Delayed Cord Blood Clamping

Introduction

Delayed umbilical cord clamping (DCC) is common among term and preterm infants. It is a beneficial term that is said to increase hemoglobin levels at birth improving iron stores in the several months of life after birth. The iron stores are favorable on the developmental outcomes of the infant. Additionally, this condition is associated with an increase of jaundice, though small, but it requires phototherapy, especially on term infants who have been undergoing this delayed umbilical cord clamping. It is the role of the obstetrician-gynecologists and obstetric care providers to ensure that infants with this delayed condition, are placed monitored and treated for neonatal jaundice. Additionally, on preterm infants, the condition is also associated with other neonatal benefits that include increased red blood cell volume and decreased need for blood transfusion (American Academy of Pediatrics, 2017). Conversely, the condition is not attributed to blood losses in mothers during birth, nor increased hemorrhage. However, the delayed cord blood camping which should take place between 30 to 60 seconds, after birth depends on the nature of the institution's efforts, and every organization is in the race to ensure that its practice is based on this quality. This essay addresses various reviews of literature that have been presented by different scholars on the discussion for delayed cord clamping.

Literature Review on Delayed Cord Clamping Implementation

Implementation of Delayed Cord Clamping in Hospital Setting

Delayed umbilical cord clamping (DCC) is a condition that permits transfusion between placental-to-newborn transfusion and results. In this case, there has been an increase in the neonatal blood volume of infants aged below 1 year. However, the endorsement by most of the medical government bodies has been reluctant to adopt DCC in their institutional practice. Adams, Backes, and Hutchon (2015) present information on the implementation of the DCC practice in the hospital environment, based on guidelines that are best developed by a specialist using their experiences. However, a quality improvement should be in compliance with DCC performance that takes place within the first six months, which are followed by treatment protocol.

Additionally, the implementation of DCC in the hospital setting should follow some well-structured procedure. These latter procedures include the application of multidisciplinary educational approaches that focus on motivational potential stakeholders that have been impacted by DCC. Further, addressing the issues that concern safety on this condition, thus developing a profound treatment, primarily the developing a standardized DCC treatment protocol. The steps of administering the latter treatment in the first months to premature newborn babies are done in the neonatal intensive care unit. They have been promised of cure with the treatment protocols but the overall compliance is decreasing significantly with time. Besides, the information on DCC presented by most of the obstetricians reveals the risks and benefits of DCC in the past 6 months (McAdams, Backes & Hutchon, 2015). These specialists have a great understanding of maternal hemorrhage, where the baby needs to be resuscitated, immediately for cord clamping. Moreover, when working to promote evidence-based practice on DCC we should focus on meta-analysis reviews to capture relevant randomized control trials (RCTs) and evidence from well-designed controlled RCTs, which make the level I and level II  of evidence respectively. The overall implementation of new DCC practice in the nursing department, primarily attracts planning and actions that focus on modification of the existing and collective behavior and a goal that the institution aims at achieving when dealing with these premature newborns. These efforts, significantly vary from organization depending on the condition of the institution in terms of dissemination accuracy, consistency in practice, which is determined by the health organization preparedness.

DCC Implementation in Premature Infants

Various benefits on neonates are a result of delayed cord clamping. These benefits are seen in the community-based perinatal care setting where the DCC practice takes more than 60 seconds on infants within the suckling ages. The community clinicians present to us that the adherence and best practice that incorporates DCC for premature infants. This practice also helps in reducing the initial labor and delivery pains, for mothers who give birth to premature infants. However, creating and initiate the practice in the community-based nursing department is not an easy thing as it demands evidence-based clinical practice guidelines (Pantoja et al., 2018). The latter guidelines are sought from key stakeholders who need to provide timely feedback that focus on the DCC providers to ensure the great performance of the process.

However, the implementation of the DCC is not an easy practice in the community-based clinical departments. The reason for this fact is that the community based clinical institutions are majorly non-profiting thus lack motivation on practice. The fact that services in this nature of institution are cheaper is also a challenge to the clinical practitioners, as they expect a huge number of deliveries on daily basis. The supply of gynecology-obstetricians in these clinics is also limited when compared with the number of people visiting the institution, thus opt to hire mid-wives and train residents on how to handle DCC related issues (Pantoja et al., 2018). Although the trainees help much they still have a challenge meeting the 60 seconds on DCC for all eligible premature infants with gestational age less than 35 weeks. Through increased training and community commitment, implementation of DCC for premature infants can turn to be one of the most successful practices, thus increasing gestational age, and more importantly, develop evidence-based guidelines. The success of the entire process is determined by the efforts of the stakeholders, which include the community residents.

Delayed Cord Clamping and Stressed Newborn Tables

Delayed Cord clamping is a medical practice that entails cutting the umbilical cord. Cord clamping exists in two types, which are lotus birth and delayed cord clamping (Malloy, 2016). Malloy insists and emphasizes delayed cord clamping, which is found to be safe, and it advantageous to both the mother and its baby. This type of clamping applies to mothers who have a cesarean or vaginal delivery. Stressed newborns and premature babies need special medical attention and this can be achieved through delayed cord clamping. According to lily’s story, we learn that lotus birth, which involves the immediate cutting of the umbilical after birth, is dangerous as she shouted as the doctor was trying to separate the mother and its baby. After the separation (cord clamping), the baby is taken to a special room (warmer) where they are taken care of by provision of oxygen, warmth, and suction capability. Delaying clamping reduces anemia and iron deficiency and also improves the iron status of the infants both prematurely and with complications. Delayed cord clamping improves the neuro-development benefits as well as cognitive and fine motor development.

Traditional midwifery teaching suggests that delayed clamping helps in correcting physiological disorders such as low blood volumes, difficulties in breathing, and insufficient blood circulation in the brain (Malloy, 2016). Immediate clamping and cutting of the umbilical cord and taking the baby to the warmer increases the risks of babies being stressed further, hypovolemia (low blood volume circulating in the body). In New York City, after a baby has been born, clamping, and cutting done, it receives extra medical care from a pediatrician. Therefore, there is a need to adopt new movable tables in every maternity or delivery room. This will enable individuals to understand the significance of keeping a baby connected to its mother especially when the baby is a stressed newborn, have meconium, or is born by cesarean.

Essential Antenatal, Perinatal, and Postpartum Care

The study focuses on understanding the knowledge and skills of health professionals and policymakers that are needed in maternity care and modern practices and technologies used for pregnancy care. It also involves labor and birth care controls and the postpartum period. Antenatal care helps women to remain healthy and this also improves the health condition of the unborn baby (World Health Organization, 2002). It requires support from health care workers and family or partners to help the pregnant woman transit to parenthood. The health workers provide specialist care and antenatal education, teaching the women about the knowledge skills that help them to protect their health. Antenatal health care involves pre-pregnancy and inter-pregnancy care. This helps in health promotion and also influences fertility rates considering internal and external factors. This type of care monitors pregnancy progress to ensure the mother and the fetus are safe. It provides support and psychological pregnancy adjustment, parenthood, childbirth, and breastfeeding practices. Antenatal care helps the women and their caregivers to build a trusting relationship and gives them appropriate information that is used to make decisions.

Perinatal care focuses on protecting the lives of mothers and infants. It occurs the time before and after birth when the baby is in its mother’s womb. This care is used to help mothers after birth. At this period, mothers are required to get enough rest, eat an appropriate diet, and vaginal care (World Health Organization, 2002). Finally is postpartum care, which occurs six weeks after childbirth. This period is important as it helps a mother build a bond with her baby. It involves a transition to motherhood, and also post-delivery checkups for both mother and the baby.  During this stage, women need to get plenty of rest, eat healthy meals, engage in exercises, and seek help from friends and family who can prepare meals, help with other tasks at home and run errands. In conclusion, appropriate antenatal, perinatal, and postpartum health care services play an important role in promoting fertility rates and the health of mothers and their babies. Besides, it helps to reduce infant mortality rates as well as the risk of losing a mother’s health.

Effects of Delayed Cord Clamping Of Term Babies at 12 Months

Various impacts of DCC are seen on infants at the age of 12 months. The impacts can either be positive or negative, some of which are presented by Rana and colleagues in their article written in 2018. DCC in most cases is attributed to the reduction of anemia, especially in children aged one year and four, these impacts are associated with an increase in iron in infants. The infants’ connection between the parents is a good interface for the newborn babies to access oxygen and nutrition from the mother’s blood through the umbilical cord (Rana et al., 2019). The connection via the placenta is of great help to the infant but a challenge to the mother as it causes third stage labor. The importance of the child is to increase blood supply for the child and protect the infant also from iron deficiencies, which can be from birth to up to a period of 8 months.

Additionally, DCC helps in increases the risks of polycythemia, which is an increase in the number of red blood cells in the body. This process causes healthy difficulties in children as it results in blood clots due to increased blood thickness, which perhaps leads to adverse effects on both the mother and the infant. Despite the need for increased discussion and debates on DCC, there is still much that needs to be done to comprehensively understand the impact of this delayed condition. The concern should focus on evaluating the importance of iron, some of which include the development of the brain. Additionally, in the prevention of anemia, which results from negative effects of neurocognitive development. Other effects that might develop in the children include learning impairments, behavioral complications, and poor emotional and social development and sometimes result in an increase in the fatty sheath surrounding the neuronal process, thus impacting electrical transmission in the body.

Delayed Umbilical Cord Clamping After Birth

The American College of gynecologists and obstetricians plays an important role when addressing the issues revolving around DCC. According to them some procedures and recommendations need to be considered when timing the DCC process after birth. For in term infants DCC should increase the hemoglobin levels at birth thus increasing iron content achieving good developmental outcomes (American Academy of Pediatrics, 2017). DCC for preterm infants increases transitional circulation, the establishment of red blood cells, lowered demand for a blood transfusion on infants, and thus decreasing the instances of intraventricular hemorrhage. It now for these conditions that professional organizations would be in a position to encourage DCC for at least 30 to 60 seconds after birth.

Conclusion

Delayed umbilical cord clamping has many benefits attributed to it, this period should range from 30 to 60 seconds. This practice however is determined by the effort of the clinical organization. For both term and preterm infants, this process helps in gaining iron, which is essential in the developmental characteristics of children. Additionally, failure to initiate the DCC infants born might develop cognitive challenges, thus a need for implementation of a mechanism that would help monitor and treat neonatal jaundice. Also, an implementation needs stakeholders’ commitment and focus to ensure that infants benefit from the entire practice, which should involve training of the community and midwives to handle these mothers. Conversely, DCC might lead to negative effects such as anemia that affects the overall infant development.

 

References

American Academy of Pediatrics. (2017). Delayed umbilical cord clamping after birth. Pediatrics.

Malloy, M. E. (2016). Delayed Cord Clamping Requires a New Table for Stressed Newborns. Midwifery today with international midwife, (117), 59-62.

McAdams, R. M., Backes, C. H., & Hutchon, D. J. (2015). Steps for implementing delayed cord clamping in a hospital setting. Maternal health, neonatology, and perinatology, 1, 10

Pantoja, A. F., Ryan, A., Feinberg, M., DeMarie, M., Britton, J., Liptsen, E., Chen, M., & Crow, J. (2018). Implementing delayed cord clamping in premature infants. BMJ open quality, 7(3), e000219. https://doi.org/10.1136/bmjoq-2017-000219

Vento, M., &Lista, G. (2015). Managing preterm infants in the first minutes of life. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25827245

World Health Organization. (2002). Essential antenatal, perinatal and postpartum care: training modules (No. EUR/02/5035043/2). Copenhagen: WHO Regional Office for Europe.

Rana, N., Ashish, K. C., Målqvist, M., Subedi, K., & Andersson, O. (2019). Effect of delayed cord clamping of term babies on neurodevelopment at 12 months: a randomized controlled trial. Neonatology, 115(1), 36-42.