Delayed cord clamping may also be beneficial in rich settings

Delayed cord clamping reduces infant anaemia in resource poor settings.¹ There are, however, other implications, and neonatal anaemia is still important in developed countries. In Darlington we have a guideline to delay cord clamping for at least 40 seconds.²

It was a pragmatic decision to make 40 seconds the interval, and the rather longer time as suggested by van Rheenen and Brabin is likely to be closer to the physiological interval. We have also developed a method of resuscitation of the neonate at caesarean section with the cord intact .Although this method has not been included in the guideline there are plans to do so.

Fetal distress is a common reason for instrumental delivery or caesarean section. The fetal compromise is often due to cord compression associated with a nuchal cord. A nuchal cord results in compression of the low pressure venous return of oxygenated blood from the placenta. Blood continues to be pumped out by the fetal heart, and the obstructed return from the placenta results in a congested placenta and a depleted fetal blood volume. If the cord is clamped immediately at delivery, although the return from the placenta is now relieved, the excess blood, which is oxygenated blood, never has any opportunity to return to the newborn. In these circumstances it is particularly important to be able to resuscitate the baby with the cord return still intact. Preparation for neonatal resuscitation needs to be made at the same time as preparation for the caesarean section. Every maternity unit in the UK needs to adopt these guidelines.