Doctors in the delivery room are increasingly urged to hold off cutting the umbilical cord of a newborn. Delayed clamping, as it's called, allows blood to continue flowing from the placenta, improving iron stores in the baby.
But the practice has been slow to catch on in part because doctors have also been advised that for it to be most effective, they also must hold the wet, screaming infant at the level of the mother's vagina for a crucial minute or longer so that gravity will help blood flow.
Doctors have long considered the maneuver awkward, and now a new study, published on Wednesday in The Lancet, has found that it is probably unnecessary. Babies who were placed on their mothers' stomachs before clamping fared just as well as those who were held lower, the researchers found.
"They found no difference whether the baby was at abdomen level or on the chest, or the baby was held at the vagina," said Dr. Tonse Raju, the chief of the pregnancy and perinatology branch at the National Institute of Child Health and Human Development, who wrote a comment accompanying the study. "It made no difference in terms of extra blood the baby got."
The authors hope their finding will convince doctors reluctant to delay cord clamping to start the practice.
"A mother would prefer to have the baby on top of her," Dr. Néstor Vain, the lead author and a professor of pediatrics at the University of Buenos Aires in Argentina. "And that doesn't change the amount of placental transfusion, and facilitates the procedure for the obstetrician."
The study assigned 194 healthy full-term babies to be placed on their mother's abdomen or chest for two minutes and 197 babies to be held at the level of the vagina for two minutes. All of the newborns were still attached to umbilical cords, and weighed before and after the allotted time.
The group placed on their mothers' abdomens gained 53 grams of blood, while the babies held lower gained 56 grams.
Delayed clamping of the cord remains underused despite mounting evidence that it helps reduce iron deficiency in babies and poses no added risk of maternal blood loss. (A recent analysis did find roughly 2 percent more babies whose cord clamping was delayed had to be treated for jaundice.)
One reason the practice hasn't been more widely adopted could be simply that holding a bloody, squirming newborn is cumbersome, said Dr. Raju. A minute or two in this position, he said, can feel like "an eternity" with an exhausted mother looking on.
Obstetricians also increasingly recognize the benefits of early skin-to-skin contact, said Dr. Jeffrey Ecker, the chairman of the committee on obstetric practice of the American College of Obstetricians and Gynecologists. Immediate contact helps the baby stay warm, promotes maternal-infant bonding and may even improve breast-feeding.
The new study suggests no trade-off is necessary.
"You can delay cord clamping and do skin-to-skin contact, and it's not going to affect the volume of blood that is added to a baby's circulation," said Dr. Ecker, who was not involved in the study.
Premature babies and newborns who needed resuscitation or were delivered via cesarean section were excluded from the study. Research still is needed into blood flow in the umbilical cord in these infants.
Diane Farrar, an author of a review of alternative positions before cord clamping, said some cesarean births may be different for two reasons.
"You cut through the uterus, and the uterus doesn't contract as well, so the effect on placental transfusion may be different, may be less," said Dr. Farrar, a senior research fellow at the Bradford Institute for Health Research in England.
Also, after a C-section the surgeon will sometimes hold the baby up. "If the cord is still intact," she said, "that's a long way up for baby to go, and there's a potential for blood to drain from the baby to the placenta if you do that."
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