Author:Moreland OB-GYN
Delayed cord clamping is the practice of allowing extra time before clamping and cutting the umbilical cord. Cord clamping happens after the baby is born—before the placenta has been delivered and while the baby is still attached to the umbilical cord. The umbilical cord connects the baby to the placenta in the uterus, carries oxygen and food from the placenta to the baby, and moves waste from the baby to the placenta. It has previously been standard practice to clamp and cut the umbilical cord immediately after birth, but the discourse on this practice is changing thanks to science and clinical studies. It is now recommended for preterm and full-term deliveries to delay this process for at least 30-60 seconds.
Delayed cord clamping has become the standard of care in many hospitals because of its benefits to newborns and minimal risk to the mother. Delayed cord clamping is considered safe and beneficial for full-term and preterm infants. The American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping for at least 30-60 seconds after birth. Continue reading to learn more about delayed cord clamping and its benefits.What Is Delayed Cord Clamping and How Does It Work?
- The clamping delay allows warm, oxygenated blood to flow from the placenta to the newborn.
- Studies show that approximately 80 mL of blood is transferred from the placenta to the baby one minute after birth and can reach 100 mL three minutes after birth.
- Delayed cord clamping is safe for vigorous (crying and moving) babies born vagin*lly and via cesarean delivery.
What is Umbilical Cord Milking?
Umbilical cord milking is a little more controversial. This technique involves gently squeezing the clamped or unclamped cord with the thumb and fingers and slowly transferring the blood through the cord into the infant. Studies have found umbilical cord milking may be suitable for newborns requiring resuscitation. The study also found cord milking did not cause any resuscitation delays compared to immediate cord clamping. However, according to ACOG (the American College of Obstetrics and Gynecology), cord milking is not recommended in extremely preterm infants, those less than 28 weeks gestation, and there isn’t enough “evidence to support or refute cord milking in babies born at or above 32 weeks gestation, even in term infants”.
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What Are the Benefits of Delayed Cord Clamping?
The benefits of delayed cord clamping have recently made this practice more widespread. In full-term babies, the additional blood transferred from the placenta to the baby supplies iron to the infant, decreasing the risk of iron deficiency during the baby’s first year. Iron deficiency early in life is linked to impaired and potentially irreversible cognitive, motor, and behavioral development. Further, the extra iron helps prevent anemia, a condition where the blood lacks healthy red blood cells. Higher red blood count levels can lead to better development for the baby.
The benefits of delayed umbilical cord clamping are also prevalent in preterm births. Preterm babies are at a higher risk of severe health problems, and the additional healthy blood from the umbilical cord can help decrease these risks.
Benefits include:
- Improved transitional circulation.
- Better establishment of red blood cell volume.
- Lesser need for blood transfusion.
- A reduced chance of necrotizing enterocolitis and intraventricular hemorrhage.
Delayed cord clamping also encourages the transfer of immunoglobulins and stem cells, key factors in tissue and organ repair. The increased amount of immunoglobulins and stem cells is beneficial for repairing cellular injury, inflammation, and organ dysfunction, which are common in preterm births.
In a 2015 study published by JAMA Pediatrics, 263 children were studied from birth to age four. Half of these children had their umbilical cords immediately clamped, while the others delayed this process. At age four, the children who had undergone delayed cord clamping had a higher fine motor and social skills than the other children, especially the male children.
Another study highlighted the benefits of delayed cord clamping in extremely premature babies (22 weeks- 28 weeks). This study of 4,680 preemies found delaying cord clamping for thirty seconds or more was linked to increased survival and reduced risk of severe neurological injury.
Delayed Cord Clamping Risks
There are minimal risks associated with delayed cord clamping, and it is generally considered safe for both mom and baby.
Due to the increased blood volume, the biggest risk associated with delayed cord clamping is jaundice in the baby. The extra blood from the delayed clamping may cause bilirubin to form in the blood, which can harm a baby’s developing brain. However, because all babies are monitored for jaundice, doctors can detect jaundice if present. If jaundice does occur, babies are placed under a special light that helps break down extra bilirubin in the blood.
Some medical professionals debate whether delayed cord clamping causes polycythemia in newborns. Polycythemia occurs when red blood cell counts are too high. High levels of red blood cells may result in the blood becoming too thick, leading to breathing and circulation problems and elevated bilirubin levels. There is a minimal risk for polycythemia, which is manageable with the same phototherapy treatment used for babies with jaundice.
In certain cases, delayed cord clamping is not advised. When the mother is hemorrhaging, an abnormal placenta is involved, or the newborn needs immediate medical care, delayed cord clamping is not recommended. In such situations, doctors will immediately clamp and cut the cord to focus on the health of the mother and baby.
Delayed clamping poses no increased risks of postpartum hemorrhaging or significant blood loss at delivery. Additionally, there is no association with different levels of postpartum hemoglobin or the need for blood transfusion.
Talking to Your Moreland OB-GYN Doctor About Delayed Cord Clamping
The benefits of delayed cord clamping are clear. Allowing additional time for extra blood to flow from the placenta to the baby has been found to provide the baby with an extra boost of iron and red blood cells in full term-births. While there are risks of jaundice and polycythemia, these risks are low and manageable.
While the option for delayed cord clamping may vary between institutions and situations, most obstetricians understand the benefits of waiting to clamp and cut the umbilical cord. It is within your right to request delayed cord clamping for your baby. While pregnant, discuss delayed cord clamping with your doctor and develop a plan for your labor and birth.
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