Care of the Newborn and Cord During the Third Stage of Labour (Scientific Impact Paper No. 78).

The third stage of labour happens after the baby or babies are born and when the placenta (afterbirth) is delivered. This Scientific Impact Paper reviews new evidence related to clamping of the umbilical cord, and other interventions that impact the birthing woman and newborn during this part of labour. The paper summarises recent additional information on anatomy (structure of the circulation system) and physiology (how the system functions) of the newborn baby's circulation before the umbilical cord blood vessels close, whether naturally or after a clamp is placed on the umbilical cord. The minutes after birth are now recognised as a time of remarkable change within the baby and we have learned that interfering with this natural process can cause potential harm. 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. Since the last Scientific Impact Paper, more 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 (e.g., thermal care, stimulation). 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.