A brief pause before cutting the umbilical cord of newborns will benefit them by delivering a surge of oxygen-rich blood, the American College of Obstetricians and Gynaecologists (ACOG) suggest.

The new recommendations suggest waiting "at least 30 seconds to 60 seconds after birth," for all healthy newborns - double of what happens now. Currently, doctors cut the cord almost immediately, within 15 to 20 seconds of birth, unless the baby is premature.

A lot of oxygen-rich blood reaches the baby through the umbilical cord shortly after birth, said Dr. Maria Mascola lead author of the guidelines and member of ACOG's Committee on Obstetric Practice.

The blood may flow for up to five minutes, and "there are various recommendations regarding optimal timing for delayed umbilical cord clamping" but majority of the placental blood transfers in the first minute and there is increasing evidence that it has some health benefits, she added.

Supplementing the first few breaths of the baby

It provides a boost when the baby takes his or her first breath, according to Dr. Tonse Raju of the National Institutes of Health. In the womb, the placenta is like the foetus' lungs and within seconds of birth, the lungs of the baby, which were once filled with fluid, will inflate as the baby inhales air.

Cutting the access to lingering placental blood in the cord too soon, will deplete some oxygen to the baby which can supplement the first few breaths.

Before the 1960s, doctors often waited five minutes or more to cut the cord, however as medicine progressed, doctors began clamping and cutting almost immediately.

"Unfortunately, the value of immediate clamping has never been shown," said Raju, a perinatology specialist at NIH's National Institute of Child Health and Human Development, who was not involved with the new recommendation.

Latest evidence showed that premature babies benefit greatly from longer access to cord blood, with a lower risk of transfusions, anaemia and bleeding in the brain. ACOG then issued recommendations to pause before cutting for premature babies.

Now ACOG says that full-term babies benefit from the pause as well, with a lower risk of even mild iron deficiency that could delay cognitive development. One study showed that waiting 3 minutes to cut the cord led to slightly better early brain development.

How long is long enough?

The WHO suggests a minute, other say two to five minutes. ACOG has settled on "at least" 30 seconds to a minute. However long the pause, it should not interfere with early care, including drying and stimulating for the first time and immediate skin-to-skin contact, Mascola said.

Raju recommends telling parents, "While the baby's nice and warm on your skin, we'll take our time and then clamp."

The biggest question is if there is a risk if the cord is not clamped after five minutes. Doctors usually do not delay cutting if the baby has breathing problems and requires emergency care. Initial fears of delayed clamping leading to maternal bleeding has also been proven to be unfounded. However, babies do need to be monitored for signs of jaundice as the risk is slightly increased with delayed clamping.

Delayed clamping also results in less umbilical cord blood to be stored for possible future medical use. ACOG suggests that families should be counselled accordingly for an informed decision to be made. MIMS

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