July 24, 2018
The umbilical cord connects the fetus to the placenta, an organ that removes wastes and provides nutrition and oxygen to the fetus. The cord comes out of the fetus’ navel (belly button). After a baby is delivered, the cord is clamped and cut, but a small piece remains attached to the baby’s navel until it dries up and falls off.
Delayed cord clamping (DCC) refers to prolonging the period of time between a baby’s birth and clamping their cord. Instead of clamping in the first 10 seconds after birth, delayed clamping happens between 25 seconds and 5 minutes. Is it possible that waiting to clamp the umbilical cord after birth could result in long-term benefits to the baby? A growing body of evidence suggests that it just might.
Benefits of Delayed Cord Clamping
Since the 1960s, standard practice in the United States has been to clamp the umbilical cord within 10 seconds of birth because it was believed to lower the incidence of postpartum bleeding. Even after research showed no correlation between cord cutting and maternal hemorrhaging, the practice continued. Today, the American College of Obstetricians and Gynecologists (ACOG) recommends that providers wait a minimum of 30 to 60 seconds before clamping the cord. International researchers have shown some meaningful benefit to both preterm and full term babies:
- Especially in preterm infants (those born before 37 weeks gestation), up to 30% extra blood volume resulting from DCC shows a significant benefit in improved circulation, up to 60% more iron-rich red blood cell volume, decreased need for blood transfusions, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhaging. Increased iron stores continue to be seen up to 6 months of age in babies who have DCC, though benefits beyond that are not yet proven.
- In full term infants (those born between 39-40 weeks gestation), there also may be some benefit to DCC. Studies show that DCC may result in increased hemoglobin levels at birth and improved iron stores in the first several months of life. Since healthy brain development correlates to the iron stores in a baby’s blood, DCC can assist in favorable developmental outcomes and a lower risk of anemia. The Journal of American Medicine (JAMA) also found a small increase in the neurological development of young children who had DCC at birth.
- Delayed umbilical cord clamping has not been found to increase the risk of postpartum hemorrhage.
As Dr. Heike Rabe, a neonatologist specializing in related research in the United Kingdom, states, “There is growing evidence from a number of studies that all infants, those born at term and those born early, benefit from receiving extra blood from the placenta at birth. The extra blood at birth helps the baby to cope better with the transition from life in the womb, where everything is provided for them by the placenta and the mother, to the outside world. Their lungs get more blood so that the exchange of oxygen into the blood can take place smoothly.”
Some studies have found that boys whose cords were cut at least 3 minutes after birth had better fine motor and social skills at age 4, though the same average IQ, when compared to those whose cords were cut earlier. It is believed that estrogen levels in the womb may provide added protection to girls.
Downside of Delayed Cord Clamping
While the benefits of delaying cord clamping appear to far outweigh the detriments, there may be a very slight increase, less than 2%, in the incidence of jaundice that requires phototherapy in full term infants who had DCC. As a result, healthcare providers should be prepared to monitor and treat neonatal jaundice as needed.
Additionally, DCC can be incompatible with cord blood banking because there is not enough blood left in the cord to bank. That being said, some argue that there is a significant benefit to the nutrient rich stem cells being passed on to the baby at birth as the result of a delay in cutting their cord.
What is the recommended amount of time to delay cord clamping?
While the exact timing of DCC remains a topic of some debate, the following organizations all recommend some delay for both vaginal and caesarean births:
- American College of Obstetricians and Gynecologists (ACOG): recommends waiting at least 30 to 60 seconds before clamping the cord. "While there are various recommendations regarding optimal timing for delayed umbilical cord clamping, there has been increased evidence that shows that the practice in and of itself has clear health benefits for both preterm and term infants," says Dr. Maria Mascola, lead author of the updated ACOG guidelines. "And, in most cases, this does not interfere with early care, including drying and stimulating for the first breath and immediate skin-to-skin contact."
- American College of Nurse-Midwives (ACNM): recommends DCC as standard practice for full and preterm newborns.
- World Health Organization (WHO): recommends late cord clamping performed 1 to 3 minutes after birth for all births while also initiating simultaneous essential newborn care. The cord should only be cut prior to 1 minute after birth if it is necessary to resuscitate the infant.
- Royal College of Midwives: recommends DCC at a minimum of 1 minute and ideally between 3 to 5 minutes postpartum.
If you are pregnant, considering pregnancy, or have questions, Certified Nurse Midwife Margie Brandquist is welcoming new patients. To schedule an appointment, please call the office at (703) 726-1300.