Intended for healthcare professionals

Rapid response to:

Views & Reviews Personal View

Why do obstetricians and midwives still rush to clamp the cord?

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5447 (Published 11 November 2010) Cite this as: BMJ 2010;341:c5447

Rapid Response:

Is it time to end early cord clamping?

Several points from Mr Hutcheon's article are worthy of comment.

Firstly what defines early or late clamping - the literature remains
unclear. Secondly he talks of the physiology of blood transfer but of
course this is probably short circuited by the use of oxytocin in modern
obstetric practice.

He criticises the NICE guidance in the Intrapartum Care guideline but in
spite of two literature reviews the guideline development group (GDG) were
unable to derive a cogent consensus which was sufficiently robust to
warrent a change in practice. There was some evidence of benefit in the
developing world (which was where most of the research had been
undertaken) where babies were often born anaemic but benefit was much less
clear for healthy term babies born in the UK. And could there be any
disadvantages from an infusion of placental blood in the form of neonatal
jaundice , not probably harmful but certainly distressing to parents and
likely to result in the need for investigations.

The conclusion of the GDG and Mr Hutcheon is the same - there is a need
for more research. However the juxtaposition of the article on stillbirth
and the desperate need for research in to it puts everything into context.
I know where I would put my money.

Competing interests: Ex Director of the NCC-WCH for Women and Children's Health 2006 to 2009

13 December 2010
Martin J Whittle
Retired
Emeritus Professor of Fetal Medicine University of Birmingham