Delayed Cord Clamping
That adorable little belly button your baby has was once part of your baby’s “womb mate”, the placenta. The placenta’s role is to carry oxygen and nutrients to baby and carry away waste via the umbilical cord. For decades the standard of care has been to immediately clamp and cut the cord once baby was delivered, because its been thought that full term babies already have all the nutrients they need, that babies would get too much blood (polycythemia) that could overload organs and systems or that blood could flow backward back to the placenta if not immediately clamped. However, modern studies and data suggest there are several benefits to delaying cord clamping (DCC), and there is not enough sufficient data to suggest any risks.
While in utero, blood is constantly being filtered and pumped to and from the placenta and your baby. At any time the placenta can hold up to as much as one third of your baby’s blood volume. When the umbilical cord is immediately clamped after birth, that third of your baby’s iron rich blood never makes it back and remains retained in the placenta, putting your baby at risk for iron deficiency and anemia. Delaying clamping allows for an increases infant’s iron stores and an increase of red blood cells, meaning more oxygen for lungs and tissues, giving your baby better protection against organ damage, brain injury and death.
How long you should wait before clamping is debated. The World Health Organization recommends waiting 1-3 minutes, while most midwives will say its best to wait until the cord stops pulsating, meaning the placenta has stopped pumping, usually about 5 min. To understand the importance DCC, one must look a little closer at the value of the blood itself.
It’s becoming a growing trend and choice of parents to bank their child’s cord blood. The value of this is that the cord blood carries high levels of embryonic stem cells. Embryonic stem cells are powerful because while they are not specialized, tissue specific cells, meaning they cannot work together to pump blood like cells in the heart or carry oxygen like a RBC, but they can give rise to specialized cells and they can also renew themselves, divide and create more stem cells for long periods of time (think of a medicine that keeps on working). Embryonic stem cells are different because they can become any type of cell while adult stem cells typically only give rise to new cells from the tissue in which they’re found. While it can be beneficial to collect and store these stem cells in the event that your child could benefit from stem cell therapy in the future, one should also see how important it is that your child get as many of these amazing cells that have the ability to renew and restore cells and tissues into the body to act as a preventative measure. It should be noted that cord blood can still be collected and banked if the cord is clamped between 1 and 3 minutes, as long as the cord has not stopped pulsating.
The benefits of delayed clamping started to come to light after it started being used in preterm infants to increase blood volume. From there the benefits have continued to become clear for all infants. A study done by the University of Rhode Island concluded that children who experienced delayed cord clamping had increased brain myelin, important for early life functional development and associated with motor sensory processing/functioning and visual development.
The American College of Nurse Midwives suggests that delayed cord clamping be the standard of care for all full term and preterm infants. Immediate cord clamping is advised against unless under emergency context when the infant is in need of immediate care. Even when a cesarean section is needed and the cord needs to be clamped quickly, it is advised that Dr’s wait up to 40 seconds to clamp and proceed by milking the cord to ensure the baby gets as much cord blood as possible.
The benefits of delaying clamping are becoming increasingly clear, but no matter what you and your physician chose is best for you and your baby, we can all agree that the placenta is an amazing organ with profound properties that support, sustain, nourish and grow a child to full development!
ACOG, American College of Obstetricians and Gynecologists. Delayed Umbilical Cord Clamping After Birth. 2017. Americanpregnancy.org
American College of Nurse-Midwives. Delayed Umbilical Cord Clamping (Position Statement). 2014. Midwife.org
NIH, National Institute for Health. Department of Health and Human Services. Stem Cell Information, Stem Cell Basics V. 2019. Stemcells.nih.gov
WHO, World Health Organization. Guidelines for Recommendations on Newborn Health. 2019. Who.int
National Public Radio. Delayed Umbilical Cord Clamping May Benefit Children Years Later. 2015. NPR.org