Delayed cord clamping refers to the practice that involves cutting of the umbilical cord only after pulsations end and the placenta is delivered. The process takes in about three minutes after the delivery of a baby. Amongst healthcare providers, new parents as well as researchers, the decision to proceed with delayed cord clamping after the birth of a baby has popularity. A question that many wonder is the effect of the delayed cord clamping on the bilirubin levels, haemoglobin and haematocrit as well as the residual placental blood volume of the newborn.
Delayed cord clamping has limited practise. It raises the fear of the newborn getting polycythemia and hyperbilirubinemia (Mercer et al., 2017) . It is until the year 2013 that research was conducted in the United States on delayed cord clamping and the effects on infants. The research concerning the impact of the delayed cord clamping on infants was done between July 2013 and November 2015 period. The research was undertaken at Providence, Rhodes Island's Women and Infants Hospital involved a total of 73 women expecting healthy newborns at term. The research proceeded after the informed consent of the women.
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For purposes of quality of the research, the women recruited on the conditions that, they had healthy babies in a vertex position at term, were of legal age, had no obstetrical problems, spoke English and had breastfeeding plans (Mercer et al., 2017) . An intervention group consisting of thirty-seven women were selected randomly, and the other thirty-six women were randomly selected also to form the control group. After delivery, the infants of the women in the control group had cord clamping done immediately in a time frame less than twenty seconds. For women in the intervention group, the infants were placed on the abdomen of the mothers, in the skin to skin manner. The infants then received a five minutes delay in the cord clamping, and for precision in time, a stopwatch was used to do the timing. For the women that had complications regarding vaginal delivery, and had to deliver through the caesarean section, had the umbilical cord of their infants milked five times before clamping.
The collection of the residual placental blood volume was achieved through the draining of the cord to the point that there was no more blood return to the collection bag used (Mercer et al., 2017) . The blood collected was then weighed. Determination of the amount of blood transfused to the infant is dependent on measuring the residual placental blood volume in the period between birth and clamping of the cord. After delivery, the metabolic sample of the infant was taken through the heel of the newborn (Mercer et al., 2017) . The metabolic sample was taken between 24 and 48 hours after birth.
The results obtained from the study indicated that delayed cord clamping generally has beneficial impacts on the infant. From the results of infants in the controlled group, six of them had haematocrit levels exceeding 65% but developed neither the symptoms of polycythemia or received treatment for it. By coincidence, five of the infants falling under the control group had hematocrit levels below 47%. Of the five infants, none received treatment for anaemia according to the decision of the paediatricians (Mercer et al., 2017) .
Regardless of whether the infants had delayed cord clamping or not, the bilirubin levels proved insignificant. From the research, infants from both the intervention and control groups during their stay in hospital received phototherapy. Finally, the results from the study showed that the infants who had umbilical cord milked or delayed cord clamping had lower residual placental volume amounts. In line with the research, that reiterates the impacts on the health and growth of infants, an increasing number of parents are considering delayed cord clamping for their newborns. The importance of the practice includes reduced anaemia or iron deficiency, given that the baby gets sufficient erythrocytes. Additionally, delayed cord clamping aids in the reduction of blood transfusion for the infant and also betters neurodevelopmental outcomes of the infant. For the case of premature babies, delayed cord clamping is essential because it offers live support. The transfer of oxygen to the infants improves the immune cells; thus, brain injuries, organ damage and death are prevented. Childbirth has significantly improved with the practice of delayed cord clamping.
The nursing practice achieved a significant impact on the implementation of delayed cord clamping practice. For purposes of advancing the practice of delayed clamping, new developments are being put into place. Among the evidence-based implementations, one of the primary ones is the somersault manoeuvre. The somersault manoeuvre involves clamping of the cord during the delivery process when the shoulders are out. The clamping after the delivery of the shoulders helps increase the time necessary for the infant to regain haemoglobin and blood cells from the placenta.
Literature review’s Findings Summary
Journal 1
Delayed cord clamping reduces the need for blood transfusion in infants. Additionally, in comparison to early cord clamping, delayed cord clamping indicates a notable increase in the levels of haemoglobin for infants. Delayed cord clamping reduces instances of intraventricular haemorrhage. The practice of delayed cord clamping has no record of neonatal risks.
Nursing practices play a significant role in reducing the occurrence of instances such as infant deaths, maternal deaths, as well as stillbirths (Brocato et al., 2016) . Provided that an infant is placed below the perineum, studies show that harm is reduced for a fully developed infant despite a delay in cord clamping of even ten minutes. Nursing professionals advocate for the practice of somersault manoeuvre that requires that the nuchal cord should be clamped only after the delivery of the shoulders. From the journal, delayed cord clamping has provided beneficial results. The results include minimal haemorrhaging after the mother gives birth and the general improvement of the infant's health. Additional research needs to be done to ascertain the optimal time for cord clamping.
In comparison to delayed cord clamping, somersault manoeuvre is of greater importance given that it enables a delay in cord clamping for up to ten minutes. Usually, the delayed cord clamping that does not involve somersault manoeuvre takes only three minutes. With increased time, the infant has the advantage of recovering red blood cells from the placenta; thus, the risk of contracting anaemia is significantly reduced ( Bayer & Gephart, 2016) . The immune system of the infant also gets a boost because of the increase in haemoglobin levels. Another essential factor about the delayed cord clamping is the reduction of haemorrhaging in the mother after delivering. The reduction of postpartum haemorrhaging in the mother helps reduce the occurrence of maternal death.
Somersault manoeuvre is very crucial; hence some risks are involved whenever it is not used when delivering a baby with the practice of delayed clamping. The risks involved emanate from the inability of specific procedures to provide enough time necessary for the newborn to recover blood cells from the placenta. Neurological harm is among the consequences of failing to use somersault manoeuvre. The harm may occur due to clamping of the nuchal cord before delivery of the shoulders (Mercer et al., 2017) . Some other procedures may cause haemorrhaging of the mother, which consequentially leads to maternal death.
To advance the adoption of somersault manoeuvre, as far as the practice of delayed cord clamping is concerned, various strategies can be put in place. One of the strategies would include having talks relaying the benefits, and the drawbacks of adopting somersault manoeuvre, in so doing the procedure would be popularised. Engaging childbirth professionals in seminars on somersault manoeuvres would make the procedure more practical. Information regarding the benefits of delayed cord clamping as well as the safety of the somersault manoeuvre procedure needs to be provided to patients and their families. The information would go a long way in encouraging patients to consider the procedure.
Communicating the somersault manoeuvre procedure would involve making a comparison of various cases in the practice. The effects of different procedures can be reached after selecting samples to follow through; thus, colleagues get to adopt the procedure in handling delayed cord clamping. For implementation to be done, the policies and practices to accommodate the somersault manoeuvre (Coggins & Mercer, 2009) . Having the management of health institutions understanding the importance of the procedure makes adoption of the somersault manoeuvre for delayed cord clamping cases simple.
Journal 2
Haemoglobin levels, as well as birth weight in delayed cord clamping, had a higher score than immediate cord clamping. Between the ages of three to six months, the newborns that were put through early cord clamping were predisposed to iron deficiency. On the other hand, infants subjected to delayed cord clamping required jaundice phototherapy (McDonald et al., 2014) . Regarding the results of maternal haemorrhage and maternal deaths, there was no notable difference.
Somersault manoeuvre formed one of the primary evidence-based nursing practices. The practice was adopted after the dangers of cord clamping before the delivery of the shoulders was discovered. During delivery, the head of the newborn is kept near the perineum to avoid grip on the cord. When the process is achieved, the newborn gets more blood from the placenta.
The health of the infant, as well as the mother, is crucial; thus, proper timing of cord clamping is vital. Clinic policies and practices dictate the variation of the timing. The benefits associated with delayed cord clamping include elevated haemoglobin levels, minimal risk of anaemia in new burns and improved birth weight. It is also important to take note of jaundice that is resultant of the delayed cord clamping.
In conclusion, delayed cord clamping the practice of cutting the umbilical cord after placental delivery alongside the end of pulsations. The practice is done after three minutes other than the thirty seconds in the early cord clamping. Before 2013, fears were there concerning the effects of delayed cord clamping in infants. Concerning both the mother and the infant, delayed cord clamping has proven to be beneficial health-wise. More studies have undertaken to extend the practice of delayed cord clamping. Various programs and studies have been conducted, and all are affirmative that delayed cord clamping has beneficial impacts. Among the benefits from the findings of the multiple types of research are reduced results of postpartum haemorrhaging of the mother, elevated haemoglobin levels in infants, reduced stillbirth instances, reduced deaths of infants and improved birth weights.
The immune system of the infant gets a boost given that with delayed cord clamping, blood cells from the placenta can be retained by the infant. The improved immune system consequently betters neurodevelopmental outcomes and also reduces the chances of contracting anaemia. Nursing practices have been improved to achieve more advantages from the delayed cord clamping practise, the discovery and the practice of somersault manoeuvre on infants during birth makes delays on cord clamping for up to ten minutes a reality. The ten minutes allows the infant to benefit by retaining placental blood cells.
For better results, a combination of both somersault manoeuvre and delayed cord clamping is a recommended procedure when delivering an infant. Conveying the importance of the practice to medical practitioners through training is paramount in spreading the knowledge. The clinic practices and policies require amendments to provide room for the implementation of the somersault manoeuvre as well as delayed cord clamping.
References
Bayer, K., & Gephart, S. (2016). Delayed Umbilical Cord Clamping in the 21st Century. Advances in Neonatal Care , 16 (1), 68-73.
Brocato, B., Holliday, N., Whitehurst Jr, R. M., Lewis, D., & Varner, S. (2016). Delayed cord clamping in preterm neonates: a review of benefits and risks. Obstetrical & gynecological survey , 71 (1), 39-42.
Coggins, M., & Mercer, J. (2009). Delayed cord clamping: advantages for infants. Nursing for women's health , 13 (2), 132-139.
McDonald, S. J., Middleton, P., Dowswell, T., & Morris, P. S. (2014). Cochrane in context: Effect of timing of umbilical cord clamping in term infants on maternal and neonatal outcomes. Evidence‐Based Child Health: A Cochrane Review Journal , 9 (2), 398-400.
Mercer, J. S., Owens, D. A.E., Graves, B., & Haley, M. M.(2017). Evidence-Based Practices for the Fetal to Newborn Transition. Medscape, 52 (3), 262-272.
