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Strictly Physiological Neonatal Transition at Birth

David JR Hutchon FRCOG

For over 100 years, according to some experts, the umbilical cord has been clamped and cut much too quickly after birth. The rationale for this intervention was never established but impatience to separate the neonate and mother was probably the main reason. It was certainly not started with any intended health benefit for the neonate. With the formal recommendation of active management of the third stage of labour [AMTSL] in the 1980's, early cord clamping was included as one of the required elements for successful reduction in post-partum haemorrhage [PPH] probably to facilitate controlled cord traction, one of the other elements of AMTSL. Since the 1980's it has been recognised that early cord clamping plays no place in reducing PPH. Early cord clamping has been shown to have harmful effects on the immediate health of the neonate. The intervention has been withdrawn as part of AMTSL by most authorities and by ILCOR in its advice for the care of the neonate. Early cord clamping was introduced by accident and has well documented short term harms. More research has been called for but is it possible that there are long term benefits of early cord clamping which defy rational explanation?