ACOG shares about delayed cord clamping (DCC), referring to only 30-60 seconds of leaving the cord attached after birth. Although this does help baby receive more of their own blood and benefits… delaying for only 30-60 seconds is actually ‘early clamping.’ True delayed cord clamping is waiting to clamp and cut the cord until it’s empty of blood. So, let’s go over the benefits of delayed cord clamping and debunk some lies.
Benefits of Delayed Cord Clamping
Babies need their blood.
At any given time, about 1/3 of your baby’s blood is circulating through the placenta. This blood is rich in millions of stem cells and iron which is used to make hemoglobin. Additionally, trials have found that babies whose cord is unclamped for longer have higher hemoglobin levels in the first year of life.
One study found when the cord is left unclamped for 60 seconds that babies will get 80% of their blood. And if left unclamped for 3-5 mins, they will get 87% of their blood.
By receiving more of their blood, research has found delayed cord clamping leads to:
- This leads to better perfusion of your baby’s lungs and a smoother cardiopulmonary transition to life outside your uterus [25]. This also points to why all hospitals need to start keeping babies’ cords intact, especially if fetal resuscitation is needed (in most cases).
- Superior hemodynamics (flow of blood within organs and tissues in the body) [25]
- Higher iron levels leading to better brain development and a lower risk of anemia in their first year of life [1].
- Higher APGAR scores at 1 and 5 min after birth when resuscitation was needed [19]
- Improved oxygen saturation after birth [22]
- Improved sucking and breastfeeding success after birth [22]
- Better vitamin B12 and thyroid hormone (free T3 & free T4) levels one day after birth when compared to infants who had earlier cord clamping [23]
- Higher myelin content in brain regions that control motor function, visual/spatial and sensory processing at 1 year of age [24]
What is myelin? Myelin is an encapsulating layer that coats our nerves and allows electrical impulses to travel efficiently along the nerve cells.
Jaundice and Delayed Cord Clamping:
Some health professionals don’t delay past 1 min because they believe it’s dangerous. Others also believe DCC increases the risk of jaundice.
In a 2013 Cochrane meta-analysis, it was found that there was an increase in light therapy to treat jaundice in babies with delayed cord clamping (4.4% vs early cord clamping: 2.7%). This was found by one large, unpublished dissertation study. And the conclusion was still that delayed cord clamping is beneficial [2].
A different systematic review published in JAMA did not include this unpublished study, and they did not find any relationship between jaundice and delayed cord clamping [3].
Furthermore, a study from May 2022 compared outcomes for babies whose cords were clamped and cut at different times after birth. The average delayed cord clamping time was 6 minutes, and this study showed that 6 minutes of delayed cord clamping is safe and waiting does not increase jaundice requiring phototherapy [15].
How to do Delayed Cord Clamping
What if There’s an Emergency?
In the hospital setting, delayed cord clamping is rarely ever allowed to be performed in infants who require immediate evaluation and resuscitation; however, if the umbilical cord is pulsing and full of blood, as most are, if a newborn needs resuscitation which always includes oxygen, it makes no sense to cut them off from their natural source of oxygen during transition to breathing air. Resuscitation should always be done on the mother’s chest, even if the baby “needs a warmer” we have already determined that a mother’s chest warms the baby better than any baby warmer in the hospital [4, 5], even if the baby is preterm [6].
Additionally, we have a study from 2019 that provides important information on the benefits of resuscitation with an intact umbilical cord. This study found improved SpO2 (percentage of oxygen in the blood), a higher APGAR score, and an absence of negative consequences [14].
“A previous experimental study in newborn lambs showed that heart rates and right ventricle output were markedly decreased within 120 s of cord clamping. In contrast, if umbilical cord clamping was delayed until after ventilation had commenced, these large changes in heart rate, arterial pressures, and flows were greatly reduced, resulting in a much more stable cardiovascular transition after birth [16, 17]. We hypothesize that delayed cord clamping allows time for the infant to aerate its lungs and increase pulmonary blood flow before venous return from the placental circulation is lost [18].”
Delayed cord clamping with resusciation:
Furthermore, “Lefebvre et al. demonstrated that intact cord resuscitation was associated with higher APGAR scores at 1 and 5 min after birth. The pH was higher, and the plasma lactate concentration was significantly lower at one hour after birth in the intact cord resuscitation than in the immediate cord clamp group… commencing resuscitation and initiating ventilation while the infant is still attached to the placenta is feasible in infants with congenital diaphragmatic hernia (CDH). The procedure is safe and may support the cardiorespiratory transition at birth in infants with CDH” [19].
A Lie from Medical Professionals
One neonatal resusication provider and instructor has told student that “the umbilical vein (carrying blood to baby) collapses really quickly after birth, but the arteries (carrying blood to mom) remain open. So, it’s best to clamp right away so the blood doesn’t drain from those opem arteries.” Therefore, saying that the blood can flow backwards into the baby. This simply is not the physiology of the placenta after birth
After birth, the placenta is detaching from the uterine wall, ceasing placental circulation where it’s normally pumping baby’s blood and mom’s blood in the placenta. Mom’s cardiovascular system is no longer interacting with the placental circulation and baby is transitioning to breathing air, receiving the last oxygenated blood from the placenta, and now living life as a respirating being. (and if they are not yet, they should be attached to the placenta for more oxygenated blood. Remember, this is the source of oxygen it has been living from for the last 9 months!)
The blood does not flow back into the placenta after a while of DCC because the placenta is slowly not pulsating any blood throughout it anymore. Plus, if this was true, we would never see white umbilical cords as we do from women who choose true (full) DCC.
So, mothers and birth professionals alike, can flush that lie down the toilet.
(And be sure to keep up with the Birthing Balance blog to learn many more sayings and lies that you can flush down the toilet!!)
Delayed Cord Clamping AND Skin-to-Skin
With this research in mind, if the umbilical cord if full of blood and pulsing, it is reckless to cut the cord and take a baby away from its mother (unless absolutely needed, like for an infant surgery asap), knowing the long list of benefits that skin-to-skin has immediately following birth for both the baby and mother. Just a few of these benefits include:
- Significantly reduced crying in response to pain for newborn testing, such as the heel prick [7].
- More sleep for baby versus in an incubator [7].
- Higher breastfeeding initiation rates [8].
- Lower rates of postpartum hemorrhage, which is one of the three leading causes of maternal mortality in the U.S. [9] worldwide [10, 11].
- Improves cerebral blood flow [12]
- Improves circulation [13]
- Babies burn fewer calories while held vs. in an incubator [5]
- And so many more!
Conclusion with Guidance from WHO
“Considering the facts and benefits known about skin-to-skin and delayed cord clamping, in most cases, resuscitation should be done coexisting with the advantages of these practices. We’re already looking forward to using these practices for infants with congenital diaphragmatic hernias.” [18]
Dr. Rachel Reed wrote, “However, most guidelines (and care providers) still recommend premature cord clamping for resuscitation. In contrast to most guidelines, WHO guidance on delayed cord clamping states that “if the clinician has experience in providing effective positive-pressure ventilation without cutting the cord, ventilation can be initiated at the perineum with the cord intact to allow for delayed cord clamping.” Unfortunately, this is contradicted in the WHO guidelines on resuscitation of the newborn which state that “the cord should be clamped and cut to allow effective ventilation to be performed.” As usual, it will probably take many years to change a practice that was initially implemented without evidence” [20].
Did you know it takes 17 years for research to reach clinical practice in hospital systems [21]? Except for when it’s things that make the business of birth in hospital systems more quick and controlled, such as the adoption of the ARRIVE trial promoting 39 week inductions, or other research for more cesareans.
Share your thoughts, feelings, and questions about delayed cord clamping below!👇🏻
References:
[1] Andersson O, Lindquist B, Lindgren M, Stjernqvist K, Domellöf M, Hellström-Westas L. Effect of Delayed Cord Clamping on Neurodevelopment at 4 Years of Age: A Randomized Clinical Trial. JAMA Pediatr. 2015 Jul;169(7):631-8. doi: 10.1001/jamapediatrics.2015.0358. PMID: 26010418.
[2] Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes
[3] Hutton, Hassan. Late vs early clamping of the umbilical cord in full-term neonates
[4] Kambarami RA, Chidede O, Kowo DT. Kangaroo care versus incubator care in the management of well preterm infants–a pilot study. Ann Trop Paediatr. 1998 Jun;18(2):81-6. doi: 10.1080/02724936.1998.11747932. PMID: 9924567.
[5] Mellien, Arleen. (2001). Incubators Versus Mothers’ Arms: Body Temperature Conservation in Very-Low-Birth-Weight Premature Infants. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN / NAACOG. 30. 157-64. 10.1111/j.1552-6909.2001.tb01531.x
[6] Lawn JE, Mwansa-Kambafwile J, Horta BL, Barros FC, Cousens S. ‘Kangaroo mother care’ to prevent neonatal deaths due to preterm birth complications. Int J Epidemiol. 2010;39 Suppl 1(Suppl 1):i144-i154. doi:10.1093/ije/dyq031
[7] Ludington-Hoe SM, Hosseini R, Torowicz DL. Skin-to-skin contact (Kangaroo Care) analgesia for preterm infant heel stick. AACN Clin Issues. 2005;16(3):373-387. doi:10.1097/00044067-200507000-00010
[8] Safari K, Saeed AA, Hasan SS, Moghaddam-Banaem L. The effect of mother and newborn early skin-to-skin contact on initiation of breastfeeding, newborn temperature and duration of third stage of labor. Int Breastfeed J. 2018 Jul 16;13:32. doi: 10.1186/s13006-018-0174-9. PMID: 30026787; PMCID: PMC6048813.
More references:
[9] https://www.cdc.gov/vitalsigns/maternal-deaths/index.html
[11] Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, Gülmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun;2(6):e323-33. doi: 10.1016/S2214-109X(14)70227-X. Epub 2014 May 5. PMID: 25103301.
[12] Korraa AA, El Nagger AA, Mohamed RA, Helmy NM. Impact of kangaroo mother care on cerebral blood flow of preterm infants. Ital J Pediatr. 2014 Nov 13;40:83. doi: 10.1186/s13052-014-0083-5. PMID: 25391600; PMCID: PMC4234866.
[13] Sehgal A, Nitzan I, Jayawickreme N, Menahem S. Impact of Skin-to-Skin Parent-Infant Care on Preterm Circulatory Physiology. J Pediatr. 2020 Jul;222:91-97.e2. doi: 10.1016/j.jpeds.2020.03.041. Epub 2020 May 7. PMID: 32389414.
[14] Andersson, O., Rana, N., Ewald, U. et al. Intact cord resuscitation versus early cord clamping in the treatment of depressed newborn infants during the first 10 minutes of birth (Nepcord III) – a randomized clinical trial. matern health, neonatol and perinatol 5, 15 (2019). https://doi.org/10.1186/s40748-019-0110-z
[15] Winkler A, Isacson M, Gustafsson A, Svedenkrans J, Andersson O. Cord clamping beyond 3 minutes: Neonatal short-term outcomes and maternal postpartum hemorrhage. Birth. 2022 May 2. doi: 10.1111/birt.12645. Epub ahead of print. PMID: 35502141.
[16] Bhatt S, Alison BJ, Wallace EM, Crossley KJ, Gill AW, Kluckow M, te Pas AB, Morley CJ, Polglase GR, Hooper SB. Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs. J Physiol. 2013 Apr 15;591(8):2113-26. doi: 10.1113/jphysiol.2012.250084. Epub 2013 Feb 11. PMID: 23401615; PMCID: PMC3634523.
More references:
[17] Hooper SB, Binder-Heschl C, Polglase GR, Gill AW, Kluckow M, Wallace EM, Blank D, Te Pas AB. The timing of umbilical cord clamping at birth: physiological considerations. Matern Health Neonatol Perinatol. 2016 Jun 13;2:4. doi: 10.1186/s40748-016-0032-y. PMID: 27298730; PMCID: PMC4904360.
[18] Le Duc K, Mur S, Rakza T, Boukhris MR, Rousset C, Vaast P, Westlynk N, Aubry E, Sharma D, Storme L. Efficacy of Intact Cord Resuscitation Compared to Immediate Cord Clamping on Cardiorespiratory Adaptation at Birth in Infants with Isolated Congenital Diaphragmatic Hernia (CHIC). Children (Basel). 2021 Apr 26;8(5):339. doi: 10.3390/children8050339. PMID: 33925985; PMCID: PMC8146982.
[19] Lefebvre C, Rakza T, Weslinck N, Vaast P, Houfflin-Debarge V, Mur S, Storme L; French CDH Study Group. Feasibility and safety of intact cord resuscitation in newborn infants with congenital diaphragmatic hernia (CDH). Resuscitation. 2017 Nov;120:20-25. doi: 10.1016/j.resuscitation.2017.08.233. Epub 2017 Aug 30. PMID: 28860014.
[20] https://midwifethinking.com/2016/04/13/the-placenta-essential-resuscitation-equipment/
[21] Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011 Dec;104(12):510-20. doi: 10.1258/jrsm.2011.110180. PMID: 22179294; PMCID: PMC3241518.
[22] Taşkin R, Kanbur A. The effect of delayed umbilical cord clamping on Newborn’s oxygen saturation and sucking success in primiparous pregnant. J Obstet Gynaecol Res. 2022 Sep 5. doi: 10.1111/jog.15417. Epub ahead of print. PMID: 36065164.
[23] Çelikel, Ö. Ö., Altuntaş, N., & Aksoy, N. (2021). Effect of cord clamping time on neonatal vitamin B12, folate and urinary iodine concentration. Ginekologia Polska. https://doi.org/10.5603/gp.a2021.0115
[24] Mercer JS, Erickson-Owens DA, Deoni SCL, Dean Iii DC, Tucker R, Parker AB, Joelson S, Mercer EN, Collins J, Padbury JF. The Effects of Delayed Cord Clamping on 12-Month Brain Myelin Content and Neurodevelopment: A Randomized Controlled Trial. Am J Perinatol. 2022 Jan;39(1):37-44. doi: 10.1055/s-0040-1714258. Epub 2020 Jul 21. PMID: 32702760.
More references:
[25] Yigit B, Tutsak E, Yıldırım C, Hutchon D, Pekkan K. Transitional fetal hemodynamics and gas exchange in premature postpartum adaptation: immediate vs. delayed cord clamping. Matern Health Neonatol Perinatol. 2019 Apr 12;5:5. doi: 10.1186/s40748-019-0100-1. PMID: 31011431; PMCID: PMC6460527.
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