Delayed cord clamping: Why and when it might be useful

“Do you want to cut the cord?” Many partners get this question seconds after the birth of a baby and want to participate in the activity that marks the transition from fetus to newborn.

The umbilical cord is your baby’s lifeline. During pregnancy, it delivers blood and nutrients from the placenta to the baby. But the umbilical cord can continue to play a role in your baby’s health after birth – specifically the blood that is still contained within the umbilical cord and the placenta.

When cord blood is mentioned, most people think of cord blood banking – when the stem cells within the cord blood are collected and stored to treat diseases such as leukemia later in life. But there’s another use for the blood in the umbilical cord that is becoming more common.

Changing views on when to cut the umbilical cord

Before the 1950s, the umbilical cord usually was cut after it stopped pulsating, anywhere from one to five minutes after birth. After studies showed that more than 90 percent of a baby’s blood volume was achieved within the first few breaths after birth, and no studies could determine the optimal time to cut the cord, the time between birth and clamping the cord grew shorter and shorter.

In most births in the United States, the umbilical cord is clamped and cut 15 to 20 seconds after birth. However, this timeframe has received increased attention in recent years in relation to a practice known as delayed cord clamping. Some health care providers believe that allowing more time for blood to flow from the placenta into the baby after birth may be beneficial – especially for premature infants. Think of it as a blood transfusion from the baby to itself before the placenta is delivered.

Potential benefits to delayed cord clamping

Waiting to cut the cord for a short period of time allows extra blood – blood that normally would be discarded with the cord and placenta – to get into the baby’s circulation. This can have a positive impact in several ways:

• Increased blood volume: We draw blood from babies for various tests. Premature babies require even more testing, which can lead to anemia and require blood transfusions. Starting out with a higher blood count can help prevent the need for transfusions.
• Increased iron: Babies who are breastfed require iron supplementation to reduce the chance of anemia, and this may help cut down on that need. Baby formula often comes with iron supplements added.
• Stabilization of heart rate and blood pressure: Premature infants are at increased risk for bleeding into their brains, which can cause long-term developmental problems for the infant. We think the increase in blood volume helps stabilize blood pressure and improve other cardiovascular functioning that reduces the risk of intraventricular hemorrhage by about 50 percent.

A 2015 study also suggested delayed cord clamping may result in a small boost in neurodevelopment years later. In this study, one group of full-term babies had their cords clamped less than 10 seconds after birth, while the second group was clamped three minutes after birth. The groups were monitored for four years, and researchers noted the children with delayed cord clamping performed slightly better when tested for fine motor skills and social skills. There was no difference between the groups in overall IQ.

Potential risks to delayed cord clamping

Standing next to your patient and holding an infant that’s been delivered but not separated from the umbilical cord can be unnerving for an obstetrician. We worry about mom’s and baby’s conditions: Is mom bleeding? Is the infant getting cold while we wait to cut the umbilical cord? There are times when it’s just not advisable.

When the baby needs immediate medical attention: If the infant needs to be resuscitated or if there is a birth defect or complication that needs immediate attention, we would want to clamp and cut the cord as soon as possible and hand the infant off to the pediatric providers who can see to its immediate needs.

Increased maternal bleeding: If there is excessive bleeding, we need to clamp and cut the cord to focus our attention on the mother. If there is evidence that the placenta has already separated from the uterus or wasn’t functioning well to begin with, there isn’t really any reason to delay the cord clamping.

There is another possible downside to delayed cord clamping. The extra red blood cells that the baby receives from delayed cord clamping get broken down in the circulation and bilirubin is released. High bilirubin levels are not good for infants – but treatment is pretty straightforward. Newborn jaundice can be treated with phototherapy – special light treatment – and it rarely leads to serious complications. Still, if this happens, the baby does require extra evaluation and treatment – something a baby born at term typically wouldn’t require.

What are the current cord clamping recommendations?

Recommendations for when to clamp and cut the cord differ. The American Congress of Obstetricians and Gynecologists (ACOG) advises waiting 30 to 60 seconds after the birth of a preterm infant, but acknowledges there is insufficient evidence to support delayed cord clamping in full-term infants born in areas that do not lack resources. The World Health Organization recommends one to three minutes after birth.

In October 2015, the Neonatal Resuscitation Program formally changed its position and now recommends delaying cord clamping for 30 to 60 seconds in the vigorous full-term and preterm infants.

Now that you understand the pros and cons to delayed cord clamping, you can see why these differences in expert opinion exist. Childhood anemia is a serious problem worldwide. But in the United States, childhood anemia is uncommon – our patients have access to supplements that many breastfeeding women in underdeveloped countries don’t. And we don’t like to see side-effects – or the need for additional treatment – due to a procedure that may not be essential.

As we assess our cord clamping protocols here in Dallas, one big question we are asking is whether the benefits to delayed cord clamping outweigh the risks. Talk to your Ob/Gyn about your own pregnancy and whether delayed cord clamping is safe and beneficial for you and your baby.

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