The Effect of Delayed Cord Clamping on Breastfeeding
by Anne Eglash MD, IBCLC, FABM
After birth, the umbilical cord is clamped and cut to separate the newborn from the placenta. The question is when should this be done? The World Health Organization considers cord clamping in the first 60 seconds as early, and delayed if done after the first 60 seconds or when the cord stops pulsing.
Delayed cord clamping (DCC) is associated with improved infant iron status for up to 6 months postpartum, because the delay allows infant transfusion of the blood remaining in the placenta. Ideally, infants are placed skin to skin while waiting to clamp the cord.
There is also evidence that DCC improves oxygenation to the brain and body overall, at least in the first few 10 minutes postpartum. The authors of today’s study hypothesized that DCC would increase newborn sucking success because of this improved oxygenation status.
This study performed in Turkey involved 101 low risk primiparous women who had uncomplicated vaginal deliveries with a single infant. The women were randomized to either the early cord clamping (ECC) control group or the DCC experimental group. The researchers documented that the DCC newborns were placed skin-to-skin immediately after birth, but there was no information about the skin-to-skin status for the ECC group.
The researchers measured the newborn’s oxygen saturation at 1, 5, 10, and 15 minutes after birth. They also performed a LATCH score on the newborns within the first 2 hours.
- The LATCH score was significantly higher among newborns with DCC, as compared to those with ECC.
- There was no difference in LATCH score between newborns with DCC vs ECC.
- The oxygen saturation of newborns in the DCC group was the same as the ECC group.
- The oxygen saturation of newborns in the DCC group was higher than in the ECC group.
See the Answer
The objective of this study was to examine the effect of delayed umbilical cord clamping on the newborn’s oxygen saturation and sucking success in primiparas.
The study was conducted based on the experimental model with a control group, between March 15–November 10, 2020. The sample of the study consisted of 101 primiparous pregnant (48 primiparous with delayed cord clamping within 1–3 min and 53 primiparous with early cord clamping within 1 min) (having no high-risk pregnancy, 38–42 weeks, vaginal birth) in Turkey. The data were collected using a personal information form, the LATCH breastfeeding tool and the pulse oximetry. Statistical analyses were conducted using percentage distribution, arithmetic means, chi-square testing, and independent samples t-testing.
Oxygen saturation values of newborns with delayed umbilical cord clamping were higher than those of newborns with early cord clamping. The saturation was first minute 66.43 versus 74.37, fifth minute 81.90 versus 88.60, tenth minute 91.77 versus 94.50 (p < 0.05). When compared to the group with early cord clamping, oxygen saturation is higher in the first by 11.95%, in the fifth by 8.18%, and in the tenth minute by 2.97% in the group with delayed cord clamping. The LATCH breastfeeding scores were found to be higher in the group with delayed cord clamping compared to the group with early cord clamping.
It was determined that delayed cord clamping positively affected oxygen saturation values and sucking success in neonatal babies. Delayed umbilical cord clamping is an important issue that needs to be addressed in its different dimensions. Key words: delayed cord clamping, evidence-based practice, neonatal oxygen saturation, primiparous, SO2, sucking success.
I try to avoid discussing small studies in my blog, but this is the first one I could find on the association between DCC and newborn feeding skills. A significant problem with this study is the lack of information about skin-to-skin status of the infants in the ECC group. IF they were not placed skin-to-skin, then it is not valid to compare early breastfeeding skills in these 2 groups. Nevertheless, DCC naturally enables healthcare staff to place newborns skin-to-skin, because they need to place the newborn somewhere for drying and warmth while waiting for cord clamping.
Even if the infants in the ECC group were placed skin-to-skin just like the DCC group, improvement in the LATCH scores is not necessarily associated with DCC. The LATCH score includes measurements of the actual latch success, audible swallows, type of nipple, nipple pain and positioning. Only latch success and audible swallowing could be modified by timing of cord clamping. The researchers didn’t show the raw LATCH scores, so we don’t know if the improved LATCH scores in the DCC group were based on improved latch success or audible swallows.
The researchers did validate improved oxygen status in the first 10 minutes for infants with DCC as found in other studies.
This is an interesting topic, and further research in this topic is warranted.