Delayed Cord Clamping

For many years, it was common practice for obstetricians and midwives to clamp and cut the umbilical cord immediately after a baby’s birth. Based on results of research regarding the benefits of delayed cord clamping, The American College of Obstetricians and Gynecologists (ACOG) now recommends that clamping of the cord be delayed at least one minute for all term and premature deliveries. The latest practice guidelines, released in December, 2016, replaces the 2012 statement recommending that cord clamping be delayed only in premature births.

Delayed cord clamping is also endorsed by the American College of Nurse Midwives, which recommends a delay of two to five minutes before clamping the umbilical cord. The American Academy of Pediatrics, as well as the World Health Organization recommends at least a one-minute delay in both term and premature babies that do not require resuscitation at birth. Also, the 2017 Neonatal Resuscitation guidelines has incorporated delayed cord clamping of at least 30 to 60 seconds into the standards of care for most term and premature newborns that do not require resuscitative measures at birth.

There is no exact amount of time that should elapse before the cord is clamped. It is recommended that there be a minimum of one minute delay, however, depending on the mother’s preference and recommendations from the physician or midwife, it may be a longer period of time.

Benefits of Delayed Cord Clamping

In premature babies (born before the 37th week of pregnancy), delayed cord clamping:

  • Improves the transition from fetal to newborn circulation
  • Increases baby’s blood volume, which reduces the need for blood transfusions
  • Reduces the risk of bleeding in the brain (intraventricular hemorrhage)
  • Reduces the risk of an intestinal disease known as necrotizing enterocolitis
  • Helps to stabilize baby’s blood pressure
  • Increases urine output

In term babies (born after the 37th week of pregnancy), delayed cord clamping:

  • Increases baby’s blood volume (hemoglobin levels)
  • Improves iron stores in the blood, reducing the risk of iron-deficiency anemia during baby’s first year of life (iron deficiency can cause delays in cognitive development and motor skills)

The Umbilical Cord

The umbilical cord serves as the lifeline that delivers blood rich in oxygen and nutrients from the placenta to the baby before birth. Most of the time, the umbilical cord contains two arteries and one vein. The blood that is rich in oxygen and nutrients flows to baby (fetus) through the umbilical vein. The umbilical arteries carry unoxygenated blood and waste products from baby.

When baby is delivered, the placenta continues to perform gas exchange, as well as transfer blood volume to baby. Approximately 75% (80milliliters) of this blood is transferred within the first minute after birth and an additional 20 milliliters is delivered at three minutes after birth. If the umbilical cord is clamped immediately after birth, baby doesn’t benefit from this transfer of blood. In addition to blood, immunoglobulins and stem cells are also transferred to baby’s body.

The results of clinical trials have shown that the flow of blood from the placenta does not depend on the position of baby in relation to the placenta. In the past, it was recommended that a baby must be positioned at the level of the placenta, or lower, to allow for the blood to flow. After a vaginal delivery, it is recommended that baby be placed on the mother’s chest or abdomen, dried and covered with dry linen, allowing for immediate skin-to-skin contact while waiting for the cord to be clamped, then cut. During a cesarean delivery, baby may be placed on the mother’s abdomen or legs, or be held by a member of the surgical team as close to the level of the placenta as possible.

With delayed cord clamping, there is an increased risk of jaundice in babies born at term. If jaundice develops, baby may require treatment with phototherapy to reduce the bilirubin levels in the bloodstream.

Delayed cord clamping should never interfere with immediate care that is required for a baby that is not breathing, or showing signs of other difficulties. Also, it should never interfere with care that is needed if the mother is unstable. In situations where there is a known abnormality with perfusion of the placenta, the risks and benefits of delayed cord clamping should be prompt a discussion among the parents, obstetrician, and neonatology team.

In situations where umbilical cord blood banking is desired, delayed cord clamping has been shown to significantly reduce the number of cells available for banking. If you are considering cord blood banking, talk to your physician or midwife.