Late unbuttoning and cord blood collection. Is it possible?

When is the umbilical cord cut?

According to the current 2018 Regulation of the Minister of Health on the organizational standard of perinatal care, the umbilical cord is cut only after its pulse stops, but not before one minute after the baby is born. However, this is a vague term, and common practice is to wait a minute or so, after which it is safe to cut the umbilical cord. For many Parents, however, it is important to wait even longer until the umbilical cord has completely stopped pulsating. For this reason, they forgo the collection of cord blood in favor of allowing all the blood to flow from the umbilical cord vessels into the baby’s circulatory system. In turn, they don’t realize that late cord severance provides opportunities for cord blood banking.

In the U.S. or Canada, there is a move away from subjective assessment of when the umbilical cord is clamped. According to current recommendations from organizations in these countries, unbuttoning should occur a minimum of 30-60 seconds after birth. WHO
^[i]
also recommends waiting to cut the umbilical cord a minimum of one minute after delivery. Interestingly, the National Institute for Health and Care Excellence (NICE) recommends that the umbilical cord be cut before 5 minutes after the baby is born.^[ii] So it is understandable that due to the ambiguous recommendations, Parents want to wait longer before cutting the umbilical cord. It is believed that in the case of the so-called. of late unbuttoning can be successfully collected cord blood in a volume sufficient for subsequent clinical use (¶ 75 ml). This is blood that remains in the vessels of the umbilical cord and placenta after delivery and would otherwise simply be disposed of by the hospital. 

Early and late unbuttoning

Waiting until the peptic cord is clamped allows the newborn’s circulating blood volume to increase: hematocrit (the ratio of erythrocyte volume to blood volume), hemoglobin and iron levels rise. This is a kind of prevention of the occurrence of possible anemia in the child.  On the other hand, it has been studied that 90% of the blood from the placenta flows to the baby within a few seconds after birth as a result, among other things. the baby’s first breaths and the reduction of external pressure after passing through the birth canal. In addition, waiting too long poses a risk of postpartum jaundice, which can be dangerous to intellectual development and require prolonged hospital stays for the newborn. Therefore, it can not be said , “the later it is unbuttoned the better”.

Hence, the timing of the clamping of the umbilical cord is important. There are two ways of detachment. The first – early – means cutting the umbilical cord less than 30 seconds after birth, or even immediately afterwards. However, it has been proven that babies who are unbuttoned so quickly have a higher risk of the aforementioned anemia. However, this procedure is necessary in certain clinical situations when neonatal resuscitation or other neonatal procedures are required.

Late de-briefing, on the other hand, according to various sources, occurs between 2. a 5. Minutes after birth. The trend toward delaying unbuttoning first appeared in babies born prematurely, where it became a recommendation. Current guidelines indicate that late weaning should also be performed in babies born at term. At the same time, they clearly indicate that the closure of the umbilical cord after one minute is already a “late unbuttoning.” Americans from ACOG (American College of Obstetricians and Gynecologists) in their recommendations^[iii] point out that it can be done after 30 seconds and we are still talking about “late unbuttoning.”

Umbilical cord blood collection vs. late unclamping

“By banking cord blood, you can take away valuable components from the baby, which should flow peacefully from the umbilical cord into its circulatory system after birth.”- this is a very popular myth about securing cord blood. Because of this, many Parents think that in order to be able to collect stem cells, it is impossible to perform a late umbilical cord. On the other hand, by collecting cord blood, we ensure its protection in the future, which is also important. Umbilical cord blood collection does not have any effect on the timing of cord cutting. The midwife or doctor performs it after the umbilical cord is unbuttoned, the timing of which they agree with the Parents.

Technically, the earlier we start collecting cord blood, the more of it we collect. However, even if this occurs 30-60 seconds after detachment – it is still possible and an important amount of blood is obtained for subsequent treatment. What’s more, the Polish Bank of Stem Cells makes it possible to collect blood from the placenta after it has been expelled – this is known as a “blood donation”. second fraction of cord blood.

Thus, the procedure of collecting cord blood does not affect the course of labor, nor does it take anything away from the newborn. On the contrary: valuable stem cells that would have been destroyed without cord blood donation will be safely stored, and may save health or life in the future. If you, as Parents, have made the decision to have a late cord, you can take advantage of cord blood banking. Nothing prevents you from storing this precious material.

If you have any doubts or questions, we are at your service. https://www.pbkm.pl/kontakt/napisz-do-nas

^[i]
 https://apps.who.int/iris/bitstream/handle/10665/148793/?sequence=1

^[ii] https://www.rcog.org.uk/en/guidelines-research-services/guidelines/sip14/

^[iii] https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/12/delayed-umbilical-cord-clamping-after-birth