Umbilical CordThe umbilical cord is the lifeline between a baby in utero and, through the placenta, its mother.  It is the conduit through which oxygen-rich blood and nutrients flow to the baby, and deoxygenated blood and waste products flow out. At birth, when left uncut, the umbilical cord will continue to pulsate for several minutes, sending oxygen-rich blood from the placenta, still inside the womb, to the baby, outside the womb. There is some debate in our medical culture about the optimal time after birth to clamp and cut that cord.  Let’s look at the studies and examine it from a few perspectives.

First, the fact: about one-third of a newborn’s blood is still in the placenta at birth. That blood is rich in iron and increases an infants’ iron storage for several months, if not longer, which is essential for the healthy development of a baby’s brain and for reducing the baby’s risk of anemia.  Early cord clamping is generally described as occurring before one minute after birth, while delayed clamping typically refers to waiting a minute or longer.

Midwives, including the Certified Nurse Midwives at Breath of Life, typically take the more natural approach and practice delayed cord clamping.  This is supported by the American College of Nurse-Midwives, which encourages midwives to wait at least five minutes after birth if baby is placed skin-to-skin with the mother, or two minutes, if the baby is held below the level of the placenta immediately after birth.

Some obstetricians, including many in the Tampa Bay area, follow the same practice as midwives when it comes to delayed clamping.  Others, however, take a more conservative approach and follow the guidelines of the American College of Obstetricians and Gynecologists, which suggests waiting only 60-seconds before clamping the cord.  In its 2012 opinion, ACOG concludes that “insufficient evidence exists to support or to refute the benefits from delayed umbilical cord clamping for term infants that are born in settings with rich resources.”  That opinion is shared by the American Academy of Pediatrics.

What do the studies show?  Let’s take a look:

  1. This one is a review of the studies, compiled by the National Institutes of Health. It finds that infants who had early clamping – less than one minute – experienced fewer incidences of jaundice, but were also twice as likely to be deficient in iron at three to six months old.  Their review concludes that “a more liberal approach to delaying clamping of the umbilical cord in healthy term infants appears to be warranted, particularly in light of growing evidence that delayed cord clamping increases early haemoglobin concentrations and iron stores in infants. Delayed cord clamping is likely to be beneficial as long as access to treatment for jaundice requiring phototherapy is available.”
  2. The World Health Organization states that “late cord clamping (performed approximately 1–3 min after birth) is recommended for all births, while initiating simultaneous essential neonatal care.” The WHO has a brochure with concise information about delayed cord clamping that can be printed and shared with pregnant women and their caregivers.
  3. This study, from the Brighton and Sussex Medical School in the UK, suggests that the benefits of delayed clamping – at least 3 minutes after birth – might improve the neurodevelopment of preschoolers.

Delayed clamping is an issue for families around the globe, and one of its champions is pediatrician Dr. Alan Greene, MD, FAAP.  Dr. Greene founded a worldwide movement called “Transitioning Immediate Cord Clamping to Optimal Cord Clamping (TICC TOCC)”, which encourages caregivers to wait at least 90-seconds before clamping the cord.  He sums up his passion for delayed clamping in his Ted Talk.

Finally, Dr. Mark Sloan, pediatrician and author of the book, “Birth Day,” cites some of the above research and more in his article for Lamaze International’s blog.  Dr. Sloane says with all the benefits of delayed clamping, without any known downsides, “the questions isn’t ‘Why switch to delayed cord clamping?’ It’s this: ‘Why continue to intervene?’”

The bottom line advice for pregnant moms:  be sure to ask your caregiver about when he/she clamps the umbilical cord and that his/her practice aligns with your preferences.

Umbilical cord clamping in the news: