In 2007 an editorial by Andrew Weeks advised that it was better for the baby not to rush to clamp and cut the cord at birth (BMJ 2007;335:312, doi:10.1136/bmj.39282.440787.80). He believed that it was time for us to follow the World Health Organization and the International Federation of Gynecology and Obstetrics and that other guidelines should remove the need for early cord clamping as part of active management of the third stage of labour. In the three years since this editorial there has been no significant change in practice and no change in the guidelines of the UK National Institute for Health and Clinical Excellence (NICE). Why are obstetricians so reluctant to change?

All mammals must transfer from placental to pulmonary respiration at birth; and, as with all our functions, Darwinian principles have ensured that this can usually occur without outside intervention. Transition involves ventilation of the lungs, which opens the pulmonary circulation, and this is followed by closure of the placental circulation. During these first few minutes the neonate remains at roughly the level of the placenta. In nature no clamp is involved, and constriction of the arteries (followed by …