Image by Monet Nicole
What is Early Cord Clamping?
Early cord clamping was routine in the 1960s, as it was believed that clamping the cord immediately after baby was born reduced the likelihood of postpartum maternal hemorrhage. Although no evidence supports this theory, this continues to be the practice in many hospitals today; ACOG reports that cords are routinely clamped within 15-20 seconds after birth. However, the practice of delayed cord clamping continues to grow as the benefits are realized.
Why Delay Cord Clamping?
You may hear different things regarding how long to delay cord clamping. The World Health Organization suggests waiting around 3 minutes: “the optimal time to clamp the umbilical cord for all infants regardless of gestational age or fetal weight is when the circulation in the cord has ceased, and the cord is flat and pulseless (approximately 3 minutes or more after birth).” The Royal College of Midwives suggests waiting 3-5 minutes, as transfusion continues during this time. One important thing to note is that the position of baby: “delaying the clamping of the cord for 5 minutes if the newborn is placed skin-to-skin or 2 minutes with the newborn at or below the level of the introitus ensures the greatest benefit.” (American College of Nurse-Midwives)
Image by Esther Edith
Interestingly enough, delayed cord clamping is not a new idea! In 1801, Charles Darwin’s grandfather wrote, “Another thing very injurious to the child is the tying and cutting of the navel string too soon, which should always be left till the child has not only repeatedly breathed but till all pulsation in the cord ceases. As otherwise the child is much weaker than it ought to be, a part of the blood being left in the placenta which ought to have been in the child and at the same time the placenta does not so naturally collapse, and withdraw itself from the sides of the uterus, and is not therefore removed with so much safety and certainty.” Erasmus Darwin, 1801
What about the Risks of Delayed Cord Clamping?
Back Flow Bleeding?
The possibility of the blood flowing from baby back into the placenta is extremely unlikely, especially in uncomplicated births. Mark Sloan, M.D. assures, “As the newborn’s oxygen saturation increases, the umbilical arteries close, which stops nearly all blood flow from baby to placenta. The umbilical vein, which isn’t sensitive to oxygen, remains open somewhat longer, allowing a final bit of blood to flow from placenta to baby before it, too, closes.”
Although some health care providers warn their patients that delayed cord clamping causes severe jaundice, many scientists and doctors agree this to be untrue. Sloan says, “Since bilirubin, the source of neonatal jaundice, originates in red blood cells, it seems logical that the increased blood volume associated with delayed clamping could lead to severe hyperbilirubinemia.
Yet while some studies have demonstrated mildly increased bilirubin levels in DCC babies in the first few days postpartum, most have found no significant difference between DCC and ICC.
This seeming paradox—relatively stable bilirubin levels in the face of substantially increased blood volume—may have to do with increased blood flow to the neonatal liver that comes with the higher total blood volume associated with DCC. Yes, more blood means more bilirubin, which in turn could mean more jaundice, but better blood flow allows the liver to process bilirubin more efficiently.”
In the case of a nuchal cord (a cord around baby’s neck), “only if the birth is prevented should cutting be permitted,” ✻ otherwise, a somersault maneuver is recommended. “Some studies have associated nuchal cord with an increased rate of variable fetal heart rate decelerations during labour, and tight nuchal cords to a higher proportion of fetal distress and low Apgar scores. However, in these retrospective studies the definition of tight nuchal cord were those ‘clamped and cut before delivery of the shoulders’ – therefore short-term morbidity was more likely caused by the interventions rather than the presence of nuchal cord.” ✻
What if baby needs resuscitation, and/or immediate pediatric care? Is delayed cord clamping still safe? Mark Sloan M.D. suggests it could be the best option for such cases: “One of the first things a truly sick baby in the NICU is going to receive is fluid support—often as a 20 to 40 ml/kg bolus of normal saline or blood. Yet that is exactly what’s left behind in the placenta with ICC—about 30 ml/kg of whole blood. There is considerable evidence that sick babies, both term and preterm, have better outcomes with DCC. It’s better to let nature do its own transfusing.”
A c-section is not an automatic case for early cord clamping. The American College of Nurse Midwives writes,
“The usual practice at cesarean delivery is immediate cord clamping; however, infants born by cesarean can benefit from placental transfusion resulting from delayed cord clamping or umbilical cord milking. Researchers initially reported that placental transfusion did not occur at the time of cesarean delivery, but this was most likely associated with uterine atony and the use of general anesthesia.(21) In a small observational study, Farrar and colleagues recently demonstrated that a full placental transfusion does occur at cesarean delivery, but the optimal timing of delayed cord clamping remains unclear.(22) Ogata et al. reported that a 40-second delay in clamping provided the infant with a partial placental transfusion.23 Concerns were raised that blood would flow back to the placenta if the cord was clamped after 40 seconds, but this reverse flow has not been demonstrated.(23)
Another approach at the time of cesarean delivery is to milk the umbilical cord. This approach is ideal for cesarean birth when time and speed are important factors. In a small, randomized controlled trial, Erickson-Owens et al. compared immediate cord clamping with umbilical cord milking. They found less placental residual blood volume and higher newborn hematocrit levels at 48 hours of age in infants who received umbilical cord milking. (9) Delayed cord clamping and umbilical cord milking are approaches the clinician may consider at the time of cesarean delivery to facilitate placental blood transfer to the newborn.” ✻
Is it Worth Delaying Cord Clamping for Full-Term Babies?
Although some believe that delayed cord clamping only benefits premature babies, this is untrue. “Whether a fetus is premature or full term, approximately one-third of its total blood volume resides in the placenta. This is equal to the volume of blood that will be needed to fully perfuse the fetal lungs, liver, and kidneys at birth.” (Mark Sloan, M.D.)
Image by Monet Nicole
7 Benefits of Delayed Cord Clamping for Babies:
1. Prevents iron deficiency during baby’s first year
Iron deficiency is sometimes an issue during a baby’s first year; allowing them to receive the extra blood through DCC (delayed cord clamping) can greatly aid this issue: “Five trials of term infants (1152 infants) measured indicators of iron deficiency at 3–6 months of age. Infants with delayed clamping were significantly less likely to have iron deficiency than early-clamped infants” – World Health Organization
2. Allows healthy function of liver, lungs, and kidneys
DCC provides an adequate blood supply, which is vital for healthy organs. “Whether a fetus is premature or full term, approximately one-third of its total blood volume resides in the placenta. This is equal to the volume of blood that will be needed to fully perfuse the fetal lungs, liver, and kidneys at birth.” Mark Sloan, M.D.Additionally, “In term neonates, delayed cord clamping has been associated with decreased iron-deficient anemia and increased iron stores with potential valuable effects that extend beyond the newborn period, including improvements in long-term neurodevelopment.” Ryan McAdams, M.D.
3. Increases blood platelet levels (important for clotting)
A common concern at birth is baby’s ability to clot well, due to potential Vitamin K deficiency, and possible birth bruising/injury. Delayed cord clamping ensure that “the baby can receive the complete retinue of clotting factors.” ✻
4. Increases number of stem cells
Also in relation to birth injury, a rich level of stem cells can help to repair any potential brain damage. Mark Sloan, M.D. also notes that stem cells “play an essential role in the development of the immune, respiratory, cardiovascular, and central nervous systems, among many other functions. The concentration of stem cells in fetal blood is higher than at any other time of life. ICC (immediate cord clamping) leaves nearly one-third of these critical cells in the placenta.”
5. Stabilizes blood pressure
Dr. Heike Rabe, a neonatologist at Brighton & Sussex Medical School in the United Kingdom reports, “Preemies who have delayed cord clamping tend to have better blood pressure in the days immediately after birth, need fewer drugs to support blood pressure.” Additionally, studies show “a 52% reduction in the rate of blood transfusions for low blood pressure among preterm babies when delayed cord clamping is practiced.”
6. Allows for better growth and development of brain and central nervous system (impact can last for years)
Due to an increase in iron, and stem cell supplies, this allows baby a healthier functioning brain, and central nervous system. The development of these systems is crucial, especially in the earliest years, and the impact can have long-term effects.
7. Increases blood volume
Whether baby is premature, or full term, 1/3 of baby’s blood resides in the placenta, and waiting as much as 3 minutes can allow baby to receive a significant amount of this blood volume, which means fewer blood transfusions, higher birth weight, and overall health (as listed above).
2 Ways Mothers Benefit from Delayed Cord Clamping
1. Allows for an easier, faster, and safer delivery of the placenta.
According to the World Health Organization, “less blood-filled placenta shortens the third stage of labour and decreases the incidence of retained placenta.” Since most of the blood has been transferred to baby, the placenta will no longer be plump with blood; this allows for a potentially quicker delivery of the placenta, and increases the chances of delivering placenta intact.
2. Gives mother and baby some time to bond, (preferably, whilst skin-to-skin).
Since baby is still attached to the placenta, this prevents baby from being taken away from the mother, allowing them to bond and get to know each other on this side of life. Although there has been some question about how gravity influences the blood transfusion to baby from the placenta, The Lancet Medical Journal “Position of the newborn baby before cord clamping does not seem to affect volume of placental transfusion. Mothers could safely be allowed to hold their baby on their abdomen or chest. This change in practice might increase obstetric compliance with the procedure, enhance maternal-infant bonding, and decrease iron deficiency in infancy.” Mother and baby can freely begin breastfeeding during this time, which may cause contractions, and hence contribute to the delivery of the placenta.
Is Delayed Cord Clamping Compatible with Cord Banking?
If you are wondering whether you can opt for both delayed cord clamping, and cord banking, Frances Verter, PhD. board member of the Umbilical Cord Blood Education Alliance says “Yes!” But she advises that delaying more than 3 minutes may result in little to not enough blood for cord banking. However, even if you only delay cord clamping for up to 3 minutes, the possibility of cord banking depends on the collector: “Delayed cord clamping is not often compatible with cord blood donation or storage. The reason being is that in order for them to collect the amount of blood they want to store, some collectors will say that they need the cord cut immediately, and some (as confirmed by one of the biggest Australian cord blood collection companies, as recently as September 2013) will only allow up to 60 seconds before they want the cord clamped. This is not long enough for most of the benefits to reach your baby. If you would like your baby to have it’s full supply of cord blood, you may need to reconsider you plans to donate or store cord blood. From the above recent study (2010) the following comments were made on cord collection: “There remains no consensus among scientists and clinicians on cord clamping and proper cord blood collection,” concluded co-author and obstetrician Dr. Stephen Klasko, senior vice president of USF Health and dean of the USF College of Medicine. “The most important thing is to avoid losing valuable stems cells during and just after delivery.” So prevention is clearly better than cure – your baby will be better off keeping what is rightfully theirs.”
ACOG advises, “The routine practice of umbilical cord clamping should not be altered for the collection of umbilical cord blood for banking.”
Penny Simkin on Delayed Cord Clamping
Here’s an excellent visual presentation by Penny Simkin on why it’s important to delay cord clamping.
What did/will you choose for your birth?
Please feel free to comment with your questions, stories, and feedback, and please share this post with others to help spread awareness about the benefits of delayed cord clamping.
American College of Nurse Midwives
American Congress of Obstetricians and Gynecologists
Evidence Based Birth
Guideline: Delayed Umbilical Cord Clamping for Improved Maternal and Infant Health and Nutrition Outcomes
Guidelines on Basic Newborn Resuscitation
International Childbirth Education Association
Intrapartum Care: Care of Healthy Women and Their Babies During Childbirth
Mark Sloan M.D.
NPR, Delayed Cord Clamping
National Center for Biotechnology Information
National Childbirth Trust
World Health Organization
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