Delayed Cord Clamping

Waiting to Clamp Your Umbilical Cord

Good Idea or Not?

• What is delayed umbilical cord clamping?
• History of Delayed Cord Clamping
• Benefits of Delayed Cord Clamping
• Risks of Delayed Cord Clamping
• Cases Where Delayed Cord Clamp is NOT Appropriate
• Should delayed cord clamping be used if my baby has fetal distress?
• Can delayed cord clamping interfere with cord blood banking?
• Multiple Gestation Pregnancy (Twins or greater)
• Milking the Umbilical Cord

What is delayed umbilical cord clamping?

Delayed cord clamping means there is a delay in clamping the umbilical cord when your baby is born. Delayed cord clamping can be done with vaginal and cesarean deliveries and does not interfere with skin-to-skin care. This delay can be as short as 30 seconds or as long as 5 minutes.

In the United States, the American College of Obstetrics and Gynecology and the American Academy of Pediatrics recommends a 30-60 seconds delay in cord clamping for vigorous preterm and full-term babies. The Royal College of Obstetrics and Gynaecologists recommends a 2-minute delay in cord clamping for preterm and term babies. The American College of Nurse-Midwives recommends a 2-5 minute delay in cord clamping for full-term and preterm babies. Finally, the World Health Organization recommends a 1-minute delay in umbilical cord clamping for preterm and full-term infants with no breathing difficulty. 

History of Delayed Cord Clamping

Until recently, most hospitals in the United States practiced early (immediate) cord clamping for 50-60 years. Your doctor would cut your baby’s umbilical cord within 10-15 seconds of birth. This was not always the case.

Before the mid-1950s, standard practice was to wait for one to five minutes before cutting the cord. Around this time, however, the number of births in hospitals began to rise. There was no research to show the benefits of waiting to clamp the cord. Also, there was a belief that early cord clamping could prevent maternal hemorrhage. So, healthcare providers began clamping the cord sooner after birth.

Fast forward to the current day. In recent years, research suggests that delaying cord clamping for at least 30–60 seconds after delivery is beneficial to the baby. Delayed cord clamping allows the transfusion of warm, oxygenated blood to flow from the placenta to the newborn. Waiting to cut the cord creates several benefits to both preterm and full-term babies. However, the most significant benefit occurs in preterm babies.

Evolution of Delayed Cord Clamping

• Before the 1950’s- delayed cord clamping routine.
• 1950’s-shift towards immediate cord clamping.
• 2012- World Health Organization (WHO) recommends against immediate cord clamping.
• 2012-American College of Obstetrics and Gynecology (ACOG) and American Academy of Pediatrics (AAP) recommend delayed cord clamping for preterm babies.
• 2015-Neonatal Resuscitation Program (NRP) recommends a 30-60 second delay in cord clamping for preterm and full-term babies when appropriate.
• 2017-ACOG recommends a 30-60 second delay in cord clamping for preterm and full-term babies when appropriate.

Benefits of Delayed Cord Clamping

By waiting to clamp the umbilical cord, warm oxygenated blood will continue to flow from the placenta to your baby. This additional blood transfusion increases your baby’s blood volume. It reduces their risk of anemia, bleeding in the brain, and intestinal damage.

Because anemia can cause cognitive and neurodevelopmental problems, reducing the risk of anemia can have substantial long-term benefits to your baby as they grow and develop.

Benefits of Delayed Cord Clamping

• Continued blood flow to the baby even after delivery (placental transfusion)
• Increased blood volume, which helps to stabilize blood pressure
• Reduced risk of iron deficiency anemia
• Reduced risk of blood transfusions
• Reduce risk of bleeding in the brain (intraventricular hemorrhage)
• Reduced risks of damage to the intestine (necrotizing enterocolitis)
• Increases hemoglobin levels at birth and iron levels for the first six months of life
• Increases in the number of antibodies and stem cells transferred to the baby, which is essential for tissue and organ repair.

Risks of Delayed Cord Clamping

By waiting to clamp the umbilical cord, there is a risk that the baby may receive too much blood. Babies who receive too much blood are at risk of developing jaundice.

Jaundice is a term used to describe a condition of excess bilirubin levels in the blood. A breakdown of red blood cells causes excess bilirubin levels. Babies who are jaundiced develop a yellow tint under the skin. Light therapy treats jaundice.

There was initial concern that delayed cord clamping may increase your blood loss during delivery. More recent studies have shown that is not the case. Delayed cord clamping does not increase the risk of maternal hemorrhage.

Cases Where Delayed Cord Clamp is NOT Appropriate

While your doctor is waiting to clamp the umbilical cord, your baby continues to receive care. A member of the neonatal team dries and stimulates the baby to encourage breathing. The team suctions excess fluid from your baby’s mouth. For vaginal deliveries, this care takes place on your abdomen.  You still experience skin-to-skin care.

Suppose your baby does not respond to the measures of drying, warming, and stimulation. In that case, your doctor may cut the umbilical cord early. The team takes your baby to the warmer where they can receive more extensive resuscitative efforts. Cases of severe maternal injury or hemorrhage will also prevent delayed cord clamping to allow immediate care as needed.

There are some situations where your provider may not attempt a delay in cord clamping.

Cases Where Immediate Cord Clamping is Necessary

• Placenta Previa- placenta is in front of the baby, necessitating C-section.
• Placental Abruption- placenta breaks away from the uterus before the baby is born.
• Vasa Previa- fetal blood vessels run through the amniotic sac close to the cervix.
• Umbilical Cord Avulsion- umbilical cord is broken before delivery.
• Active Maternal Seizure- a mother that convulses during delivery
• Cesarean Sections performed under general anesthesia.
• Abnormal Umbilical Cord dopplers- abnormal blood flow between the baby and the placenta.
• Tight Nuchal Cord- if the umbilical cord around the neck is tight, it will need to be cut right away to allow for delivery of the baby.
• No spontaneous breathing in the baby by 20-30 seconds after birth.
• Certain Congenital Abnormalities.

Should delayed cord clamping be used if my baby has fetal distress?

The decision to practice delayed cord clamping in the setting of fetal distress will be a decision made by your doctor in conjunction with the doctor who is caring for your baby. Together, they will decide what is best for your baby at that moment. That decision may change depending on your baby’s vigor at birth.

Can delayed cord clamping interfere with cord blood banking?

Delayed cord clamping allows additional blood to flow to the baby from the placenta. This will reduce the amount of blood available to store in a blood bank. Together, you and your doctor will decide on what is a priority and how to proceed. To have sufficient blood left in the cord to bank, your doctor may choose just a short delay before clamping the umbilical cord.

Multiple Gestation Pregnancies (Twin or more)

Studies showing the benefit of delayed cord clamping did not involve twin pregnancies. Twin pregnancies are at increased risk of preterm delivery. Currently, the American College of Obstetrics and Gynecology has taken the stance that there is not enough information to recommend for or against cord clamping in pregnancies with twins or greater. A decision on delayed cord clamping in twins (or greater pregnancies) must be made by you and your delivery team.

Milking the Umbilical Cord

In delayed cord clamping, there is a passive flow of blood from the placenta to the baby. There is an alternative process called “milking the umbilical cord.” In milking the cord, your doctor manually pushes blood through the cord several times to encourage a more rapid and robust blood flow. Sometimes, when there is a need for immediate cord clamping, your doctor may milk the cord to get the same benefit of delayed cord clamping.

Studies involving umbilical cord milking are far fewer than those involving delayed cord clamping. In addition, the technique of milking the umbilical cord is varied, which makes a standard recommendation challenging.

Studies comparing umbilical cord milking to immediate cord clamping have shown some benefits to milking the umbilical cord. Other studies comparing umbilical cord milking to delayed cord clamping have shown no difference in neonatal outcomes.

A more recent study in 2019 showed that milking the umbilical cord in very preterm babies, 23- 27 weeks, may increase their risk of bleeding in the brain (intraventricular hemorrhage). For this reason, the American College of Obstetrics and Gynecology does not recommend umbilical cord milking for babies born 28 weeks or earlier. It is unclear if milking the umbilical cord in preterm infants produces benefits or causes harm. When possible, simply delaying cord clamping is best for preterm babies.

Copyright: myObMD Media, LLC | Written by: Lisa Shephard, MD | March 21st, 2021 | Edited by:Dayna Smith MDNumber 814

ReDecember 2020