While delayed cord clamping (DCC) was once considered an "alternative" practice, it is now the evidence-based standard of care for most uncomplicated births. Major organizations, including the World Health Organization (WHO), the American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Pediatrics (AAP), recommend delaying umbilical cord clamping for at least 30 to 60 seconds after birth for vigorous term and preterm newborns. When both the newborn and birthing person are stable, many guidelines support waiting one to three minutes, or longer, before clamping the cord (ACOG, 2020; WHO, 2022; ACOG, 2025).

Over the past two decades, research has consistently shown that delayed cord clamping improves newborn iron stores, reduces iron deficiency during infancy, supports a smoother cardiovascular transition after birth, and provides important benefits for preterm infants, including lower rates of intraventricular hemorrhage and blood transfusion. Furthermore, studies have found no increase in postpartum hemorrhage or other significant maternal risks associated with delayed cord clamping in uncomplicated births (Fogarty et al., 2018; Seidler et al., 2023; ACOG, 2020).

As a result, researchers are no longer asking whether delayed cord clamping works. Today's questions focus on optimizing timing, supporting newborn stabilization with the cord intact, and improving implementation across diverse birth settings.

Despite broad professional support, delayed cord clamping is not yet practiced consistently. Long-standing clinical routines, logistical challenges, and persistent misconceptions continue to influence care. Let's examine some of the most common questions and concerns—and what current evidence tells us.

1. "I have a busy practice. Delayed cord clamping takes too much time."

Not necessarily.

Most placental transfusion occurs naturally during the first one to three minutes after birth, a period that can also be used to dry the newborn, assess breathing, encourage skin-to-skin contact, and support the first feeding. Delayed cord clamping rarely prolongs overall birth care and can usually be incorporated into routine clinical practice without disrupting workflow (Mercer & Erickson-Owens, 2012; ACOG, 2020).

Rather than viewing delayed cord clamping as "waiting," many clinicians now consider it part of the normal physiologic transition from fetal to newborn circulation.

2. "Immediate clamping helps prevent postpartum hemorrhage."

Current evidence does not support this concern.

One of the earliest reasons for immediate cord clamping was the belief that it reduced maternal bleeding. However, multiple randomized controlled trials, systematic reviews, and national guidelines have found no clinically significant difference in postpartum hemorrhage, severe maternal bleeding, or need for transfusion between delayed and immediate cord clamping in uncomplicated births (Andersson et al., 2012; ACOG, 2020; Seidler et al., 2023).

In other words, delaying cord clamping provides important newborn benefits without increasing maternal bleeding risk.

3. "A healthy, term baby doesn't benefit very much from delayed cord clamping."

Healthy term infants have much to gain from delayed cord clamping.

At birth, approximately one-third of a baby's total blood volume remains in the placenta. Delayed cord clamping allows this blood to transfer naturally to the newborn through placental transfusion (Mercer & Erickson-Owens, 2012). This additional blood supports several important aspects of newborn adaptation.

Improved iron stores

Perhaps the best-established benefit is improved iron status. Babies who experience delayed cord clamping have higher hemoglobin levels shortly after birth and improved iron stores for several months afterward, reducing their risk of iron deficiency during a critical period of rapid brain development (Chaparro, 2011; Andersson et al., 2011).

Smoother cardiovascular transition

Birth requires one of the most dramatic circulatory changes of human life. Before birth, the placenta performs the work of oxygen exchange. After birth, the lungs must quickly take over. As the newborn begins breathing, blood flow shifts from the placenta toward the lungs, allowing oxygen-rich blood to circulate throughout the body.

Current research suggests that maintaining placental circulation during this transition helps stabilize blood pressure and cardiac output while supporting a smoother cardiopulmonary adaptation to life outside the uterus (Bhatt et al., 2013; Hooper et al., 2015–2024).

What about stem cells?

You may also hear that delayed cord clamping transfers additional stem and progenitor cells to the newborn. These cells have important biological functions in tissue repair and immune development. However, while this remains an exciting area of research, the long-term clinical significance of increased stem cell transfer during routine birth has not yet been established (Mercer & Erickson-Owens, 2012).

Today, the strongest evidence for delayed cord clamping continues to be its effects on iron stores, cardiovascular transition, and improved outcomes for term and preterm infants.

4. "Okay, delayed cord clamping gives babies more blood and more iron. But isn't iron deficiency rare in developed countries?"

No. Iron deficiency remains one of the most common nutritional deficiencies worldwide, including in high-income countries.

While nutrition, feeding practices, and overall health all influence an infant's iron status, the amount of iron a baby is born with also matters. Delayed cord clamping allows additional placental blood to transfer to the newborn, increasing iron stores that can support healthy growth during the first several months of life (Chaparro, 2011; Andersson et al., 2011).

Studies consistently show that term infants who experience delayed cord clamping have higher ferritin concentrations and improved iron status through at least four to six months of age compared with infants whose cords are clamped immediately (Andersson et al., 2011; Andersson et al., 2014).

This matters because infancy is a period of extraordinary growth. During the first year of life, blood volume expands rapidly, the brain develops at an astonishing pace, and iron requirements are high. Beginning life with larger iron reserves provides a valuable physiologic advantage.

Delayed cord clamping is certainly not the only factor influencing childhood iron deficiency, but it is one simple, evidence-based intervention that can improve a newborn's iron endowment without additional cost or risk (ACOG, 2020; WHO, 2022).

 

5. "Doesn't iron deficiency just make babies tired?"

Iron deficiency affects much more than energy levels.

Iron plays an essential role in brain development, particularly during late pregnancy and early infancy when neural connections are forming rapidly.

Research has linked iron deficiency during infancy with differences in cognitive, motor, behavioral, and social-emotional development. Some studies suggest that these developmental differences may persist even after iron deficiency has been treated, highlighting the importance of prevention rather than waiting until deficiency develops (Chaparro, 2011; Andersson et al., 2015).

Because delayed cord clamping improves newborn iron stores during this critical developmental window, it represents one strategy that can help support healthy early neurodevelopment.

6. "Don't babies get plenty of iron from breast milk?"

Breastfeeding and delayed cord clamping work together. They're not substitutes for one another.

Human milk contains relatively small amounts of iron compared with infant formula, but the iron it does contain is highly bioavailable, meaning babies absorb it very efficiently.

Even so, healthy term infants rely primarily on the iron stores they accumulated before and during birth to meet their needs during the first several months of life. Delayed cord clamping helps maximize those iron reserves before the demands of rapid growth increase (Chaparro, 2011; Andersson et al., 2011).

Rather than replacing the benefits of breastfeeding, delayed cord clamping complements them by helping newborns begin life with an optimal supply of iron.

7. "Can't blood flow back into the placenta if the cord isn't clamped right away?"

Current evidence suggests this concern is largely based on outdated understandings of newborn physiology.

During the transition from fetal to newborn circulation, blood does not simply move randomly between the baby and the placenta. Instead, as the newborn begins breathing and the lungs expand, blood flow shifts toward the lungs while the placental circulation gradually closes.

Maintaining an intact umbilical cord during these first moments allows placental transfusion to continue while the newborn establishes breathing and circulation. Rather than causing significant "backflow" into the placenta, delayed cord clamping supports a smoother cardiovascular transition by allowing these physiologic changes to occur before the cord is clamped (Bhatt et al., 2013; Hooper et al., 2015–2024).

This evolving understanding of newborn transition is one reason many researchers now advocate for physiologic cord clamping (allowing the baby's breathing and circulation to stabilize before interrupting placental blood flow) rather than focusing on an arbitrary number of seconds after birth. Although brief fluctuations in blood flow can occur during contractions or crying, studies consistently demonstrate that delayed cord clamping results in a meaningful increase in neonatal blood volume and improved early circulatory adaptation (Mercer & Erickson-Owens, 2012; Bhatt et al., 2013).

8. "Does delayed cord clamping increase the risk of jaundice?"

Delayed cord clamping may slightly increase bilirubin levels, but the overall benefits outweigh this small potential risk for most healthy newborns.

Because delayed cord clamping increases a newborn's blood volume, researchers have long wondered whether it might also increase jaundice. The evidence suggests a nuanced answer.

Several studies have found that babies who experience delayed cord clamping have slightly higher bilirubin levels and may be somewhat more likely to receive phototherapy. However, delayed cord clamping has not been associated with increased rates of severe hyperbilirubinemia, kernicterus, or other serious complications when routine newborn monitoring and treatment are available (ACOG, 2020; Seidler et al., 2023).

Current professional guidelines continue to recommend delayed cord clamping because the well-established benefits outweigh the small increase in phototherapy use for most newborns (WHO, 2022; ACOG, 2020).

As with all newborn care, bilirubin should be monitored according to standard clinical practice regardless of when the cord is clamped.

9. "Does delayed cord clamping make a baby's blood too thick?"

No evidence suggests that delayed cord clamping causes clinically significant hyperviscosity in healthy newborns.

Delayed cord clamping naturally results in a higher hematocrit because the newborn receives additional placental blood. This is an expected physiologic response, not a complication.

For decades, some clinicians worried that this increase in red blood cells might cause "sludging" of blood or increase the risk of stroke, kidney injury, or other complications. Fortunately, extensive research has not supported these concerns.

Although hematocrit values are modestly higher following delayed cord clamping, studies have not demonstrated increased rates of symptomatic hyperviscosity or clinically important complications attributable to delayed cord clamping alone (Ceriani Cernadas et al., 2006; ACOG, 2020; Seidler et al., 2023).

In healthy newborns, the increase in blood volume appears to represent a normal physiologic adaptation rather than a pathologic one.

10. "Can you still do immediate skin-to-skin contact if the cord isn't clamped?"

Absolutely. In most births, delayed cord clamping and immediate skin-to-skin contact are completely compatible.

Years ago, some clinicians worried that holding a baby on the parent's abdomen or chest might reduce placental transfusion because the baby was positioned slightly above the placenta. Current evidence suggests this concern has been overstated.

Studies have shown that newborns placed skin-to-skin immediately after birth still receive an effective placental transfusion. While gravity may modestly influence the rate of transfusion, it does not appear to prevent the newborn from receiving the benefits of delayed cord clamping (Mercer & Erickson-Owens, 2012; ACOG, 2020).

In fact, delayed cord clamping often complements other evidence-based newborn practices. In the first minutes after birth, many babies can remain skin-to-skin while being dried, assessed, observed for effective breathing, and supported in initiating breastfeeding, all with the umbilical cord intact.

Rather than competing priorities, delayed cord clamping and skin-to-skin care are often part of the same physiologic approach to supporting newborn transition.

11. "What if the baby needs resuscitation?"

This is one of the most rapidly evolving areas of newborn care. Historically, newborns needing resuscitation were separated immediately from the birthing parent so the cord could be clamped and the infant transferred to a warmer.

Today, researchers are asking a different question:

Can some newborns be stabilized before the cord is clamped?

Growing evidence suggests the answer is often yes.

Maintaining placental circulation while establishing breathing may support cardiovascular stability and reduce fluctuations in blood pressure, particularly for preterm infants. As a result, many hospitals are exploring intact cord resuscitation (also called physiologic-based cord clamping or bedside stabilization), in which the newborn receives initial assessment and respiratory support while the umbilical cord remains intact (Bhatt et al., 2013; Hooper et al.; ACOG, 2025).

This approach requires specialized equipment, careful planning, and coordinated teamwork. It is not appropriate in every birth, and there are situations in which immediate cord clamping remains necessary to provide urgent care. Nevertheless, intact cord resuscitation represents an exciting shift in neonatal care, one that aligns with our growing understanding of newborn physiology by supporting the baby's transition before interrupting placental circulation.

Research in this area continues to evolve, but it reflects an important change in perspective: rather than asking how quickly the cord can be clamped, clinicians are increasingly asking how long placental support can safely continue while newborn stabilization begins.

What about cesarean births?

Delayed cord clamping is recommended after both vaginal and cesarean births whenever maternal and newborn conditions allow.

The physiologic benefits of placental transfusion are not limited to vaginal birth. Current guidelines support delaying cord clamping during uncomplicated cesarean births when both the newborn and birthing parent are stable (ACOG, 2020; WHO, 2022). Although the exact duration may vary depending on the clinical situation and surgical considerations, delayed cord clamping can usually be incorporated into routine cesarean birth without compromising maternal or newborn care.

As more hospitals adopt family-centered cesarean practices, delayed cord clamping has become an increasingly routine component of evidence-based care in the operating room.

How long should the cord remain unclamped?

There is no single "perfect" amount of time.

Current recommendations emphasize allowing placental transfusion to occur while considering the clinical condition of both the newborn and birthing parent.

Most professional organizations recommend waiting at least 30 to 60 seconds, while many clinicians routinely wait one to three minutes or longer when both are stable (ACOG, 2020; WHO, 2022). Some providers choose to wait until the cord stops pulsating or until placental transfusion appears complete. Although there is no strong evidence that one specific endpoint is superior to another, longer delays generally result in greater placental transfusion without increasing maternal risk in uncomplicated births.

Rather than focusing on an exact number of seconds, many experts now advocate for an individualized, physiologic approach that supports newborn transition while accommodating the clinical circumstances of each birth.

Summary

Over the past two decades, delayed cord clamping has evolved from an emerging practice to a routine component of evidence-based maternity care. Current research consistently demonstrates that, for most vigorous term and preterm newborns, delaying cord clamping supports a smoother cardiovascular transition after birth, improves neonatal iron stores, and reduces the risk of iron deficiency during infancy. For preterm infants, the benefits extend even further, including lower rates of blood transfusion, intraventricular hemorrhage, and mortality (Fogarty et al., 2018; Seidler et al., 2023; ACOG, 2025). Equally important, delayed cord clamping has not been shown to increase postpartum hemorrhage or other significant maternal complications in uncomplicated births (ACOG, 2020; Seidler et al., 2023).

Like many evidence-based practices, implementation remains variable. Hospital policies, clinical workflows, available equipment, and provider training all influence whether delayed cord clamping is consistently offered. At the same time, research continues to refine our understanding of optimal timing, intact cord resuscitation, and physiologic cord clamping, particularly for newborns requiring additional support after birth.

For childbirth educators, delayed cord clamping offers an opportunity to help families understand not only what is recommended, but why. Parents who understand the purpose of delayed cord clamping are better prepared to discuss their preferences with their healthcare team and participate in informed decision-making during labor and birth.

The science has moved beyond asking whether delayed cord clamping is beneficial. Today's focus is on ensuring that every newborn has the opportunity to receive its benefits whenever it is safe and feasible to do so.

 

Questions for Childbirth Educators

When discussing delayed cord clamping with expectant families, consider asking:

• Is delayed cord clamping the standard practice at the hospital or birth center where you plan to give birth?
• Under what circumstances might the timing of cord clamping differ?
• How is delayed cord clamping incorporated during cesarean births?
• Is immediate skin-to-skin contact routinely offered while the cord remains intact?
• If a newborn needs assistance transitioning after birth, what options are available for stabilization before cord clamping?

Helping families understand these questions encourages shared decision-making and can foster meaningful conversations with their healthcare team before labor begins.

 

Key Takeaways

• Delayed cord clamping is the recommended standard of care for most vigorous term and preterm newborns.
• Major organizations, including WHO, ACOG, and AAP, recommend delaying cord clamping for at least 30 to60 seconds, with many supporting one to three minutes or longer when parent and newborn are stable.
• Delayed cord clamping improves newborn iron stores and reduces iron deficiency during infancy.
• For preterm infants, delayed cord clamping decreases mortality and several important neonatal complications.
• Delayed cord clamping does not increase postpartum hemorrhage or significant maternal bleeding.
• A small increase in phototherapy may occur, but serious complications from jaundice have not been shown to increase.
• Skin-to-skin contact, breastfeeding initiation, and delayed cord clamping are generally compatible and can occur together.
• Emerging research on physiologic cord clamping and intact cord resuscitation continues to refine best practices for newborn transition.

 

Updated References

American College of Obstetricians and Gynecologists. (2020). Delayed umbilical cord clamping after birth: Committee Opinion No. 814. Obstetrics & Gynecology, 136(6), e100–e106. https://doi.org/10.1097/AOG.0000000000004167

American College of Obstetricians and Gynecologists. (2025). Clinical Practice Update: An update to clinical guidance for delayed umbilical cord clamping after birth in preterm neonates. Obstetrics & Gynecology.

Andersson, O., Domellöf, M., Andersson, D., & Hellström-Westas, L. (2014). Effect of delayed versus early umbilical cord clamping on iron status and neurodevelopment at 12 months: A randomized clinical trial. JAMA Pediatrics, 168(6), 547–554.

Andersson, O., Hellström-Westas, L., Andersson, D., & Domellöf, M. (2011). Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: A randomized controlled trial. BMJ, 343, d7157.

Andersson, O., Lindquist, B., Lindgren, M., Stjernqvist, K., Domellöf, M., & Hellström-Westas, L. (2015). Effect of delayed cord clamping on neurodevelopment at 4 years of age: A randomized clinical trial. JAMA Pediatrics, 169(7), 631–638.

Bhatt, S., Alison, B. J., Wallace, E. M., Crossley, K. J., Gill, A. W., Kluckow, M., et al. (2013). Delaying cord clamping until ventilation onset improves cardiovascular function at birth. The Journal of Physiology, 591(8), 2113–2126.

Ceriani Cernadas, J. M., Carroli, G., Pellegrini, L., et al. (2006). The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: A randomized controlled trial. Pediatrics, 117(4), e779–e786.

Chaparro, C. M. (2011). Timing of umbilical cord clamping: Effect on iron endowment of the newborn and later iron status. Nutrition Reviews, 69(Suppl. 1), S30–S36.

Fogarty, M., Osborn, D. A., Askie, L., et al. (2018). Delayed versus early umbilical cord clamping for preterm infants: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 218(1), 1–18.

Hooper, S. B., Te Pas, A. B., Kitchen, M. J., et al. (2016–2024). Reviews on fetal-to-neonatal cardiopulmonary transition and physiologic cord clamping. Archives of Disease in Childhood: Fetal and Neonatal Edition and related journals.

Katheria, A. C., et al. (2019). Association of umbilical cord milking vs delayed umbilical cord clamping with death or severe intraventricular hemorrhage among preterm infants. JAMA, 322(19), 1877–1886.

Mercer, J. S., & Erickson-Owens, D. A. (2012). Rethinking placental transfusion and cord clamping issues. The Journal of Perinatal & Neonatal Nursing, 26(3), 202–217.

Mercer, J. S., Erickson-Owens, D. A., Vohr, B. R., et al. (2016). Effects of placental transfusion on neonatal and 18-month outcomes in preterm infants. The Journal of Pediatrics, 168, 50–55.e1.

Seidler, A. L., Aberoumand, M., Hunter, K. E., et al. (2023). Deferred cord clamping, cord milking, and immediate cord clamping at preterm birth: A systematic review and individual participant data meta-analysis. The Lancet, 402(10415), 2209–2222.

World Health Organization. (2022). WHO recommendations on maternal and newborn care for a positive postnatal experience.

 

 

Published: August 05, 2026

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