Changing the way a baby is held before its umbilical cord is clamped could improve take-up of a procedure that will improve rates of iron deficiencies in newborns, according to a new study in The Lancet.

Current recommendations on how babies should be held immediately after birth are based on studies conducted 35 years ago. They suggest that the baby needs to be held in the "introitus position," which is at the level of the placenta, so that enough blood can pass from the placenta to the baby.

But this position is cumbersome for the person holding the baby and also interferes with immediate contact between the mother and her child.

Studies have also shown that delaying clamping of the umbilical cord until 2 minutes after birth improves this placental transfusion and reduces the risk of iron deficiency in the infant.

But the researchers behind the new study believe that there may be a low take-up of delayed cord clamping in hospitals as a result of the awkwardness of the introitus position, and that this may result in more babies than necessary having iron deficiencies.

To promote this procedure in hospitals, the researchers compared the effectiveness of the introitus position in transferring blood from the placenta with an alternative, more comfortable position.

Effectiveness of introitus position compared with placing baby on mother's abdomen

Across three hospitals in Argentina, the researchers compared 197 babies who were held in the standard introitus position while undergoing delayed cord clamping, with 194 babies who were immediately placed on the mother's abdomen or chest after birth, while also undergoing delayed cord clamping.

The babies' weights were recorded at birth and immediately after the delayed cord clamping. This allowed the researchers to measure the volume of blood that had passed from placenta to baby.

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Placing the baby on the mother's chest immediately after birth may encourage more hospitals to pursue delayed cord clamping, which could improve rates of iron deficiency in newborns.

They found that there was no statistical difference between the two groups in terms of the amount of blood transferred from the placenta to the baby.

This means that placing the baby on the mother is no less effective than the introitus position, but it does have the advantage of being less awkward, and allows immediate contact between the mother and her child.

Lead author Prof. Nestor Vain explains that "because of the potential of enhanced bonding between mother and baby, increased success of breastfeeding and the compliance with the procedure, holding the infant by the mother immediately after birth should be strongly recommended."

Also, the relative comfort offered by the alternative holding method may encourage more hospitals to pursue delayed cord clamping, which could improve rates of iron deficiencies in newborns.

"Introduction of delayed cord clamping into practice has been sporadic, with logistical issues being one possible reason," admits Dr. Tonse Raju, of the Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, MD.

Writing in a comment linked to the study, Dr. Raju says that it is intuitive to keep the newborn baby's position below the level of the placenta, as gravity should maximize the volume of transferred blood. However:

"...trying to hold on to a wet, vigorously crying, and wriggling infant at the perineum for 2 minutes, in gloved hands, is awkward and can be risky. When the mother is waiting anxiously to hold her baby and the father is taking photographs, 2 minutes could seem like an eternity."

"The study by Nestor Vain and colleagues in The Lancet should bring a sigh of relief from those trying to incorporate delayed umbilical cord clamping into practice," concludes Dr. Raju. "The results are convincing and show that gravity did not have an effect on volume of placental transfusion."