Summary
The third stage of labour happens after the baby or babies are born and when the placenta (afterbirth) is delivered.
The minutes after birth are now recognised as a time of remarkable change within the baby. Up until birth, the fetus's oxygen supply comes from the mother via blood flow through the umbilical cord. The baby's first breath promotes rapid and profound changes to the circulation, allowing the baby to transition to a new oxygen supply from its own lungs. Fetal blood handles oxygen in a different manner to adult blood, which may be more important immediately after birth when the baby takes its first breaths.
Evidence confirms there is very little justification for immediate cord clamping at all gestations. Neonatal harm and death can be reduced when blood from the placenta is allowed to transfuse spontaneously to the baby in the minutes following birth. Those attending the birth should avoid intervening too early or too much while providing initial care. The benefits of waiting a few minutes before clamping are especially significant for premature babies.
Early cord clamping will result in the baby having a lower blood volume as it is estimated that a baby at full term will receive around 30% of its total blood volume from placental transfer via the umbilical cord. The decision on timing to clamp the umbilical cord should be based on observations of the baby, its heart rate and breathing rather than a predefined interval after birth. Also, the palpable pulsation of the cord is unrelated to the blood flowing back and forth therefore it should not be used to guide the time when clamping occurs. Clamping at the placental end allows some blood in the cord to transfer to the newborn. There are other benefits to the baby from the placental transfer of blood such as transfer of stem cells.
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