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Amanda Burleigh is a midwife with a mission. She wants the official NHS clinical guidelines on childbirth to be changed, so that newborns’ umbilical cords are not clamped immediately, but are left attached for at least two to five minutes.
Ms Burleigh, a midwife for 16 years, has been busily lobbying Britain’s professional organisations to achieve this. Now she has launched a mass petition on the internet.
To many people, the precise time at which a baby’s umbilical cord gets clamped may sound like a niggling detail in the great drama of childbirth — or merely the obsessive stuff of hippy-dippy Earth mothers.
The practice of immediately clamping the cord after birth is currently widespread in NHS hospitals
But, as Ms Burleigh points out in her petition, a growing weight of respected scientific research is linking early clamping with a host of serious developmental problems.
Independently published clinical studies and reports say that these may include anaemia, learning difficulties, ADHD, autism and even sudden death.
The scientific evidence convinced bodies such as the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists to change their guidelines last November to recommend delaying clamping for around three minutes after delivery.
The Royal College of Midwives was inspired to make the change by a survey of clinical evidence published by the highly respected Cochrane Review. This came down in favour of delayed clamping — though it did say that doing so may increase the risk of the infants suffering from jaundice.
But the official NHS guidelines still state that the cord should be cut within 30 seconds. That guidance is set to remain unchanged for the time being.
In fact, immediate clamping of the umbilical cord is only a comparatively recent practice. In the 19th century, it was thought that it was better to delay clamping.
Charles Darwin’s grandfather, the physician Erasmus Darwin, wrote in 1801: ‘Very injurious to the child is the tying of the navel string too soon. It should be left till all pulsation in the cord ceases. Otherwise the child is much weaker than it ought to be, a portion of the blood being left in the placenta, which ought to have been in the child.’
And even when the first commercial cord-clamping devices were advertised in the Lancet in the 1890s, the instructions directed that they should be applied only after the cord ceased to pulsate.
However, immediate cord clamping became widely adopted in the Fifties.
A theory emerged that it would help to minimise the amount of anaesthetic a baby might get from its mother’s blood.
This theory has since been disproved, but in the highly medicalised world of modern healthcare, the practice continued to spread because it sped up the birthing process, and speed was considered to be key to efficiency.
Some NHS maternity units such as Worcestershire Acute Hospitals NHS Trust have changed their protocols (file photo)
‘I started thinking about the number of children I was encountering who had special educational needs including ADHD and health conditions such as asthma, allergies and hearing problems.’ When she looked into it, there seemed to be no good reason for cutting the cord immediately — and plenty of reasons against it.
In recent years expert reports have begun to link it to serious risks in childbirth and possibly in later life. Just over a year ago, a study in the British Medical Journal found that babies clamped early were significantly more likely to be anaemic at four months old than those whose clamping was delayed.
The lead researcher, Dr Ola Andersson, the chief physician at Halland Hospital in Sweden, says: ‘Iron deficiency in infants, even without anaemia, has been associated with impaired development, by altering the chemical preconditions in the brain. For instance, a recent study showed a link between iron deficiency and ADHD.’
Dr Andersson is now testing the children he studied to see if immediate clamping has indeed affected their development.
Back in 2007, the World Health Organisation was moved by emerging health worries about anaemia to reverse its guidance on early cord clamping and recommend a delay of up to three minutes instead.
That same year, an editorial in the British Medical Journal advised that the NHS should follow suit and change its official guidelines. These are written by the care watchdog, the National Institute for Health and Clinical Excellence (NICE).
In 2010, this call for change was repeated in the same journal by Dr David Hutchon, a consultant obstetrician at Darlington Memorial Hospital. He warned that professionals and their leaders in the UK were being resistant to change, not least because of the NICE guidelines.
More recently, Dr Hutchon suggested early cord cutting may be linked to a child’s risk of sudden infant death syndrome (SIDS).
He believes the sudden impact of immediate clamping may cause a shock wave in the baby’s natural blood supply that could then harm the baby’s brain — and in particular the part of the brain that controls their breathing. Such breathing problems have frequently been associated with SIDS.
That idea remains moot but certainly the latest Swedish evidence was sufficient to persuade the Royal College of Obstetricians and Gynaecologists to change its own guidelines.
It now says delaying cord clamping by more than 30 seconds may help newborn babies by ‘reducing anaemia’, while premature babies may benefit because it allows ‘time for transfusion of placental blood’.
This was the reason Dr Andrew Gallagher, a consultant paediatrician at Worcestershire Acute Hospitals NHS Trust, changed his unit’s policy on cord clamping. Two premature babies died on the unit in 2009 after they had to have blood transfusions.
‘It became clear to me that delayed cord clamping could have helped them,’ he says. ‘The blood contained in the placental cord comprises between a quarter to a third of a premature baby’s blood volume. If you clamp the cord immediately, the babies are effectively losing it. That blood belongs to them, but they are not given the opportunity to get it if the cord is immediately clamped after birth.’ Dr Gallagher is now a vocal supporter of changing the practice.
While some pioneering NHS maternity units such as Worcestershire Acute Hospitals NHS Trust have changed their protocols so they don’t cut the cord for two minutes or more, nationally ‘early cord clamping is still routine among maternity staff’, according to an article published in the Journal of the Royal Society of Medicine last August.
For even though the midwives’ own professional organisation has reversed its position, this is not in itself sufficient to reverse national practice, says Jane Munro, a professional advisor at the Royal College of Midwives.
‘A change in the NICE guidelines is very important in ensuring widespread change of practice,’ she says. ‘Their guidance is a cornerstone of NHS practice.’
In fact, following years of pressure from leading health professionals and journals, NICE has agreed there is enough evidence for it to review the current guidelines. But this will not happen until October next year at the earliest.
However, Ms Burleigh, who works at St James’s Hospital in Leeds, says there’s no reason why action could not be taken now — and every day of delay may imperil some of the 2,000 or so babies who are born in Britain every day. Her campaign is backed by the Fertility and Birth Network, a collective of pregnancy and birth specialists, and the National Childbirth Trust.
In her latest move, she’s launched a petition to get NICE to make an immediate change.
‘Any delay from NICE is an unnecessary delay,’ Ms Burleigh says. ‘There is strong clinical evidence that, by changing practice now, we could make a difference to the those children who will be born in the UK between now and the review date.’
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