Lost Causes and Side Effects: The Neurological Damage Caused by Immediate
Cord Clamping is Irreversible

by G. M. Morley, MB, ChB (Ed.), FACOG

A recent study in the British Medical Journal adds more evidence to the
association of infant anemia with neurological impairment [1]. However, the
small improvement in language/motor disability with iron therapy in this
study contrasts with other studies which show no resolution of grade-school
neurological defects with iron therapy in infancy.

This difference may be explained by the fact that the study took place in
Zanzibar, rather than in a Western nation, engaging in modern medical
childbirth practices. This is due to the fact that there are differing
causes of the anemia and, consequently, different primary causes of the
neurological defects.

Neonatal asphyxia (hypoxia) for as short a time as six minutes causes
permanent neurological damage - death of neurons. Loss of brain tissue has
been demonstrated in asphyxiated newborn primates and correlated with memory
dysfunction and spastic paralysis. [2]

During a "normal" birth (unclamped umbilical cord), continuous brain
oxygenation is provided by the placenta until the infant's lungs are
oxygenating the brain. At this time the cord vessels close reflexively.
During this interval, the placental transfusion supplies additional blood
volume for adequate perfusion of the pulmonary vessels and gaseous
exchange.[3][4] This duplicate placental/pulmonary oxygenation precludes
hypoxic brain damage and adequate blood volume prevents ischemic brain
damage.

On the other hand, immediate cord clamping, as promoted by the American
College of Obstetricians and Gynecologists (ACOG) [4] and as unnecessarily
demanded by resuscitation neonatologists, produces immediate neonatal
asphyxia until the lungs begin to function. It also prevents placental
transfusion, thus delaying adequate pulmonary perfusion and pulmonary
respiration.[3][4]

If the consequential asphyxia is not reversed within six minutes, brain
damage will occur and progress, until the lungs begin to function.

The immediately clamped newborn, deprived of up to 50% of its normal blood
volume, is also doomed to develop iron deficiency anemia.[6]

The child which is delivered without the use of a cord clamp receives a full
placental transfusion with enough iron to prevent anemia for the first year
of life;[6] newborn hemoglobin levels are high regardless of the iron status
of the mother. Such a child would appear to be immune to neurological
defects "caused" by anemia. Hurtado, et al, correlated the degree of grade
school mental deficiency with the degree of infant anemia.[7]

Thus, neurological defects of hypoxic/ischemic origin share a common cause
with infant anemia - premature clamping of the umbilical cord at birth. The
anemia is NOT the primary cause of the neurological defect, but a
coincidental effect of hypovolemia (inadequate blood volume) induced by
immediate cord clamping.

Unfortunately, treatment of the resulting anemia will be of very limited
benefit. The hypoxic/ischemic brain lesions will not improve with treatment
of the iron deficiency anemia, nor with any other treatment.

In many "primitive" births, the mother or midwife severs the cord (without
ever tying or clamping) after delivery of the placenta, long after the
natural placental transfusion is complete. If this occurred, these neonates
would not be anemic, hypovolemic or asphyxiated. Any subsequent anemia, such
as that found in the study of anemic children in Zanzibar[1], must have
developed gradually after birth. The language/motor defects seen and their
subsequent improvement with iron supplementation may indicate neurological
impairment caused by anemia and reversible by its correction.

Physiological cord closure (facilitating placental transfusion) produces a
physiological blood volume optimal for survival, and a healthy, normal baby.
Contrary to common misconceptions, it does not routinely cause pathological
jaundice, hypervolemia (excess blood volume), hyperviscosity, polycythemia
or plethora; if it did, the human race would be extinct.

Immediate cord clamping, as endorsed by ACOG[5] is a dangerous practice that
is universally condemned in the literature. It causes loss of placental
oxygenation and lack of blood volume; the consequent hypoxic, ischemic
encephalopathy may cause obvious damage resulting in neonatal death[8] or
spastic paralysis, or it may be so mild as to cause behavioral defects which
only become apparent years later. The associated infant anemia[7] is only a
reflection of how much of the infant's blood volume was left clamped in its
placenta.[9]

The cord clamp is a very dangerous instrument.[3][4]

British Medical Journal web site, posted December 17, 2001

References:
[1] Stoltzfus RJ, Kvalsvig JD, Chwaya HM, Montresor A, Albonico M, Tielsch
JM, Savioli L, Pollitt E. Effects of iron supplementation and anthelmintic
treatment on motor and language development of preschool children in
Zanzibar: double blind, placebo controlled study. BMJ 2001;323:1389.

[2] Windle, WF. Brain Damage by Asphyxia at Birth. Scientific American 1969
Oct; 221(4):76-84.

[3] Morley GM. Cord Closure: Can Hasty Clamping Injure the Newborn? OBG
MANAGEMENT July 1998, 29-36.

[4] Morley GM. Letters. Mode of delivery and risk od respiratory diseases in
newborns. OBSTETRICS & GYNECOLOGY, Vol 97. No.6 June 2001 1024-1026.

[5] ACOG; 1995 Umbilical Artery Blood Acid-Base Analysis. Educational
Bulletin 216.

[6] Linderkamp O. Placental Transfusion: Determinants and Effects. Clin
Perinatol. 1982 Oct;9 (3):559-92. 1982; 9: 559-592.

[7] Hurtado EK et al. Early childhood anemia and mild to moderate mental
retardation. Am J Clin Nutr. 1999; 69(1): 115-119

[8] Peltonen T. Placental transfusion - Advantage and Disadvantage. Euro.
Journal of Paediatrics, 1981; 137: 141-146.

[9]Erasmus Darwin, Zoonomia 1801: "Another thing that is very injurious to
the child, is the tying and cutting of the navel-string too soon; which
should always be left until the child has not only repeatedly breathed, but
also until all pulsation in the cord ceases. As otherwise the child is much
weaker than it ought to be, a part of the blood being left in the placenta,
which ought to have been in the child."

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