Intended for healthcare professionals

Rapid response to:


Umbilical cord clamping after birth

BMJ 2007; 335 doi: (Published 16 August 2007) Cite this as: BMJ 2007;335:312

Rapid Response:

Umbilical Cord Clamping: Try Physiology - Let the baby do it!

The Editorial “Umbilical Cord Clamping after Birth” and its ‘Rapid
Responses’ confirm that the cord clamp is injurious; physiology is not.
Knowledge of fetal, placental, umbilical and neonatal physiology is
essential if cord clamp injury is to be avoided.

Placental blood transfusion is an essential component of
physiological birth; it is controlled by the child’s reflexes and
terminated by physiological cord vessel closure. The neonate thus attains
an optimal, physiological blood volume. This additional blood establishes
the pulmonary circulation and activates all other life support organs in
the healthy neonate. Transition from placental to neonatal life support
may be complete within a minute or two, but it may take more than 20
minutes. [1]

The cord clamp is not a part of human anatomy or human physiology.
If it is applied before physiological cord closure, it disrupts normal
anatomy and physiology, injuring the child by blocking placental
respiration, and by clamping neonatal blood volume in the placenta. The
earlier the cord clamping, the greater is the blood loss and injury. The
extent of injury becomes evident in the degree of hypovolemia, ischemia
and anemia that develop in the neonate.

There is some debate in the Rapid Responses about “conclusive
evidence” on the safety of early clamping, and on documenting the time of
cord clamping. A major portion of peer reviewed literature clarifies
these points. I refer to every article on ischemic encephalopathy and
cerebral palsy (CP) that has been published in the last 20 years. There
are dozens (if not hundreds) of such articles that document hundreds
(possibly thousands) of the birth records of CP neonates.

Nearly every one of these brain-injured children has been subjected
to early or immediate cord clamping. Proof of this is found in the
arterial cord blood pH (ACBpH) report in the child’s record. An arterial
cord blood sample is obtained by clamping the cord while it is pulsating
and while blood is flowing INTO the placenta. [2] ACBpH proves that the
placental transfusion has been aborted, leaving the child hypovolemic,
ischemic and anemic. The clinical signs of hypovolemia (low BP, oliguria)
and of ischemia (MRI brain scan) and anemia (blood transfusion) are also
usually documented on individual CP records. It is very evident that
amputating a functioning placenta is injurious, and that early cord
clamping is a major causative factor in cerebral palsy.

In contrast, thousands of home births across N. America attended by
Certified Professional Midwives (CPM) routinely have cords clamped after
the placenta is delivered; all these babies receive a full physiological
placental transfusion, all have normal blood volumes, and none are at risk
for hypovolemic, ischemic or anemic complications. Physiology is not

This CPM timing of cord clamping is much less injurious than the one
minute wait suggested by Dr. Weeks. If, at one minute after delivery by c
-section, the child is not breathing, is above the placenta and the cord
is still pulsating, the child could be exsanguinated by gravity drainage
of blood into the placenta. A one minute cord clamp would finalize its
fate into ischemic encephalopathy.

Man is the only mammal to routinely injure its newborns with a cord
clamp. All other newborn mammals survive and prosper using the
physiological clamp. The human newborn can also do this.

Cord vessel closure and placental transfusion can be accelerated by
lowering the child below the placental level or by use of oxytocin to
contract the uterus around the placenta; the child should not be elevated
onto the mother’s abdomen. Bewley’s “WATCH before clamping” is sound
advice. The cord arteries should be visibly empty and pulse-less. The
vein clamp can be tested by stripping the cord away from the umbilicus –
the vein should remain empty. If it fills from the abdomen, the intra-
abdominal clamp has not been applied and the child may need more blood
volume; in this case WATCH until the uterus expels the placenta. If the
vein does not fill from the abdomen, the vein clamp can be tested by
gently trying to strip some blood into the child. A tense vein indicates
intra-abdominal closure.

At this point, physiological cord closure and placental transfusion
are complete, and the cord clamp is a completely safe and superfluous
instrument, but it can be used to stop blood from dribbling out of the
placental end of the cord. However, it will usually continue to be
applied to the bloodless cord stump on the abdomen as an act of lack of
faith in Mother Nature, and of pompous obstetrics.

[1] Gunther M. The transfer of blood between the baby and the
placenta in the minutes after birth. Lancet 1957;I:1277-1280.

[2] ACOG Committee Opinion #348, November 2006. OBSTETRICS &
GYNECOLOGY, VOL. 108, NO. 5, 1319.

Competing interests:
None declared

Competing interests: No competing interests

01 September 2007
George M. Morley, MB ChB FACOG
Retired Obstetrician Gynecologist
10242 E. Johnson Road, Northport, MI 49670 USA