Is Holding a Newborn in the Introitus Position After Delivery Necessary?

Newborns placed on their mother’s tummy or chest when the umbilical cord was clamped did not adversely affect the volume of placental transfusion, an Argentinian study published in The Lancet found.

Investigators sought to show that the long-held recommendation that newborns be in the “introitus position,” or at the level of the vagina, when the umbilical cord is clamped may need updating. By allowing for the baby to rest on the mother’s chest or abdomen, the researchers predict an increase in compliance with delayed cord clamping. 

Pertinent Points

- Placing an infant on a mother’s chest or tummy when complying with delayed umbilical cord clamping does not adversely affect the volume of placental transfusion.

- By changing practice recommendations from holding the infant in the introitus position to allowing the baby to rest on the mother’s abdomen, compliance with delayed cord clamping could be improved.

The idea behind keeping the baby in the introitus position for more than 1 minute is that gravity could affect the volume placental transfusion, the study authors explained. However, holding a newborn in such a way is awkward and delays physical contact between the newborn and the mother.

“Our study suggests that when umbilical cord clamping is delayed for 2 minutes, holding the baby on the mother's chest or abdomen is no worse than the currently recommended practice of holding the baby below this level,” explained lead author Nestor Vain, MD, of the Foundation for Maternal and Child Health in Buenos Aires, Argentina. “Because of the potential of enhanced bonding between mother and baby, increased success of breastfeeding, and the compliance with the procedure, holding the infant by the mother immediately after birth should be strongly recommended.”

Previous studies have indicated that delaying clamping for two minutes after birth allows for blood to pass from the mother's placenta to the baby and reduces the risk of iron deficiency in infancy, the authors note.

The study randomly assigned 546 newborn babies to have their cords clamped after two minutes, either in the introitus position (n=274) or while resting on their mother’s abdomen (n=272). Among those in the study, 77 babies in the introitus group and 78 babies in the abdomen group were ineligible for various reasons, including cesarean delivery, forceps delivery, or a short umbilical cord.

To test the effectiveness of both groups, the researchers weighed the newborns immediately after delivery and then again immediately after the delayed cord clamping procedure. This measurement provided the volume of blood that had transferred from the placenta to the infant.

The study, which was conducted between August 1, 2011, and August 31, 2012, found no statistical difference in the weight change between the two groups (difference 3 g, 95% CI, −5.8 to 12.8; P=0.45), the authors reported. Mean weight change was 56 g for 197 babies in the introitus group, compared with 53 g for 194 babies in the abdomen group.

"Introduction of delayed cord clamping into practice has been sporadic, with logistical issues being one possible reason,” wrote Tonse Raju, MD, of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, in a comment linked to the article. “Intuitively, to keep the newborn baby's position below the level of the placenta in situ should maximise the volume of placental transfusion. However, trying to hold on to a wet, vigorously crying, and wriggling infant at the perineum for 2 min, in gloved hands, is awkward and can be risky. When the mother is waiting anxiously to hold her baby and the father is taking photographs, 2 min could seem like an eternity."