I read with interest the Clinical Opinion by Tarnow-Mordi et al entitled “Timing of cord clamping in very preterm infants: more evidence is needed” in the August 2014 issue of the Journal. The authors were quite correct in their comment section that “perinatal medicine is replete with examples of promising interventions, the short-term benefits of which did not translate into long-term benefit, including some that caused harm.”

One such example is the intervention of formula feeding, extolled by well-meaning doctors in the 1940s to improve the health of children. With a US breast-feeding rate of 98%, no prospective randomized controlled study or basic science evidence was given for the intervention (formula) over physiology (breast-feeding).

Some 50 years after the near total change to bottle feeding, science has proven the medical and financial benefit of breast-feeding to mother, baby, and society. This simple and perhaps logical intervention has thus contributed to decades of morbidity to both baby and mother while adding health care costs.

In the same manner, immediate cord clamping (ICC) was declared the standard of care with no scientific evaluation. There was no randomized controlled study to evaluate the potential risks and no acknowledgment of the prior writings in the obstetric field as to the detrimental impact of ICC. No attention was given to prior studies on the negative impact to total blood volume or the work of pathologists showing that pulmonary alveoli are opened by increasing the blood flow to the capillaries that support the alveoli, not by the increase of air pressure.

As that experienced with breast-feeding, the discussion of immediate vs delayed cord clamping (DCC) has been turned upside down. As long as scientists view DCC as the intervention and ICC as the physiology, those dedicated to evidence-based medicine will continue to look for more data and better studies. In his review on this subject, Dr Hutchon noted that “the majority of English-language textbooks do not provide an accurate description of physiological transition” despite several excellent review articles on this subject.

Laboratory medicine is responsible for the quantification of physiological values such as hemoglobin, blood volume, O ₂ saturation, etc. Every test requires normal values derived from normal individuals under normal physiological conditions. It is not proper laboratory practice to tabulate normal values based on abnormal, nonphysiological intervention. Most newborns in the United States are treated with ICC; thus, laboratory values are developed outside the true physiological norm, obtained in iatrogenically hypovolemic patients.

For every other mammal, birth proceeds through a complex transition of biochemical events to allow life outside the womb. Mammals birth without cord clamping, receive their full blood volume, and go on to thrive without medical intervention. This transition is interrupted by the intervention ICC. Waiting until the umbilical cord reveals full transfer of neonatal blood is the physiology. Those who deliver babies must maximize the transition to life outside the womb.

In keeping with Dr Tarnow-Mordi’s evaluation of improper medical claims, ICC was never studied as an intervention as to clinical benefit, effect of survival and outcome, or risk of harm and with no basic science to back the claims was erroneously declared the standard of care. Immediate cord clamping is one more example of a promising intervention, the short-term benefits of which did not translate into long-term benefit and instead caused harm.

I implore our colleagues to stop hoping for better studies to see whether DCC is safe. A logical scientific approach to medicine and obstetrics must trump the illusion of evidence.