Delayed cord clamping/cutting

Delayed cord clamping means to delay the surgical intervention of clamping  the umbilical cord at birth. Early clamping and cutting of the umbilical cord is widely practised as part of the management of labour, but recent studies suggest that it may be harmful to the baby. At birth, he says, the umbilical cord sends oxygen-rich blood to the lungs until breathing establishes. So as long as the cord is unclamped, the average transfusion to the newborn is equivalent to 21% of the neonate’s final blood volume and three quarters of the transfusion occurs in the first minute after birth. Author Tina Cassidy in her book Birth: The Surprising History of How We Are Born sheds some light on the subject:

“Throughout history, the immediate postpartum period has been as much a victim of fashion and misconception as has labor and birth.  And standard practice still varies among countries, hospitals, doctors, and midwives.  The first act that usually occurs after the slippery baby emerges is the cutting of the umbilical cord.  …The act also forces the newborn to breathe air through its lungs for the first time.  Perhaps because of the symbolism of that moment, cord cutting has been a magnet for drama, ceremony, and superstition.

In most hospitals today, cutting the cord is such an uneventful routine that it can pass unnoticed by the overwhelmed mother.  Doctors generally wait about thirty seconds a time period long enough, they believe, for the baby to receive all the blood it needs from the placenta.  …They then apply two clamps, break out the scissors, and often ask the father if he wants to cut between the ligatures.  Doing all of this quickly also allows for the baby to be suctioned, weighed, and swaddled, before it gets cold.

Some childbirth experts argue that, rather than being guided by a clock, it’s best to wait until the cord stops pulsing before cutting, allowing the baby to receive all the blood it was meant to receive from the placenta.  They say it helps the mother as well, because the placenta shrinks as it pumps out extra blood, making it easier to deliver.”

The research that SUPPORTS delayed cord clamping/cutting:

Delayed Umbilical Cord Clamping Boosts Iron In Infants (2006): A report of a study conducted by UC Davis nutrition professor Kathryn Dewey that revealed a two-minute delay in cord clamping at birth significantly increases a child’s iron status at 6 months of age.  This study documented for the first time that the beneficial effects of delayed cord clamping last beyond the age of 3 months.

Early versus delayed umbilical cord clamping in preterm infants (2004): A Cochrane review (considered the “gold standard” of research and evidenced based practice) of studies on babies born prematurely which revealed that delaying cord clamping for greater than 30 to 120 seconds, rather than early clamping as is the current obstetrical practice, seems to be associated with less need for transfusion, less intraventricular haemorrhage, and helped the babies adjust to their new surroundings better.

Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes (2008): A Cochrane review that showed no significant difference in postpartum hemorrhage rates when early and late cord clamping were compared. The review also reported growing evidence that delayed cord clamping confers improved iron status in infants up to six months after birth, with a possible additional risk of jaundice that requires phototherapy.  (It is important to note however that the act of placing the baby on the mother’s abdomen skin-to-skin above the level of the placenta assures that blood will continue to flow, but not to excess.)

The PROS of Delayed Cord Clamping/Cutting

Below is a summary of the literature regarding the pros and cons of immediate vs. delayed clamping of the cord.

1) The blood in the placenta rightfully belongs to the baby, and babies not receiving this blood have the deal with the equivalent of a major blood loss or hemorrhage at birth.  It is estimated that early clamping deprives the baby of 54 to 160 ml of blood, which represents up to half of a baby’s total blood volume at birth.

2) There is a significant amount of iron in the cord blood which the baby needs for optimal health and for the prevention of anemia.

3) Babies benefit from the increased oxygen available to them from the cord-blood when the taking these first few breathes.  The earlier the cord is clamped, the more likely the incidents of respiratory distress.

4) The blood that babies receives through the cord after birth acts as a source of nourishment that protects infants against the breakdown of body protein.

5) As an added bonus, delayed cord clamping keeps babies in their mother’s arms, the ideal place to regulate their temperature and initiate bonding and breastfeeding.

The CONS of Delayed Cord Clamping/Cutting 

1)     May increase the baby’s risk for jaundice, a condition that many newborns develop related to the baby’s immature liver that cannot process bilirubin, a yellow byproduct of the breakdown of old red blood cells.

It seemed to me that the PROS of delayed cord clamping outweigh the CONS however I feel that it is important to explore the subject of newborn jaundice more…that is, Is it something that parents should be worried about?  Is it serious enough to trump all of the research supported benefits of delayed cord clamping?

Berwald, M. (2009). Late vs Early Clamping of the Umbilical Cord in Newborn Babies. Birth Bliss. Retrieved from website:

Buckley, S. (2005). Leaving well alone: A natural approach to the third stage of labour.

Cassidy, T.  (2006). Birth: The Surprising History of How We Are Born. Atlantic Monthly Press.

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