Delayed Cord Clamping
Do I practice delayed cord clamping?
People calling me about home birth often ask if I do delayed cord clamping. The answer is YESSSS!! The idea of cutting the cord being a priority after the baby emerges from the womb is a misconception. We want baby to continue exchanging blood through the placenta while they make their transition from the womb to air breathing and circulation.
Placenta to the baby…
Babies get their oxygen and nutrients from their mother via the placenta and umbilical cord and return carbon dioxide and blood for replenishment back the same way. The umbilical cord is the two-way connection between the baby and the placenta! Read more about the Placenta Tree of Life here!
What happens when we clamp the cord?
Clamping and cutting the umbilical cord severs the connection between baby and placenta and means the baby is fully dependent on their own breathing efforts for oxygenation.
When to Clamp the Umbilical Cord
At the very minimum, it’s important to wait at least 5 minutes to allow the baby and birthing parent’s body to regulate the baby’s blood volume. A white and flaccid cord is a good indication that the cord is no longer needed. Once the placenta has detached, which usually takes about 10-60 minutes after birth, blood flow between baby and placenta is minimal. After four hours, the blood in the cord has coagulated, and cord burning can be performed, if that is the desired means of separating baby and placenta. Some families choose to preserve the placenta over the course of several days to weeks while waiting for the cord to dry, stiffen, and separate from the umbilicus on its own. This is called a lotus birth.
What are the benefits of delayed cord clamping?
It reduces the risk of newborn complications
allows babies to continue receiving the blood and oxygen they need at the time of birth
which supports the major transition to breathing air
supplies all organs and tissues
and increases long term iron stores!
AND it allows the placenta to release baby’s blood to the baby, which eases placental separation and can reduce postpartum bleeding
Read more about the risks and benefits of delayed cord clamping here.
Babies born at home are blessed!
As a home birth midwife, the supplies I carry for neonatal resuscitation are portable and can be used pretty much anywhere, including in the birth pool, while leaving the cord intact. Check out this blog post if you are curious whether home birth is a safe choice for you and your family.
Blood Volume in term infants
Up to a third of a term infant’s blood volume is still in the placenta at the time of birth. Imagine an adult losing a third of their blood volume! Early cord clamping can lead to hypovolemic shock and force the newborn’s body to prioritize certain essential organ functions over others. In the long term, this can lead to iron deficiency.
Preterm babies
Delayed cord clamping can be especially important and beneficial for preterm babies. Babies born early may have trouble breathing if their lungs are immature at birth. They may require assisted ventilation. Unfortunately, hospital birthing rooms and resuscitation practices are set up such that delayed cord clamping is often not compatible with resuscitation efforts. But it’s still a great idea to advocate for delayed cord clamping in case of a premature labor and birth so that your premie can get as much of their placental blood as possible.
Too much blood is a myth
Some old studies suggested that babies could get too much blood and too many red blood cells if their cord was not clamped soon enough. There were concerns about hyperbilirubinemia or jaundice. Now we know that some amount of jaundice is physiologic and normal. These studies may actually reflect practices connected to the use of scopolamine to sedate laboring mothers.
What are the risks to delayed cord clamping?
Cord around the neck, rarely
Very rarely, a cord must be clamped and cut after the head has delivered to allow the rest of the baby to be born. Most of the time, nuchal cords can be looped over the baby’s head, the baby can be born through the loops of cord, or the baby can somersault out, with the head held close to the perineum, and then the cord unwrapped afterwards. I’ve never had to cut a cord early for this purpose.
Assistance with breathing for full term babies and premies in the hospital setting
In the hospital, a baby who requires assisted ventilation or other vital life support will have to be separated from the mother within the first minute after birth so that the neonatal team can do their job around the warmer. This is an unfortunate set up that needs updating!
What about Stem Cells?
Stem cells can be harvested from cord blood and preserved for future use for certain diseases. Delayed cord clamping and stem cell collection are somewhat mutually exclusive. The stem cells in the cord are destined for the baby if not harvested after early cord clamping.
What does the American College of Obstetricians and Gynecologists have to say?
ACOG recommends waiting 30-60 seconds after birth before clamping the cord for most babies. This is really not much of a delay. Most cords are still pulsing and full of blood after a minute or two. There is undoubtedly some insurance-related influence influencing this practice, in my opinion. Once the baby is in the care of the neonatal team, the OB is less liable for health issues that arise in the baby unrelated to birth.
What if the cord is clamped too soon?
Sometimes a baby’s cord is clamped early for a legitimate necessity, because of hospital policy or just because it's a common obstetrical practice. Most babies do alright anyway, because humans, and especially baby humans, are quite resilient, and neonatal care is generally adequate. If this happened to you or one of your children, don’t beat yourself up! We all do the best we can with the information and resources we have in the moment!
Iron Stores, Iron Deficiency, and Red Blood Cells
Blood is rich in iron stores and red blood cells. If the baby does not get their full placental blood supply at birth because the cord is clamped before it is done pulsing and becomes white and flaccid, the baby may require supplemental dietary iron around six months of age. Rarely a baby will require a blood transfusion. Generally speaking, early cord clamping does not lead to such severe deficiencies that a transfusion is required.
FAQ
How long should you delay cord clamping
If possible, until the cord is white and flaccid and the placenta has delivered. At minimum, wait 5-10 minutes and until the cord has stopped pulsing.
Why are doctors against delayed cord clamping
Doctors have been practicing obstetrics in a particular way for a long time. Sometimes, traditional and physiologic practices take time to make their way into hospital and obstetrical protocols. If a baby is not vigorous at birth in a hospital setting, the neonatal team needs the baby right away at the warmer so they can provide ventilation and care. Also, doctors would like to hand over babies to the neonatal team efficiently so that they are no longer responsible for any neonatal complications not related to the birth.
What are the disadvantages of delayed cord clamping
In the case of a very short cord at a water birth, the birthing mother/parent will need to get out of the water if the cord remains intact. That’s all I got.
Do most hospitals do delayed cord clamping
Not really. Many doctors and midwives in the hospital say they do, but they actually don’t wait very long.
