Improving the health of billions by strategically spreading a simple idea.
Anemia hinders a quarter of the global population, and is disproportionately concentrated in low-income groups. Iron deficiency is the leading cause of anemia – but with iron deficiency, anemia is just the tip of the iceberg. Even when iron deficiency is not severe enough to cause anemia, it has been linked to lasting damage to the developing brain. Infancy is thus both one of the most important as well as most common life cycle windows for iron deficiency. The World Health Organization estimates that solving iron deficiency in a developing nation would increase productivity by 20 percent.
Given that human milk is the ideal food for human infants, why is breast milk relatively low in iron, and why are exclusively breastfed infants at risk for iron deficiency? Perhaps, infants are designed to also receive iron from their mothers in another way.
At the moment of birth, about 2/3 of the baby’s blood (the fetal circulation) is in the baby. The remaining third is still in the umbilical cord and placenta. During the third stage of labor, which lasts from the delivery of the baby to the delivery of the placenta, the cord actively pumps iron-rich, oxygen-rich, stem-cell-rich blood into the baby.
Immediately clamping the umbilical cord was popularized in 1913 as one of three pillars of active management of the third stage of labor. While this intervention began in the West, we exported this technique to developing nations around the world. Today, in some low-income countries as many as 95 percent of delivery clinicians surveyed practice immediate cord clamping. Immediate cord clamping results in up to 10x the risk of developing iron deficiency anemia.
Alan Greene at TEDxBrussels for Ticc Tocc
Wait until the cord stops actively pumping fetal blood into the baby, unless there is a strong reason otherwise. This has been studied in countries such as Argentina, Australia, Bangladesh, Canada, India, Libya, Mexico, Pakistan, United Kingdom, USA, and Zambia. Optimal cord clamping (a more accurate term than the more frequent ‘delayed’ cord clamping) has been shown to be both safe and effective at significantly reducing the risk of iron deficiency. Other benefits may include reducing birth asphyxia (inadequate oxygen to the brain) and cerebral palsy. The health benefits from receiving the cord’s pluripotent stem cells may be the most significant impact, but has yet to be understood.
Immediate cord clamping is an active medical intervention with unproven benefit. The WHO no longer recommend immediate cord clamping.
TICC TOCC (Transitioning Immediate Cord Clamping to Optimal Cord Clamping)
Modeled on the success of the WhiteOut Now campaign to end the introduction of processed white flour rice cereal to babies, TICC TOCC will leverage existing networks to spread the word to mothers and those who assist them in giving birth.
Spreading an idea that makes intuitive sense is cost effective and a simple first step to addressing a major global health problem. Moreover, it can be expected to amplify the benefits of existing nutrition and supplement programs.
Not only have people around the world traditionally waited for the cord to stop pulsing until the 20th century innovation, every other mammal studied instinctively waits for the cord to stop pulsing as well.
More than a quarter million babies will be born today. The clock is ticking.
Alan Greene, MD, FAAP
March 20, 2012
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