WHO Practical Guide on Normal Birth Care Make it very clear what the moment of clamping should be. Below I reproduce some of the most interesting fragments although the full article is available on the WHO page.
"The cord can be pinched immediately after birth or a little later, and this can have consequences on both the mother and the fetus. There are studies about the moment of cord clamping in the newborn (Spears et al 1966, Yao et al 1971). If after the birth the child is placed at the level of the vulva or below that level for a period of time greater than three minutes before clamping the cord, an exchange of approximately 80 ml of blood from the placenta to the fetus (Yao et al 1971). Erythrocytes of this blood volume will be rapidly destroyed by hemolysis which will provide fetal reserves with about 50mg of iron and reduce the frequency of iron deficiency anemia during childhood. The late grip (or even non-grip) is the physiological means of treating the cord and early clamping is an intervention that needs a good justification. The "transfusion" of blood from the placenta to the child, if the late impingement is performed, is a physiological process and adverse effects are unlikely, at least in normal cases. If controlled cord traction is performed after administration of Oxytocin, as is the norm in many obstetrics departments, an early cord clamp is mandatory. However, when someone has been educated about the late clamping of the cord, for example, after the pulsations of the cord have ceased, generally after 3 to 4 minutes, no adverse effects have been described. "
Everything said so far leads me to some reflections on the importance of maintaining and implementing this practice that respects physiological processes. Says the WHO, the first. Apart from that, common sense tells me that interfering with the natural process of childbirth, if there is no very clear justification and studies that support it, should become something in disuse. We do not know to what extent it can have consequences. We do not know everything, everything has not been studied. To think that nothing is going to be discovered is something that I think is a mistake.
For example, until recently in Spain routine episotomy was common. WHO was against it but we still had episotomy rates that reached 90% in the first years. It has been necessary to demonstrate that it is safe and healthy not to cut routinely, instead of requiring that it be demonstrated that an intervention that is supposed to improve natural processes is necessary in all cases. That is still something that I do not understand. Soon things may change, as they are already changing in relation to the cord cut. However, not everything is said, donations of cord blood and the conservation for own use These are topics that I will address in the future.
