Delayed Cord Clamping- Worth the Wait?


By Georgia Ragonetti-Zebell, MD

 

“Here he is, momma! Happy Birthday, baby!” I place this sweet little boy on his momma’s belly as he takes his first breaths. The baby nurse comes over to stimulate and dry him off.

 

“Ok, we’re gonna take him over to the warmer to get cleaned up,” the nurse says as she lifts the baby up.

 

“Wait, wait! He is still attached!” I tell her. I’ve always been slow about cutting the cord, to give the baby time to transition.

 

And now, I actually have a guideline.

 

This month, American Congress of Obstetricians and Gynecologists (ACOG) has officially recommended delayed cord clamping for both preterm and term infants. Delayed cord clamping has previously been endorsed by the World Health Organization, the American Academy of Pediatrics/Neonatal Resuscitation Program, and the American College of Nurse-Midwives.

 

What is delayed cord clamping?

 

Delayed cord clamping refers to clamping the umbilical cord 30-60 seconds after delivery, as opposed to the more traditional practice of immediately clamping the cord upon delivery.

 

Why delay clamping?

 

Remember that the blood in the cord and placenta is all baby’s. In utero, the placenta is acting as the baby’s lungs. Blood flow bypasses baby’s lungs, and instead, picks up oxygen from the placenta. After birth, there is a transition. Blood flow must be redirected toward baby’s lungs to get the oxygen from there. That takes a few seconds to do. If the cord is clamped immediately, the blood from the placenta hasn’t been directed to the lungs yet. Baby will use the blood that he otherwise has in his body, but it will be a lower volume if the cord is immediately clamped. If cord clamping is delayed, a larger volume of blood gets to baby.

 

Approximately 80mL of blood is transferred from the placenta to baby by one minute after birth. By three minutes, it is 100mL. For context, an average newborn blood volume is approximately 280mL (less than the volume of a can of soda). That is a huge transfer of blood that can occur during that first few minutes.

 

Why is a larger volume of blood better?

 

The extra blood that baby gets increases the body’s iron stores, which leads to less anemia in the first year of life. According to the new Committee Opinion from ACOG, anemia in infants is associated with “impaired cognitive, motor and behavioral development.” The blood also contains immunoglobulins and stem cells, which may be particularly important for preterm babies. Preterm infants who had delayed cord clamping experienced fewer blood transfusions, intraventricular hemorrhage, and necrotizing enterocolitis. For term infants, delayed cord clamping increases hemoglobin, and possibly has long term improvements in social and fine motor skills.

 

Are there any risks?

 

One concern that has come up is an increased incidence of jaundice. Jaundice occurs when the baby’s liver begins to break down the extra blood cells. A by-product of this process is bilirubin, which can be dangerous if the levels become too high. There is a trend toward increased jaundice in babies who had delayed cord clamping, but the benefits appear to outweigh the risks.

 

Another concern was postpartum hemorrhage. There was some initial concern that delayed cord clamping would increase the rates of postpartum hemorrhage. Studies have now shown that not to be the case.

 

But what about the baby? Doesn’t he need stimulation and to be warmed?

 

The baby can be placed immediately skin to skin with momma. This helps with temperature regulation, just as a warmer would. Assessment of the baby can be done right on momma’s chest (or belly if the cord is shorter). However, if there is a need for immediate resuscitation, delayed cord clamping may not be appropriate. This is also true in situations where the placenta is abnormal in some way- abruption, placenta previa, etc.-or in cases of hemorrhage or maternal instability.

 

The nurse puts baby back down on momma. We ‘ooh’ and ‘aah’ over this little guy a little bit longer. Finally, after a couple minutes, I hand dad the scissors. “Right here, between the clamps,” I tell him. Everyone congratulates dad on his cutting skills. By now, baby is all cleaned up and there’s no need to take him away. He’s happy right where he is.

 

So, snuggle your baby for a minute before cutting that cord, momma. Your baby will thank you later.

 

Georgia Ragonetti-Zebell, MD is an OB/GYN practicing in Upstate South Carolina, and is mommy to four (yes, FOUR) boys. She is a graduate of the Women’s Health Pathway at Drexel University College of Medicine in Philadelphia, Pennsylvania and completed her residency in Obstetrics and Gynecology with the Greenville Health System in Greenville, South Carolina. She has a special interest in natural childbirth, breastfeeding, and alternative methods in labor and delivery. She enjoys yoga, crochet, and reading, but spends most of her free time cleaning up poop while trying not to step on Legos.


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