My wife and I are expecting a baby. Our doctor's nurse has told us that the umbilical cord must be cut or at least clamped immediately after birth to avoid excess bilirubin. We have found nothing in our research to confirm this -- in fact, we've read that waiting one minute for the pulsations to stop decreases chances of anemia. We don't want the cord to be clamped or cut immediately. What can you tell us about the pros and cons of delaying clamping or cutting? What evidence can we show our doctor?

--Matt

In a difference of opinion, it?s important to consider your doctor?s advice. He/she has a lot of experience in the field. There is no reason to clamp the cord immediately if the baby is held at the level of the uterus or lower. If the baby is placed on mom's tummy immediately and is therefore higher than the uterus, then the cord should be clamped to prevent any blood from flowing from baby to placenta and therefore causing anemia. It is true that waiting for pulsations to stop spontaneously will decrease anemia in the baby. The risk of the baby getting too much blood and becoming volume overloaded is exceedingly small in a full-term, healthy baby; in a premature infant, this is much more of a consideration.

As far as a reference, point your doctor to the "bible" of obstetrics: Williams Obstetrics, 20th edition, page 336 -- the section titled "Timing of Cord Clamping." It supports your position.