- What is delayed cord clamping?
- Is delayed cord clamping common?
- What are the benefits of delayed cord clamping?
- Are there any risks of delayed cord clamping?
- Is delayed cord clamping possible for c-section?
- What about umbilical cord blood banking?
Clamping the umbilical cord immediately after birth has been the standard practice (1). However, recent studies show that delayed clamping can have some benefits. Research also shows that immediate cord clamping (ICC) should be the option only when the neonate is asphyxiated (2).
What Is Delayed Cord Clamping?
Cord clamping is said to be delayed when the umbilical cord is cut or clamped 25 seconds to five minutes after the delivery or after the pulsations cease.
At the time of birth, the placenta and cord contain nearly one-third of the blood while the remaining two-thirds goes to the newborn. This delayed technique will allow your baby to receive more blood from the placenta and increase their iron reserves (3).
Is Delayed Cord Clamping Common?
DCC is common for preterm babies as they can benefit from any amount of additional blood they receive. Previously, standard care during placental delivery involved clamping the cord right after birth (10 to 30 seconds).
But, as suggested by Dr. Heike Rabe, a neonatologist who specialized in this research, “Delaying cord clamping for just a very short time helps the babies to adjust to their new surroundings better” (4).
What Are The Benefits Of Delayed Cord Clamping?
Studies prove that delayed cord clamping can be beneficial for the baby.
- Increased blood volume: The primary advantage of delayed clamping is that one-third of the blood left over in the placenta passes to the baby. Increased iron levels will also lead to a rise in blood platelets, which will help in better clotting. DCC increases the red blood cells by up to 60% and blood volume by 30% in neonates (5).
- Enhanced stem cells: Stem cells are essential for bodily functions and play a vital role in the development of immune, cardiovascular, central nervous and respiratory systems. Delayed cord clamping infuses the baby’s body with stem cells that are present in the highest concentration in placental blood. Stem cells also help repair any organ damages that might have occurred during a difficult delivery (6).
- Reduced risk of anemia: The increased blood supply due to delayed cord clamping delivers enough iron to the baby. According to a study, a two-minute delay will increase iron stores by 27 to 47mg. This excess iron, along with iron in the body, will lower the risk of anemia during the first six months of life (7). It helps the baby cope better in the outside world. Iron deficiency otherwise might cause central nervous system problems and cognitive impairment.
- Better blood pressure for pre-term infants: Late cord clamping in preterm babies can improve the blood pressure levels, reducing the need for drugs or blood transfusions to manage blood pressure. It lowers the incidence of necrotizing enterocolitis in preterm infants (8).
- Neurodevelopmental benefits: A study showed that DCC aids better neurodevelopmental outcomes resulting in better motor skills at seven months of age (9).
Even when you choose DCC, doctors can ensure immediate skin-to-skin contact between you and the child, which improves bonding, promotes breastfeeding, regulates heartbeat, boosts immunity, reduces the baby’s cry and cools down your chest with baby’s temperature (10).
Are There Any Risks Of Delayed Cord Clamping?
Research states that delaying cord clamping might increase the risk of conditions such as jaundice, polycythemia, and respiratory distress in the infants. According to a study, these conditions appeared to be harmless and the benefits of DCC outweighed the risks for babies (11).
It is believed that DCC can increase the mother’s risk of postpartum hemorrhage, although there is no evidence to support it. Also, there is no considerable difference in the blood loss between early clamping and delayed clamping.
DCC might not be suitable if:
- You have a problem of placenta previa or placental abruption
- You have preeclampsia or maternal anemia
- You are bleeding heavily
- There are fetal anomalies or fetal anemia
- There are intrauterine growth restrictions (12)
Delayed Cord Clamping In A C-Section
DCC after a C-section is not as easy as it is after a normal delivery. It is because the uterus is cut in a cesarean section, and it will not contract the same way as it does after a vaginal birth.
Delayed cord clamping can put the mother at the risk of hemorrhage. But modern medicine follows a few methods to facilitate safe DCC during a C-section.
- Your doctor or midwife will make an incision on the abdomen and gently pull out the baby’s head. The moment the baby starts to breathe and cry, the doctor eases out the shoulders and leaves the baby to push off the incision. The cord remains until the baby is out completely.
- When the baby is delivered entirely with the placenta and the umbilical cord attached to it, it is referred to as a lotus birth. The cord is usually left uncut and falls off naturally after a few days.
- Immediate skin-to-skin contact is also appropriate while delaying the cord cutting. The newborn may be placed on the abdomen or legs or held by the surgeon to the placental level until the cord is cut.
- Another safer approach is milking the umbilical cord. It also facilitates the transfer of blood from the placenta and is similar to delayed cord clamping. The doctor will manually milk the cord to move the blood into the baby (13).
Modern technology also enables storing of the placental and cord blood for later use.
What About Umbilical Cord Blood Banking?
Delayed cord clamping has significantly brought down the number of cord blood units donated and stored. In the case of DCC, the baby gets more placental blood while only a small amount of blood can be collected to store. Therefore, some say that the cord must be cut immediately for obtaining high quality and quantity of blood for donation or storage.
Others allow up to one minute before clamping the cord so that the baby gets most benefited from it. Waiting up to two minutes for clamping the cord will help the baby receive placental blood with a high stem cell concentration.
However, waiting more than 30-60 seconds after birth will slow down the flow of blood in the umbilical cord, forming blood clots that make cord blood collection difficult (15). In any case, you should reconsider your plans to store or donate cord blood keeping in mind how beneficial it can be for your baby (14).
Next, we address a few questions about delayed cord clamping.
Frequently Asked Questions
1. Should you add delayed cord clamping to your birth plan?
Yes, you may include DCC in your birth plan as its benefits outweigh the risks. It is a good option if you know your chances of preterm labor are high, or if you are going for a planned C-section.
2. Will delayed cord clamping increase the neonate’s risk of acquiring HIV from the mother?
No, DCC will not increase the risk to the neonate. The WHO recommends DCC for women with HIV or with unknown HIV status. The placental blood will not cause any viral transmission from the mother to the child (16).
3. Is DCC recommended for an asphyxiated newborn, who needs resuscitation?
According to the WHO, the cord should be clamped and cut immediately for improving ventilation for babies, who need positive-pressure ventilation. DCC is possible when the doctor is experienced in providing positive-pressure ventilation without clamping the cord and can initiate the ventilation at the perineum while the cord is still attached (17).
Delayed cord clamping could be beneficial to the newborn, and it is a part of the normal birth process. For premature babies, DCC will provide life support by restoring blood volume. However, the decision about umbilical cord clamping is up to you and your doctor.
Would you consider delayed cord clamping? Share your opinions and ideas with us in the comments section below.
2. Beyond survival: integrated delivery care practices for long-term maternal and infant nutrition, health and development 2nd edition; PAHO, 2013
3. P. Bailey; Delayed Umbilical Cord Clamping Boosts Iron in Infants; UC Davis (2006)
4. Rabe H, Diaz-Rossello JL, Duley L, Dowswell T; Early cord clamping versus delayed cord clamping or cord milking for preterm babies; Cochrane (2012)
5. S. Song, Y. Kim, B. Kang, H. Yoo, M. Lee; Safety of umbilical cord milking in very preterm neonates: a randomized controlled study; Obstet Gynecol Sci. 2017
6. L. Ouellette; Delayed Umbilical Cord Clamping: A State of the Science; JMU Scholarly Commons (2016)
7. Chaparro CM, Neufeld LM, et al.; Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial; Lancet (2006)
8. S. Niermeyer, S. Velaphi; Promoting physiologic transition at birth: Re-examining resuscitation and the timing of cord clamping; UC Denver (2013)
9. B. Sachs; Delayed Versus Early Umbilical Cord Clamping; SJ of Lander College (2012)
10. Skin-to-Skin Bonding; The University of Chicago Medicine
11. Hutton EK, Hassan ES.; Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials; JAMA. 2007
12. S. Purisch; Delayed Cord Clamping at Term Cesarean; Columbia University (2017)
13. M. Mascola, MD, T. Porter, MD, T. Chao, MD.; Delayed Umbilical Cord Clamping After Birth; ACOG (2017)
14. Ciubotariu R, Scaradavou A, Ciubotariu I et al.; Impact of delayed umbilical cord clamping on public cord blood donations; NCBI (2018)
15. Umbilical Cord Blood Banking; RANZCOG
16. Delayed Clamping Of The Umbilical Cord To Reduce Infant Anaemia; WHO