Waiting to Clamp Baby's Umbilical Cord -- What to Know

One of the more revered traditions in the laboring room is the ceremonial cutting of baby's umbilical cord. The job is usually bestowed upon mom's partner and signifies the transition of mom and baby as one to mom and baby as individuals. The procedure involves two steps -- one to clamp baby's umbilical cord (done in two places), which stops the flow of blood from the placenta to baby, and the second is cutting baby's cord, severing attachment to the placenta. Traditionally, baby's cord is clamped within the first 30-60 seconds after birth. In recent years, however, new research has emerged that suggests "delayed cord clamping" (waiting between 1-3 minutes after birth), or clamping after the cord stops pulsing, provides significant benefits to baby.Routine immediate cord clamping has been the norm for many years (earliest documentation is in the 1600s) due to the thought that delaying clamping would increase the risk of maternal hemorrhage and increase the occurrence of infant jaundice. This new review, which analyzed data on nearly 4,000 women and babies, found these concerns to be mostly unfounded, with benefits outweighing any potential increased risk. According to the Science & Sensibility report:Earlier this month, a new review was published in The Cochrane Database of Systematic Reviews on the subject of "delayed cord clamping," and it received national media attention. The New York Times reported: "A new analysis has found that delaying clamping for at least a minute after birth, which allows more time for blood to move from the placenta, significantly improves iron stores and hemoglobin levels in newborns and does not increase the risks to mothers." Medical News Today wrote: "A recent review of published studies suggests delaying cord clamping results in healthier blood and iron levels in babies, and this benefit outweighs the slightly higher risk of developing jaundice."

Maternal adverse outcomes: The review found no significant early cord clamping (ECC) versus delayed cord clamping (DCC) differences in any maternal outcomes, including postpartum hemorrhage, length of the third stage of labor, need for blood transfusion, and need for manual removal of the placenta.

Neonatal adverse outcomes: Similarly, with the single exception of a slight increase in the need for phototherapy to treat hyperbilirubinemia (jaundice), there were no significant differences between ECC and DCC babies in neonatal outcomes, such as mortality, Apgar scores < 7 at five minutes, need for resuscitation, NICU admission, respiratory distress, polycythemia, and clinical jaundice.

What happens during delayed cord clamping? For a great visual, I encourage you to watch the brief video below by author and childbirth expert Penny Simkin, PT. Mark Sloan, MD, also describes it beautifully in the Science & Sensibility article:

At term, roughly 1/3 of a fetus's blood supply resides in the placenta. In the course of labor and delivery, much of that blood is transfused from the placenta into the fetus/newborn, driven by the force of uterine contractions. That transfusion continues beyond the moment of birth; if left undisturbed for 1 to 3 minutes, the placenta will deliver about three additional ounces of blood to the newborn.

That may not sound like much, but three ounces of blood is equivalent to a three month supply of iron for the newborn. Iron is critical to brain growth and development; iron deficiency is a known cause of cognitive and social-emotional deficits in infants, which may be permanent. As breast milk alone may not supply a baby with all the iron he or she needs, it's that additional iron that makes delayed cord clamping (DCC) so important.

After close review of their findings, the review's authors conclude that "a more liberal approach to delaying clamping of the umbilical cord in healthy term infants appears to be warranted."

Despite the mounting evidence along with this new review's findings, many care providers still practice early cord clamping. Change won't happen overnight. But asking your doctor or midwife about her routine practice with cord clamping and if she would honor your request to delay clamping is perfectly reasonable. To ensure that your request is observed, be sure to discuss with your doctor during a prenatal meeting and again when you are in labor (or ask your partner to reiterate your wishes during labor). It also helps to include this preference in your birth plan, which should be shared with your care provider and labor and delivery nursing staff.

photo credit: wickstopher via photopin cc