Should You Do Delayed Cord Clamping?

Benefits of Delayed Cord Clamping 

Delaying umbilical cord clamping benefits both mom and baby. The main reason is the prolonged connection to the placenta, enabling a higher placental transfusion. Here are a few known benefits of delayed cord clamping:

It Increases Iron Stores, Decreasing the Risk of Anemia 

Delayed cord clamping increases the transfer of iron-rich blood from the placenta to the newborn. This increase can help prevent iron-deficiency anemia in babies by ensuring they have enough iron to produce red blood cells. 

Abundant iron stores at birth can reduce the risk of a deficiency until the baby is ready for iron-rich solid foods like beef and spinach. The added nutrition lowers the likelihood of a blood transfusion in those early months of life.

Improved Circulation & Higher Blood Volume 

Delayed cord clamping increases blood flow to the baby during this time, increasing blood volume. The higher blood volume helps maintain blood pressure and improves cardiovascular health after birth. It also supports oxygen-carrying capacity, reducing the risk of respiratory distress. The extra few minutes of placental transfer also help the baby transition from relying on the placenta for oxygen to breathing through its lungs.

Better Immune Function

The blood from the placenta contains vital immune cells, including stem cells and white blood cells. With DCC, these cells transfer to the baby, providing enhanced immune support. This extra boost helps to protect against infections as the baby adapts to the outside world. Starting life with healthy iron levels is also critical for building a healthy immune system. 

Reduced Risk of Complications

Delayed cord clamping can also decrease the risk of complications, especially in premies. A few examples include:

• Intraventricular hemorrhage (bleeding in the brain)
• Necrotizing enterocolitis (inflamed and damaged colon)
• Sepsis (a systemic inflammatory response that can lead to organ dysfunction or failure)

In general, the extended nutrient transfer leads to better neonatal outcomes.

Improved Brain Development 

Some studies show a potential link between DCC and improved brain development in children. Scientists believe the increased iron stores contribute to better cognitive and motor development. 

Better Outcomes for the Mother

Mama may also benefit from delayed cord clamping in several ways:

• Reduced risk of postpartum hemorrhage: DCC allows the continued transfer of blood to the baby, increasing the baby’s blood volume. This increase can reduce the risk of excessive blood loss in the mother after birth.
• Enhanced bonding: Skin-to-skin contact during DCC promotes early bonding between the mother and newborn. The physical and emotional closeness can enhance feelings of attachment on both sides. Ultimately, this contact promotes well-being in both mother and baby.
• Emotional benefits: DCC may also improve the whole birth experience for the mother. The period of time during DCC eases the transition from pregnancy to motherhood, which can support the mother’s emotional well-being.  
• Increased early involvement in newborn care: Delayed cord clamping slows the birth process. It allows the mother to participate in the initial caregiving, like patting dry, comforting, and breastfeeding. This active involvement can foster a sense of empowerment and confidence in the new mother.

The wonderful thing is that delayed cord clamping works in nearly every birth setting, including pre-term and C-section.

Delayed Cord Clamping in Different Birth Settings 

Pre-term Infants 

DCC may especially be helpful for pre-term babies, as it reduces the risk of birth complications. But they have to be stable enough to wait through DCC. If a pre-term baby can’t get enough oxygen, DCC may take too much time. In some cases, providers may opt for umbilical cord milking instead. Cord milking is when you push the fluid through the cord instead of letting it flow passively.

However, some research shows severe harm with cord milking in preterm infants. A 2020 analysis reviewed 19 studies that included over 2000 pre-term infants. Researchers concluded that cord milking significantly increased the risk of severe intraventricular hemorrhage compared to DCC.

Intraventricular hemorrhages and necrotizing enterocolitis are two conditions that occur less often when using DCC. A randomized, controlled trial published in Pediatrics found that DCC reduced intraventricular hemorrhages and sepsis in very preterm infants. 

Premature babies delivered with DCC also have a 54% reduction in blood transfusions due to low blood pressure.

Cesarean Section 

In babies born via Cesarean section (C-section), the WHO gives the following guidelines for the healthcare provider.

1. Deliver the baby onto a sterile environment, away from the surgical site. Give the infant immediate essential newborn care. Thoroughly dry the baby and check breathing. 
2. Within 1 minute of delivery, give the mother a uterotonic drug. (This drug reduces hemorrhaging).
3. Delay cord clamping 1 to 3 minutes after birth.
4. While waiting to clamp the cord, look over the surgery area and remove what isn’t needed.
5. Continue with essential newborn care while waiting 1 to 3 minutes before clamping the cord. Keep the baby warm and dry, and check for normal breathing or crying.
6. Deliver the placenta. 

As you can see, delayed cord clamping is easy to incorporate into C-section delivery. It’s even better if the surgical team waits until the cord turns white, not just a few minutes!

Full-Term Infants

According to a study by the American College of Obstetricians and Gynecologists (ACOG), full-term babies can also profit from DCC. In full-term infants, DCC increases hemoglobin and iron, improving development in the first few weeks of life. While some studies suggest a small increased risk of jaundice, the benefits outweigh the risks. 

The American College of Obstetrics and Gynecology (ACOG) and the American Academy of Pediatrics (AAP) now recommend DCC use for full-term infants.

Concerns Around DCC

Those critical of DCC worry that it may increase certain risks. Examples include polycythemia, hyperbilirubinemia, jaundice, and respiratory distress.

• Polycythemia is when the baby has too many red blood cell counts, causing the blood to thicken too much. However, this concern isn’t backed up by research. No current scientific literature shows an increased risk of polycythemia from DCC.
• Hyperbilirubinemia refers to high bilirubin levels, which can harm the developing brain. UV therapy (phototherapy) can help to break it down. 
• Jaundice is a yellowing of the skin and eyes due to a buildup of bilirubin. No current research shows a risk of increased jaundice from DCC. If it does occur, the baby may need phototherapy, which isn’t a big deal.
• Respiratory distress is when an infant has trouble breathing at delivery. Some practitioners worry that DCC may delay resuscitation efforts, putting the baby’s life in danger. However, resuscitation can safely be done before cord clamping. 

According to one review and meta-analysis, DCC showed a non-statistically significant increase in polycythemia in infants. Researchers concluded the condition was generally harmless. A Cochrane review concluded that while DCC may slightly increase the risk of jaundice requiring phototherapy, delaying clamping benefited full-term infants by improving their iron stores.

How Do You Know If the Cord Clamping Is Being Done Correctly?

Here’s what to look for (and ask about!) to see if your birth provider knows how to DCC the best way.

• Communication: There should be clear communication between the healthcare provider, the mother, and others present throughout the birth process. The medical professional should explain the process and the benefits of DCC. They should also ensure the mother is informed and comfortable with the birth plan.
• Timing: Optimal timing of umbilical cord clamping after birth is everything. The general recommended timing for DCC is between 30 to 60 seconds and up to 5 minutes. However, the 1 minute timing is likely not long enough. It’s better to wait until the umbilical cord stops pulsating and becomes limp and white. Then you know all the cord fluids have gone to the baby.
• Monitoring: The healthcare provider should closely monitor the baby and the mother during DCC. They should check breathing, heart rate, and overall well-being throughout the process. That helps to ensure there are no signs of distress or complications. 
• Positioning: After birth, the provider should place the baby on their its mother’s stomach or chest for immediate skin-to-skin contact. During this process, the umbilical cord remains attached to the placenta. It just so happens that the umbilical cord was designed for this very thing. It’s the perfect length for the baby to comfortably nurse before the placenta is delivered.

Ensuring the baby has physical contact with the mother promotes immediate bonding and a feeling of comfort and security for the baby during DCC. There should also be unlimited access to breastfeeding at this time. 

While DCC generally benefits the mother and the baby, sometimes specific medical conditions prevent it. That’s why it’s crucial to communicate with healthcare professionals to determine whether DCC is appropriate in your case. 

What Is Cord Blood Banking?

The umbilical cord blood contains iron- and oxygen-rich blood, plus millions of stem cells and other valuable constituents. Stems cells are especially desirable because they can differentiate into many kinds of cells. These may be able to treat certain diseases, including cancer. Stem cells simply need instructions for what kind of cell to become.

Because this stem cell-containing fluid is so valuable, many people choose to store it in a cord blood bank. One option is private or family banking, which allows you to reserve the cord blood for the baby or family members in case of illness. Another option is public banking, where the cord blood is available to other families who need it. 

If the parents give no preference, the hospital is supposed to dispose of it as medical waste.

Here are a few pros and cons of private cord blood banking:

Pros: 

• Cord blood collection is simple, and there’s no harm to mother or baby.
• The cord blood is available to the child or family members in case of illness. Cord blood may treat as many as 80 diseases, including leukemia and lymphoma. Researchers are also conducting trials to see whether it could help autism, cerebral palsy, and other conditions.
• Using cord blood for stem cells increases the likelihood of being a match for family members. There’s a 75% chance it could be a partial match for siblings.
• It’s free to retrieve it from the cord blood bank. 

Cons:

• There is a cost to preserve cord blood. Payment plans often start at $69 a month for a two-year term.

It just so happens that true delayed cord clamping decreases the umbilical cord blood available for cord blood banking. For that reason, some people choose to not transfer all the blood and stem cells to the baby. Instead, they reserve this valuable fluid for blood banking.

This is likely the reason minimal DCC (only waiting 30-60 seconds) and immediate cord clamping are popular. The stem cells in umbilical cord blood are used in stem cell research, which is big money. The umbilical cord stem cell market has seen massive increases in recent years, and continues to grow.

When to Avoid Delayed Cord Clamping 

Delayed cord clamping may not be suitable for all infants or in certain medical situations. Examples include heart rate abnormalities or coming out depressed (limp, gray, or blue). Then early cord clamping may be necessary so that the doctor can address health concerns. Often, babies can still get the medical care they need while receiving oxygen and nutrients through the cord. Otherwise, there’s rarely a good reason to avoid DCC.

Final Thoughts on DCC

If you want your doctor or midwife to practice delay cord clamping, be sure to talk it over with them and add it to your birth plan. Be sure to study the history, process, safety, and benefits when you talk to your healthcare provider. While it may not be best for everyone, this practice has stood the test of time. 

Have you opted for delayed cord clamping in your birth process? Would you consider it in the future? Share with us below!