What is delayed cord clamping? What are the benefits and the risks for your baby? How long should the delay be?
These are just a few of the questions women should ask their care provider as they plan for childbirth.
If you are thinking about adding delayed cord clamping to your birth plan, it's important to know what this means for your baby. It may sound like a good idea, but what are the pros and cons?
What is delayed cord clamping?
Umbilical cord blood contains vital stem cells, red blood cells and white blood cells, all of which help give babies a good start to life. Early cord clamping typically takes place between 10 and 60 seconds after the birth of your baby. Many studies define delayed cord clamping to be in the 30- to 60-second range. Others define delayed cord clamping as taking place after cord pulsations stops, between one to 10 minutes or more following the birth of the baby. Yet another form of managing the umbilical blood flow to the baby consists of umbilical cord "milking," which involves clamping and cutting the cord at about 25 cetemeters from the baby's umbilicus and milking the cord blood towards the baby.
The concept of delayed cord clamping is not new. The topic has been investigated for more than 60 years. Before the mid-1950s, the term "early clamping" was defined as umbilical cord clamping within one minute of birth, and "late clamping," as umbilical cord clamping more than five minutes after the birth1.
What are the benefits?
Significant benefit for delayed cord clamping has been studied in populations in countries such as India, where 70 percent of children were found to be anemic2. Delaying cord clamping in these instances allows the transfer of additional blood volume from the placenta to the baby.
Evidence also exists that supports delaying cord clamping in premature infants in order to decrease their risk of intraventricular hemorrhage and decrease incidence of or delay the onset of neonatal sepsis.
The American College of Obstetricians and Gynecologists/American Academy of Pediatrics recommends delayed cord clamping in preterm infants.
In term infants, the placental transfer of blood is approximately 80 millileters of blood by one minute after birth, and reaches approximately 100 millileters at three minutes after birth. This additional blood can supply extra iron and may help prevent iron deficiency during the first year of life.3
Additionally, placental transfer of blood (enriched with immunoglobulins and stem cells) with the delay of cord clamping may be beneficial for potential improved organ repair, especially in premature infants.
What are the risks?
Some potential risks have been identified with delayed cord clamping in regards to increasing bilirubin levels in newborns with subsequent development of jaundice and the need for phototherapy and risk of maternal postpartum hemorrhage. Multiple research trials have been conducted to assess these issues. For infants who underwent delayed cord clamping (at least one minute after birth or after cessation of cord pulsation), there was a significant increase in the need for phototherapy for jaundice4. However, there was no statistically significant increase in the development of postpartum hemorrhage.
Due to the theoretical risks for more significant polycythemia, hyperbilirubinemia, etc. some people recommend against delayed cord clamping for women who have diabetes that is poorly controlled.
Delayed cord clamping should also be approached with caution in other situations that could be associated with polycythemia (e.g., IUGR, monochorionic multiple gestations/twin-to-twin transfusion, etc.).
What is the ideal time to delay cord clamping?
We're not sure. We need to study this topic and make a decision that is evidenced-based. At the present time, what we know from previous research is that delaying the cord clamping to 30 to 60 seconds after birth – with the baby held below the level of the placenta – is associated with benefits for your newborn. These benefits include improved circulation, a better red cell volume and decreased need for transfusion.
Please feel free to comment on this discussion, I look forward to hearing from you.
1. Timing of umbilical cord clamping after birth, ACOG Committee Opinion, Number 543; December 2012.
2. Upadhyay A, Gothwal S, Parihar R, et al. Effect of umbilical cord milking in terms and near term infants: randomized control trial; Upadhyay A., et al. Am J Obstet Gynecol 2013;208:120.e1-6.
3-4. Timing of umbilical cord clamping after birth, ACOG Committee Opinion, Number 543; December 2012.
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