Booby Traps Series: Delayed umbilical cord clamping protects breastfed babies

by Tanya Lieberman, IBCLC | March 22, 2012 7:11 am

This is the 35th in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

A few years ago, in preparation for the birth of my daughter, I re-read my birth plan for my son, who was born seven years prior.

The plan mentioned many things about newborn care, but there was no mention of the disposition of the umbilical cord, except that my husband was to cut it.  This time around I knew more, and I wrote a plan that requested that the cord not be cut until it had stopped pulsing.  I requested this because it would lower my daughter’s chances of iron deficiency anemia, and the more I thought about it, might protect breastfeeding as well.

Having too little iron is a serious problem for infants, and can cause many problems including neurological issues and developmental delays.  Certain babies (such as those born prematurely, with low birth weight, or to iron deficient mothers) are at higher risk for iron deficiency anemia.  I strongly encourage you to seek the help of your health care provider if you have concerns about your baby’s iron levels.

Having too much iron is also a problem, as demonstrated by this study which found that unnecessary supplementation of exclusively breastfed babies caused slower growth, smaller head circumference, and more diarrhea.  This is likely due to the “overwhelming” of lactoferrin, a substance in the milk which binds with iron and delivers it to the baby.  When there is too much iron for lactoferrin to bind with, the extra iron serves as a food source for bacteria like E.coli, causing diarrhea and related growth problems.

Traditionally in U.S. hospitals, umbilical cords are cut immediately after delivery.  But research shows that this practice deprives the newborn of a significant amount of blood (its own blood supply, if you think about it), thereby increasing the risk that the baby will become anemic.  Delaying cord clamping for just two minutes can increase iron levels by 33%, and is reflected in babies’ iron stores six months later.

How is this all related to breastfeeding?

There is a lot of debate currently about whether and when exclusively breastfed babies should be supplemented with iron.

Most babies are born with good iron stores from their mothers, and for healthy full term babies these stores should last through the first six to nine months of life.  Also established is that the iron in breastmilk is very well absorbed into the baby’s body – far better than from formula.  As this paper summarizes the evidence, “For an exclusively-breast-fed full-term normal-birth-weight infant with delayed umbilical cord clamping, whose mother had adequate Fe status during pregnancy, the Fe provided from stores and breast milk is sufficient for > 6 months.”

In 2010, the American Academy of Pediatrics issued a new statement on the prevention of iron deficiency anemia, and in it recommended that exclusively breastfed babies be supplemented with iron beginning at 4 months and continued until iron fortified solids are introduced.  This was based on a study which found that babies supplemented with iron had higher hemoglobin levels and higher visual acuity scores at 13 months.  This study was problematic in a number of ways, and it’s unclear when the participating babies’ umbilical cords were cut, but the recommendation still stands.

In response, the American Academy of Pediatrics Section on Breastfeeding argued against the recommendation.  (Yes, that’s the same organization.  My pediatrician’s response when I explained this:  “It would be nice if the organization could agree with itself.”)

The Section on Breastfeeding stated, “Given that research has shown potential harm in infant growth and morbidity when iron supplementation is provided to iron-sufficient infants one wonders if universal iron supplementation will be deleterious to the population of developing infants who are breastfeeding exclusively.”

Their alternative recommendations?  Delayed cord clamping at birth, and screening for at-risk babies at 6 months.  This argument is supported by a recent study which found that delayed cord clamping particularly benefited babies who were exclusively breastfed.

There are other concerns, such as separation of mothers and babies for cord clamping (it can be done with the baby in the mother’s arms, as shown above), and also the pressure to start iron-enriched solid foods before six months.

To circle back to my own experience with delayed cord clamping:  My daughter’s cord was clamped after it stopped pulsing.  Her cord was short and this meant that I had a hard time seeing her for the first few minutes, but that was fine.

At six months her reaction to solids ranged from disinterested to hostile.  More months went by, and I started to get curious about her iron status.  At around ten months my pediatrician suggested that we do her 1 year lead test (standard in New England) a little early and get an iron reading at the same time.  We did, and her iron levels were fine.  At about a year she started showing more interest in solids, and now she eats just fine.

I’ll never know if the delay in clamping her cord was the reason her iron stores remained normal, but I remain pleased in our decision to delay clamping the cord.

Was your baby’s cord clamped right away, or did they wait until it stopped pulsing?  Were you told to give your baby an iron supplement?  How did this relate to your breastfeeding experience?

 



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