While all the media attention on the new NICE guidelines focused on the recommendation that low-risk women should be able to give birth at home or in midwife-led units, another important recommendation was largely overlooked.
This says that, when the baby is born, the umbilical cord should not be clamped immediately:
“Do not clamp the cord earlier than 1 minute from the birth of the baby unless there is concern about the integrity of the cord or the baby has a heartbeat below 60 beats/minute that is not getting faster.”
The question of when to clamp the umbilical cord is surprisingly contentious – there are arguments for and against early clamping. For years the default position was to clamp the cord quickly after the baby was born. But the evidence now is overwhelmingly in favour of delaying it. This is because after birth, the cord pulsates as it continues to deliver oxygen- and nutrient-rich blood to the baby from the placenta.
Why is new recommendation important?
It shows the increasing importance of evidence in the management of childbirth. Many traditional assumptions by the medical profession about what is best have had no basis in evidence. As Ben Goldacre points out in Bad Pharma, those untested assumptions often turn out to be wrong.
From the end of World War II, childbirth became increasingly medicalised, in the belief that hospital-based births in which women gave birth lying down strapped to a monitor were safer for women and babies. Campaigners who challenged this view were (and still are) often dismissed as being hippy-dippy natural birth fanatics, but with the growth in evidence-based medicine, they have often been proved to be right.
We know now, for example, that hospital births aren’t always safer. That walking around rather than lying flat on one’s back can help the progress of labour. That a compulsory enema isn’t an essential part of giving birth. And so on.
A move towards evidence-based practice can only be a good thing. It means that doctors have to justify their decisions on the basis of what the evidence shows, and women can make an informed challenge to a doctor’s decision. None of this is easy but it does mean that the days when doctors were automatically assumed to be right may be slowly disappearing.
So, let’s give a small cheer for NICE and its new guidance. Every change based on evidence rather than doctor-knows-best assumptions is, in the long run, good for women – and their babies.