You’ve probably discussed which routine labor interventions you’d like to avoid during birth, but what about after birth? Delayed cord clamping is making a comeback, but this practice is more than a trend. With massive benefits and almost no risks, read on to see how delayed cord clamping can help your baby better transition to life outside the womb.
What is Delayed Cord Clamping?
Delayed cord clamping is when the umbilical cord is not immediately cut but instead is allowed to pulsate and transfer blood to baby. As a result, billions of red blood cells, stem cells, white blood cells and other necessary substances from the cord are allowed to pass to the newborn.
How Long Should Cord Clamping be Delayed?
It depends who you ask.
The American College of Obstetricians and Gynecologists (ACOG) says at least 30-60 seconds.
The World Health Organization recommends at least 1 minute, or until the cord has stopped pulsing.
Ideally, providers should wait until the umbilical cord is completely drained, limp and white in color.
- At the 1 minute mark, baby will receive 50% of the cord blood
- At the 3 minute mark, baby will receive 90% of the cord blood
- At around the 5 minute mark, baby gets all of the necessary cord fluids
Exact times may vary from baby to baby, so the best rule of thumb is to cut the cord when it stops pulsing and is limp and white in color.
Delayed Cord Clamping Benefits
There are plenty of benefits to delayed cord clamping and researchers continue to learn more about this practice.
Here are the significant cord clamping benefits:
1. Lower Anemia Rates
Delayed cord clamping really does seem to be nature’s design when it comes to supplying baby with iron. Let’s unpack this: Iron is vital for life and proper brain development, especially in infants. But breastmilk is inherently low in iron. Mama needs iron to rebuild and nourish her body after pregnancy, and there’s not much left for her baby.
“Iron deficiency anemia occurring at an apparently crucial time in infancy results in irreparable cognitive damage.” – Frank Oski, pediatric hematologist and professor at John Hopkin’s University.
This is a not an issue when delayed cord clamping is employed, because babies receive a huge influx of iron-rich red blood cells when the cord is allowed to pulsate. And some researchers suggest that the stem cells received during delayed cord clamping might be essential to bodily repairs and immune function throughout the person’s entire life.
But What if Mama’s Anemic?
Even babies born to anemic mothers benefit from delayed cord clamping. In a 2002 study, one group of babies born to anemic mothers had immediate cord clamping, while the other group had the umbilical cord left intact until the placenta was delivered. Three months later, the early cord clamping group had rates of anemia 7.7 times higher than the delayed cord clamping group. The delay improved iron stores and hemoglobin levels even in babies born to anemic moms.
Helps Prevent Anemia Later in Life
Some experts estimate that those iron stores newborns receive through delayed cord clamping last 4-6 months, sometimes longer. This coincides perfectly with when babies start to eat solid foods, and can get more exposure to iron through food.
“If a baby gets clamped early, it will not gain access to the part of its own blood that is still in the placenta,” said Dr. Ola Andersson, a pediatrics researcher at Uppsala University in Sweden.“That extra blood could have protected the baby from anemia and iron deficiency during its first year of life.”
When baby’s umbilical cord is clamped right away, he misses out on that iron infusion and can struggle with anemia as a result. In fact, 10-20 percent of toddlers in the U.S. are anemic.
Consequences of Newborn Anemia Extend to Adulthood
Other studies have found that:
“Infants with iron deficiency anemia scored lower in cognitive, motor, social-emotional, and neurophysiologic development even 20 years after successful treatment of anemia in infancy.”
If the child was both anemic and had a low socioeconomic status, they experienced an average drop in IQ of 25 points at 19 years old.
So even when anemia resulting from early cord clamping was treated, there were still long-term, negative effects.
Supplementation Isn’t the Answer
For years many pediatricians have recommended iron supplementation for infants to prevent anemia. Formula companies add synthetic (and hard to digest) iron to their product to meet the requirements and many infant rice cereals, touted as “baby’s first food,” are fortified with iron.
But rice cereals have poor nutrition and, although they’re fortified with iron, they’re not easily absorbed. Better first foods for baby are things like grated liver, which is very high in iron.
“When breastfed infants are supplemented with iron or given iron-fortified foods, the iron they ingest… may feed pathogenic bacteria and actually contribute to lower immunity. Lactoferrin and transferrin, found in human breast milk as well as other raw milks, binds iron and withholds it from pathogenic bacteria in the infant’s intestinal tract.” – From The Womanly Art of Breastfeeding , La Leche League
2. More Oxygen for Baby
Delayed cord clamping increases hematocrit levels, the ratio between the amount of red blood cells and the total amount of blood. A study published in the journal Pediatrics found that a delayed cord clamping group had nearly 6% higher red blood cell volume than a group that experienced early clamping. That may not sound like much, but this increases the oxygen delivering red blood cells to vital organs during a critical time of baby’s development. Baby is learning to breathe on his own for the first time outside of the womb—the extra oxygen provided from the umbilical cord blood is critical.
“The extra blood at birth helps the baby to cope better with the transition from life in the womb, where everything is provided for them by the placenta and the mother, to the outside world,” says Dr. Heike Rabe, a neonatologist at Brighton & Sussex Medical School in the United Kingdom. “Their lungs get more blood so that the exchange of oxygen into the blood can take place smoothly.”
Conditions Caused by Low RBC Count
Red blood cells carry oxygen to the organs, so a decrease in red blood cells also means a decrease in life-giving oxygen. Babies that are low in red blood cells can display the following:
- Apnea (stop breathing for 20 seconds or more)
- Low blood pressure
- Abnormally high pulse
- Excessive sleepiness
- Bradycardia, or abnormally slow heart rate
- Increased hyperactivity risk: This animal study found that juvenile rats exposed to brief reductions in oxygen during infancy had a 50 percent reduction in release of dopamine and were more hyperactive later.
- Increased cerebral palsy risk: A decrease in blood and oxygen levels to the brain at or near delivery leads to a condition called Hypoxic Ischemic Encephalopathy, the leading preventable birth injury. HIE causes brain cell and tissue death in babies who develop cerebral palsy.
- Increased risk of seizures and epilepsy: HIE is also the cause of an estimated 80% of neonatal seizures. The oxygen deprivation can be a result of decreased oxygen in the baby’s blood and/or a decrease in blood flow to the brain.
3. Lifesaving for Preemies!
When a baby is born premature they’re often whisked away to a separate area (or even a separate room) and given immediate medical attention. When cord cutting is delayed, preemies fare much, much better. Pre-term babies who had delayed cord cutting had:
Even more convincing, in two 2017 studies conducted by University of Sydney researchers, delaying cord clamping by merely 60 seconds resulted in reduced hospital mortality by one third when reviewing over 3,000 premature births. This practice is simple and safe for babies and mothers who don’t need immediate resuscitation.
“We estimate that for every thousand very preterm babies born more than ten weeks early, delayed clamping will save up to 100 additional lives compared with immediate clamping,” reports David Osborn, lead author of the review, and a neonatal specialist at Royal Prince Alfred Hospital. “This means that, worldwide, using delayed clamping instead of immediate clamping can be expected to save between 11,000 and 100,000 additional lives every year.”
4. Benefits Breastfeeding
Several researchers have reported that delayed cord clamping does more than improve blood flow; it also increases the duration of early breastfeeding.
5. Provides Essential Stem Cells
The umbilical cord contains millions of stem cells that are at the highest concentration in a person’s life. Stem cells are essential to the development of the immune, respiratory, cardiovascular, and central nervous systems, to name a few. Stem cells can also help repair damage caused by a traumatic birth.
6. Improves Fine Motor and Social Skills
Delayed cord clamping can even provide benefits years later. One study found that children who had delayed cord clamping had better fine motor and social skills than their early clamped peers 4 years after birth. The most significant difference was found in boys. (Researchers speculated that girls are more protected by higher estrogen levels in utero.)
Delayed Cord Clamping Is Natural
As you can see, there are some incredible benefits of delayed cord clamping. Interesting to note: All mammals in the wild instinctively practice delayed cord clamping. In human births, delayed cord clamping used to be the norm.
Bottom line: Delayed cord clamping is evidence-based, recommended by several medical organizations as listed above, and beneficial for baby’s new life on land.
How Did Immediate Cord Clamping Become the Norm?
With all of the amazing benefits of delayed cord clamping, you may be wondering why doctors got into the practice of immediate cord clamping in the first place?
The origins of delayed cord clamping can be traced back to the era of Twilight Sleep, when laboring moms were given heavy narcotics that could harm the baby so it was important to cut the umbilical cord immediately.
The rise of C-sections also made cord clamping an easy and popular practice so that doctors could proceed with sewing up mom’s incision right away.
But, today, we have safer forms of pain management and most of the rationale for immediate cord clamping is tied to half-truths and ignorance of recent studies and positive baby outcomes from delayed cord clamping.
Let’s unpack some of those now…
Misconceptions About Delayed Cord Clamping
Myth #1: Delayed Cord Clamping Causes Postpartum Hemorrhage
One of the biggest rationale for immediate cord clamping is the belief that it speeds delivery of the placenta and reduces the risk of postpartum hemorrhage.
However, the American College of Obstetricians and Gynecologists (ACOG) recently determined that that delayed cord clamping does not increase the risk of hemorrhage and won’t interfere with care to minimize maternal bleeding.
There is one caveat. According to ACOG guidelines, if mother is actively hemorrhaging at birth, immediate cord clamping is recommended. Some midwives will leave the cord unclamped while they tend to a hemorrhaging mother and administer her Pitocin, but this isn’t the standard practice of care.
Myth #2: Managed Labor Is Best for All Moms
A managed third stage of labor means that the cord is immediately clamped, a shot of Pitocin is administered and the placenta is pulled out. In managed labor, the risk of postpartum bleeding is less as a whole, but only for women with a high risk of bleeding, where it is certainly warranted.
In one study, delayed cord clamping followed by a natural delivery of the placenta (not managed labor) resulted in higher rates of maternal bleeding. However, women with a low risk for bleeding and who had a managed third stage of labor did not hemorrhage at rates higher than the natural group, did not have low hemoglobin, and did not need a blood transfusion.
Additionally, researchers found that managed labor increases the risk for other serious side effects such as:
- Increased vomiting
- Increased birth after-pains
- Increased use of pain medication
- More maternal hospital stays for bleeding episodes
- Lower birthweight for babies
Therefore, in a normal, low risk birth, it’s best to deliver the placenta naturally and delay cord clamping.
Myth #4 C-section Mamas Can’t Delay Cord Clamping
A study of 156 women delivering by C-section divided them into early cord clamping and late cord clamping groups. Researchers found no significant risk for excessive bleeding after their C-section or need to manually remove the placenta between the groups. There was also no difference in maternal or infant deaths between the groups.
Umbilical cord milking (UCM) can help with C-sections that require a quick delivery. This is when the practitioner squeezes the blood through the cord towards the baby. In this same study, 42% of babies in the immediate cord clamping group had anemia, while none in the UCM group did.
Myth #5 Emergency Cases Can’t Delay Cord Clamping
In an emergency situation, cord milking is a suitable alternative to early clamping. However, baby will fare better if resuscitation and other procedures are performed without cutting the cord. Immediate cord clamping isn’t usually necessary, even when the cord is wrapped around the baby’s neck. An experienced provider can usually unwrap the cord and cut it after transfusion has occurred.
The Journal of Midwifery and Women’s Health found that delayed cord clamping can often take the place of routine emergency procedures. Usually, infants don’t need to be given fluids or a blood transfusion if they’re still attached to the cord, which is already doing this job.
Skin-to-skin on mama’s chest will help regulate baby’s heart rate and breathing. These infants also have a reduced need for oxygen and artificial ventilation. The extra blood to the lungs provides more oxygen to the blood, resulting in fewer breathing issues.
Infant resuscitation guidelines from Canada, Australia, the U.S., the U.K., and Europe recommend delayed cord clamping. Since 1999, the World Health Organization’s recommendation is that an experienced provider should not waste time clamping the cord and simply resuscitate the baby next to mama.
Midwives know how to resuscitate a baby without cutting the cord and often do it beside the mother or even on her chest. Hospital practices are slow to catch up though, as the infant is often taken to a separate area.
Myth #6 Baby Needs to Be Held Low
Another myth is that baby has to be held below the mother or the cord blood will drain back into the placenta. Researchers found that full blood transfusion can still occur 10 centimeters above the placenta, which is about the same height as the mother’s lap.
Transfusion takes just a few minutes longer when baby is laid on mama, but this allows baby to have all of the benefits of skin-to-skin contact.
Myth #7 HIV Positive Moms Shouldn’t Delay Cord Clamping
Some professionals are concerned that moms with HIV could more easily pass the disease to their infant if cord cutting is delayed. The World Health Organization states that:
“The evidence shows that the benefits of delaying cord clamping for 1-3 minute outweighs the risks of transmission of HIV … WHO recommends that all HIV positive pregnant and breastfeeding women and their infants should receive appropriate antiretroviral (ARV) drugs to prevent mother to child transmission of HIV. Thus, the proven benefits of at least a 1–3 minute delay in clamping the cord outweigh the theoretical, and unproven, harms. Delayed cord clamping is recommended even among women living with HIV or women with unknown HIV status.”
Myth #8 Moms with Diabetes Should Always Skip Delayed Clamping
These aren’t hard and fast rules, but sometimes it is necessary to skip delayed cord clamping. Theoretically there are risks with delayed cord clamping for babies born to mothers with poorly controlled diabetes. The baby could potentially receive too many red blood cells, a condition called polycythemia. However, some experts believe the benefits of delayed cord clamping outweigh the risks. Dr. Judith Mercer, Clinical Professor of Nursing at the University of Rhode Island and Certified Midwife, says:
“Usually studies on delayed cord clamping exclude women with gestational and full blown diabetes because these infants are more likely to be polycythemic (too many red blood cells circulating in their blood) at birth. In spite of this, these infants often have depleted iron stores because they use up the iron that fetuses are supposed to be storing in the liver in the last few weeks of pregnancy making these extra red blood cells.”
If you are pregnant with diabetes, talk to your doctor to see if delayed cord clamping is right for you.
Does Delayed Cord Clamping Cause Jaundice?
One of the biggest objections to delayed cord clamping is due to jaundice risk. It is true that there is a slight increased risk for jaundice in infants with delayed cord clamping. However, there was no increase in harmful levels of bilirubin and increased jaundice was not statistically significant according to researchers.
To back up, high levels of bilirubin in the blood cause neonatal jaundice. It makes sense then that a higher blood volume caused by delayed cord clamping can also cause naturally higher levels of bilirubin. However, delayed cord clamping also increases blood flow to the baby’s liver, which allows him/her to better process the bilirubin.
In conclusion, the many benefits of delayed cord clamping outweigh the slightly elevated risk of jaundice. ACOG and the WHO still strongly recommend delayed cord clamping.
My Personal Experience With Delayed Cord Clamping
I wanted delayed cord clamping with my first child, Griffin, however my placenta flew out of me and the midwife reacted quickly by clamping the cord. He probably got 60 seconds of transmission :(.
With Paloma, however, we left her cord intact for a good five minutes. The cord drained and, by the time Michael cut the cord, it was white and limp. Paloma was very calm and peaceful post-birth, unlike Griffin who cried for over an hour 😳, and she also healed much faster as her umbilical cord stump fell off by day two! (With Griffin, it took well over a week.)
I will say that we nicknamed her “Red” for her first few days of life. I wondered if she had a hint of jaundice or if she got “too much” blood. However, she never ended up with jaundice. Her liver was able to process the excess blood (as seen in her copious bowel movements!) Her color returned to normal within a few days postpartum. Overall, I am very happy we employed delayed cord clamping! And I’d do it again 🙂
Other Natural Mamas’ Experience With Delayed Cord Clamping
I asked the moms on my Facebook page if they chose delayed cord clamping and why. Here are some of their responses:
- I delayed cutting the cord, because I knew I didn’t want my son to have the vitamin K shot. I wanted him to get as much blood and stem cells from my placenta as possible. My son became distressed during delivery and swallowed meconium. He had to have it suctioned out and was given oxygen. He did not breathe right away, but I was able to stay calm. I knew he was still receiving oxygen, because his cord was still attached. — Tawsha
- Baby deserves all that blood, and all those stem cells that are floating around in the blood for them to use. Plus, it means baby stays connected to me. 🙂 — Samantha B
- My daughter was snow white—weak and anemic—when she was born via C-section in 2009. For my sons VBAC, I read about all the benefits [of delayed cord clamping], while researching how to avoid him being anemic as well. The difference between my two babies was SHOCKING. My son came out purple and healthy, wanting to eat and full of ALL his own blood! —Katelyn C.
- We did [delayed cord clamping] with our first born at 36 weeks, and will with our second who is due at the end of may! Our first was born early, because I had HELLP syndrome, but our provider was amazing! She allowed my husband to see and feel the pulse in the cord and see and feel when it stopped! Amazing experience for all of us! —Sondra B.
- Anemia runs in my family; both my mother, my sister, and I suffer from low iron. I delayed clamping my daughter’s cord in an attempt to break the cycle. We live in Michigan, so my daughter’s one-year checkup required a lead toxicity test due to Flint’s water issues. Iron helps prevent lead poisoning, so her iron levels were checked, too. Her results: appropriate iron levels and no lead toxicity. Delayed cord clamping is definitely WORTH THE WAIT! —Stephanie S.
What About Cord Blood Banking?
Some parents opt to bank their baby’s cord blood so that the child could access his/her stem cells later in life if a need arose. In this scenario, the cord banking company usually wants the cord clamped no later than 1 minute. This leaves a large amount of the blood cells and healing stem cells baby needs for development in the umbilical cord.
Keep in mind that research shows that stem cells received during birth play a vital role throughout a person’s entire life. This can only happen if they make it into the infant. If you desire the full benefits of delayed cord clamping, then cord blood banking may not be the right choice for your baby. (Keep in mind, too, that you can always get stem cells from baby teeth, so you can have the best of both worlds!)
How to Ask for Delayed Cord Clamping
An increasing number of midwives and even doctors practice delayed cord clamping as part of their standard procedures. The best way to make sure your provider is on board is to discuss before you go into labor! (In fact, if you are passionate about this issue, talk to your provider early so that you can change your medical team if necessary.)
Be sure to also include it in your birth plan, so that nurses and the hospital and/or birthing center staff is onboard.
Important Reminder: Doctors in a hospital setting are frequently rushed, so they may need an extra reminder. Have your partner or doula remind the doctor of your wishes during labor to ensure the cord isn’t inadvertently cut early.
Involving Your Significant Other
Your partner can still catch the baby and/or cut the cord with delayed cord clamping. The three of you will just have a few special moments of bonding time first. There’s no rush!
Resistant SOs, parents, doctors or friends?
Show them this awesome Ted Talk!
Did you do delayed cord clamping or are you planning to? Why or why not? Leave us a comment below!