Where should baby be held until cord is clamped?

Keeping baby from mom until after cord clamping is unnecessary, according to a new multicenter, randomized, noninferiority trial.

Researchers from Argentina say that recommendations to make use of gravity to assist placental transfusion by holding a newborn infant at the level of the vagina for at least 1 minute after birth is unnecessary and delays maternal-infant bonding. They say resting the infant immediately on the chest or abdomen of the mother while waiting to clamp the umbilical cord results in no lower volume of placental transfusion; is less cumbersome than holding a squirming, slippery baby; and may decrease iron deficiency in infancy by increasing compliance with delayed clamping.

The investigators divided into 2 groups babies born vaginally during a 1-year period at 3 university-affiliated hospitals. All the babies were born to healthy mothers with normal term pregnancies. The investigators excluded babies born by cesarean or forceps delivery, as well as those with a short or nuchal cord.

The first group of 197 babies remained at the level of the vagina for 2 minutes after birth. The second group of 194 babies was immediately placed on the chests or abdomens of their mothers. All the babies were weighed immediately after birth and again after cord clamping.

The researchers calculated a mean weight change between the 2 weigh-ins of 56 g for the first group of babies and 53 g for the second group. The difference of only 3 g indicated that neither approach was inferior to the other. 

According to the American College of Obstetricians and Gynecologists, physicians in the United States perform most umbilical cord clamping within 15 to 20 seconds of birth, with the infant maintained at or below the level of the placenta, but that “the ideal timing for umbilical cord clamping has yet to be established and continues to be a subject of controversy and debate.”

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