What You Should Know About Delayed Cord Clamping

As you’re writing out your birth plan and checking it twice, there’s a recommendation from the American College of Obstetricians and Gynecologists (ACOG) you’ll want to know about. 

Since the mid-20th century, anyone giving birth in a hospital would have their umbilical cord clamped immediately after delivery. But ACOG now recommends waiting at least 30 to 60 seconds before clamping.

“It’s called delayed cord clamping, and a lot of moms are asking for it now,” says Mary Lou Kopas, M.N., C.N.M., chief of Midwifery at UW Medical Center - Northwest.

What is delayed umbilical cord clamping?

After you give birth, your baby remains attached to the placenta via the umbilical cord—that rope of veins and arteries that’s spent nine months making Amazon delivery look slackerish by providing 24/7 blood, oxygen and nutrients to your little one in utero.

Birth is like last call for your baby—the last opportunity to get a few more pulses of good stuff from the placenta before having to face the world all on their lonesome.

“You get a greater net blood flow to the baby when you don’t cut the cord right away, and most of it happens within the first minute," says Kopas.

What are the advantages of delayed cord clamping?

An increase in blood volume from not clamping the cord right away supports baby’s cardiovascular system as it makes the transition from fetal to newborn circulation. It also improves baby’s iron stores and reduces iron deficiency even four months after birth.

Avoiding iron deficiency is good because it’s been linked to impairments in cognitive, motor and behavioral development.

How did the change in cord clamping recommendations come about?

The issue of when to clamp the umbilical cord has been of interest to the childbirth community for years.

“Before the 1950s, and for many centuries, when most babies were delivered by midwives, umbilical cords were likely tied off and cut a few minutes after birth, when they naturally stopped pulsing,” says Kopas. “The basic physiology of human birth is very similar to other mammals, and we know that no one was there clamping, tying off, or cutting that cord when early humans were evolving.”

Doctors at some point began cutting the cord immediately and that became the medical norm. They worried that increased blood to the newborn might result in circulatory overload, elevated levels of hemoglobin, increased risk of jaundice, and increased risk for postpartum hemorrhage in women.

"There may also have been some concern about the baby losing blood through the placenta or breakage of the cord, or mixing of maternal and newborn blood. Like many traditional medical practices, it probably started before the physiology involved was well-understood," says Kopas.

They were mostly wrong about these concerns, as a growing body of evidence began to show. But even as the evidence mounted, it was not reflected in practice.

The reasons for this are complex—custom, difficulty in implementation and gaps and errors in practitioner knowledge, compounded by the lack of specific guidelines and explicit definitions of "early" and "delayed" clamping.

When did ACOG make its delayed cord cutting recommendation?

ACOG is the leading professional association of obstetricians and gynecologists. In 2012, they published guidelines that recommend delayed cord clamping for pre-term infants (those born earlier than 37 weeks).

“They were finding that pre-term babies with delayed cord clamping had lower instances of infection, anemia, inflammation and bleeding in the brain—all of these significant complications of prematurity which you want to avoid,” says Kopas.

ACOG continued to monitor studies that were complicated and sometimes conflicting on whether delayed cord clamping might be a good practice for all infants, not only preemies.

In January 2017, ACOG recommended that the same practice should apply to vigorous full-term infants, too—those with strong respiratory efforts, good muscle tone and a normal heart rate (greater than 100 beats per minute) in the first moments after birth

Are there times when it is not a good idea to delay cord clamping?

There is one potential disadvantage to delayed cord clamping: that increase in jaundice that worried practitioners turned out to be a valid concern.

There is a small increase in jaundice, but not harmfully high levels, so not enough to recommend against it, says Kopas.

Sometimes, for the health and safety of either mom or baby, it’s best to cut the umbilical cord right away. Twins present the challenge of a circulation system that might be interconnected. Sometimes mom bleeds too much or experiences placental abruption, when the placenta separates from the wall of the uterus before birth. 

“You won’t really know until the birth unfolds, but there are times that we still cut the cord immediately, and it’s the right thing to do,” says Kopas.

She advises parents-to-be to put delayed cord clamping in their birth plan and talk it over with their provider. 

“You just want to be sure you’re on the same page so there are no last-minute surprises.” 

Of course there’s one small surprise left—once that cord dries up, will your baby turn out to be an innie or an outie?