The timing of umbilical cord clamping is very controversial, and if you ask 3 different care providers their opinion, you’ll likely get at least two different answers.
Let’s review the anatomy of the placenta to gain an appreciation for the umbilical cord and it’s roll in building a human.
The placenta is the only temporary organ in the female body, and is grown from the building blocks of the young embryo. By about 10 weeks of pregnancy, the placenta becomes the organ that facilitates food and waste exchange between mom and baby.
In a normal, healthy pregnancy, the blood of the baby and mother never touch!
The umbilical cord is attached from the baby’s abdomen to the side of the placenta that the baby sees; the other side of the placenta is attached to the inside of the uterus, on the other side of the amniotic membrane. The cord has two arteries and 1 vein; The arteries carry oxygen-depleted blood and waste away from baby to mom, and the vein carries oxygen and nutrients from mom to baby.
The baby’s blood travels through it’s body, through the umbilical cord to a space in the placenta where the two bloods come very close and the blood products move across membranes, so that the mom can get rid of the wastes for the baby and the baby can have renewed oxygen and nutrients.
Even from the very beginning you’ve been cleaning up after your kid.
But how freakin’ cool is this entire process??
After the birth, the placenta is birthed because it is no longer needed.
Why should I care about the timing of cutting my baby’s umbilical cord?
At the time of delivery, up to ⅓ of your baby’s blood is still in the placenta, and it takes 3-5 minutes for that blood to transfer.
There is much debate about the optimal timing for cord clamping, although most midwives around the world have always maintained a practice of not cutting until it has stopped pulsing or even waiting until the placenta is delivered.
As long as the cord is pulsing, blood is still being sent from the placenta to the baby.
What does the evidence say?
It is hard to compare all the research as the definitions of “early” and “delayed” differ so much.
I will consider “delayed” as at least 3-5 minutes, as that’s how long it takes for all the blood to get transferred to the baby.
What are the benefits of delayed cord clamping?
Benefit 1: Higher birth weight
With delayed cord clamping, the baby gains an average of 24-32 ml/kg of body weight. Let’s look at that in real-life terms:
An average 7.7 lb (3.4kg) baby would gain between 81.6-108.8 ml blood, making them weigh that much more.
That’s 2.9-3.8 ounces of blood that baby misses out on if the cord is cut immediately following delivery.
In a equivalent 130 lb woman like me, that’s akin to preventing an extra 50-67 ounces blood, equivalent to a 2-L pop bottle of blood.
For babies, that extra blood volume is extremely helpful, especially in babies that are considered “small-for-gestational-age”. Small babies have a harder time keeping their sugar levels normal, as they burn more energy staying warm and doing normal body processes. This extra blood from a complete placental transfusion can actually keep some babies OFF the hospital’s hypoglycemia protocol, as many babies will just slip over the edge into this “small-baby territory”, and an extra 2-3 ounces makes them “normal-for-gestational age”. Avoiding this hypoglycemia protocol can prevent frequent blood draws to test sugar levels, scheduled feedings (which is not physiologically normal for newborns) and pressure/medical recommendations to supplement.
Benefit 2: Increased iron stores
Delayed cord clamping lowers the risk of anemia up to 6 months of age, which is when parents are recommended to introduce solid food (go figure). For some infants who have low iron levels, they can have trouble gaining weight in the first six months, which can impact the breastfeeding relationship, and can be more fussy and irritable.
In a 2019 study out of Rhode Island, researchers showed increased myelin development (which needs iron and red blood cells) when the cord was cut after 5 minutes. Myelin is an insulator and very important in the transfer of messages across the nerve cells in the brain. The better the myelination, the more efficient the brain processing.
Are there any risks of delayed cord clamping?
Potential risk 1: Increased jaundice levels
The newborn’s red blood cells make some changes after birth, so when he or she receives those extra two to three ounces of blood by delayed cord clamping, those red blood cells break down and release something called “bilirubin”. Bilirubin is what makes a baby’s skin yellow, and it can cause brain damage in really high levels.
We don’t typically see brain damage from jaundice in North America, because we catch babies before they ever get to a dangerous threshold and treat the jaundice.
Jaundice treatment usually consists of putting these babies under special lights in hospital for 24-48 hours, monitoring feeding and hydration levels.
How do I balance the benefits of DCC and the risk of jaundice?
A 2013 Cochrane Review on cord clamping timing titled “Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes” suggests that the benefits of DCC outweigh this small potential risk, especially since it appears that the benefits are long-lasting, and the risks are short-term, as long as the jaundice is treated.
So what are the actual guidelines?
The Society of Obstetricians and Gynaecologist of Cansda states that: “for term newborns, the possible increased risk of neonatal jaundice requiring phototherapy must be weighed against the physiological benefit of greater hemoglobin and iron levels up to 6 months of age conferred by delayed (>60 seconds) cord clamping.”
I thought you said it took 3-5 minutes for all the blood to make it's way to the baby?
I did. This is why it’s important to discuss this prenatally with your care provider using exact timing, instead of just telling them you want Delayed Cord Clamping.
Your idea of “delayed” may not align with theirs.
Did you learn anything new in this post? Comment below to tell me your thoughts, questions, or share your past experiences with cord clamping.
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References:
University of Rhode Island. “Benefits of delayed cord clamping in healthy babies.” 11 February 2019. ScienceDaily. Accessed 18 March 2021. Available at: https://www.sciencedaily.com/releases/2019/02/190211105402.htm
Garofalo, M., Abenhaim, H.A. “Early Versus Delayed Cord Clamping in Term and Preterm Births: A Review”. June 2012. J Obstet Gynaecol Can 2012;34(6):525–531. Accessed online 18 March 2021.
Clinical Practice Obstetrics Committee. “Active Management of the Third Stage of Labour: Prevention and Treatment of Postpartum Hemorrhage”. October 2009. SOGC Clinical Practice Guideline. Number 235. Accessed online 18 March 2021. Available at: https://www.jogc.com/article/S1701-2163(16)34329-8/pdf
McDonald, S.J., Middleton, P., Dowswell, T., Morris, P.S. “Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes”. 2013. Cochrane Database of Systematic Reviews, Issue 7. Art. No.: CD004074. DOI: 10.1002/14651858.CD004074.pub3. Accessed online 18 March 2021.
Lee, L., Dy, J., Azzam, H. “Management of Spontaneous Labour at Term in Healthy Women”. 25 June 2016. Journal of Obstetrics and Gynaecology. Volume 38, Issue 9, P843-865. Accessed online 18 March 2021.
Iron Needs of Babies and Children. January 2019. Candian Paediatric Society. Accessed online 2 June 2021. Available at: https://www.caringforkids.cps.ca/handouts/pregnancy-and-babies/iron_needs_of_babies_and_children