Delayed Cord Clamping: latest research and advice

Midwife and antenatal expert, Grace Strange shares the research on why delayed cord clamping is better for your baby. 

The question surrounding exactly when to cut the cord once a baby has been born has been hotly debated and researched for centuries. Most ancient cultures have traditionally and instinctively left the cord unclamped until well after the birth of the baby but there was also a time in history where early cord clamping was believed to be ‘safest’. To this day the exact timing of cord clamping for optimal outcomes for mothers and babies in different situations is still unknown and each hospital seems to have their own protocol surrounding it, however there is plenty of evidence to suggest that delayed cord clamping is best!

HISTORY OF CORD CLAMPING

As mentioned earlier, most ancient cultures instinctively left the cord unclamped and uncut until well after birth. During this time the cord would naturally stop pulsating and stop circulating blood from the placenta to the baby. By delaying cord clamping they were choosing not to interfere with the body's natural process.

It was in the 1890s that the first commercial cord clamp device was invented – but even the people who invented it warned that it should only be used when the cord had stopped pulsating, around 3-5 minutes after birth.

During the 1950s-60s however, in order to reduce the rate of postpartum haemorrhage (significant maternal bleeding after birth) active management of the delivery of the placenta was introduced and early cord clamping and cutting started to become more prevalent. Active management is where the woman is given an injection after the birth of the baby, the cord clamped and cut and then the placenta delivered by pulling on the cord via controlled cord traction. Although this had positive effects on the rates of maternal postpartum haemorrhage, it meant that babies' cords were getting clamped and cut closer and closer to birth and they were missing out on the precious blood that still remained in the placenta.

Over the next few decades many studies were carried out on the optimal time to clamp and cut a baby’s umbilical cord and as you will read below, delayed cord clamping has many benefits.

WHAT IS DELAYED CORD CLAMPING?

Delayed cord clamping is where the cord remains unclamped and uncut and attached to the baby for at least 60 seconds after birth.

Straight after birth the baby will usually be delivered and then placed directly on mum's tummy or chest while the midwives dry the baby down with a towel; stimulating it to breathe and kick-starting all the internal systems it needs to live outside the womb. While this is happening the umbilical cord is still attached to the baby on one end, while the other end of the umbilical cord is attached to the placenta that is still inside the uterus. This allows the baby to continue to receive oxygen and nutrients and excrete waste from the placenta in those first few minutes as it transitions to life outside the womb.

The World Health Organisation recommends that all babies – including those who are born preterm (before 37 weeks) – that do not need to be resuscitated, should not have their cord clamped before 1 minute of age. In fact 'late cord clamping’ (between 1-3 minutes) is strongly recommended for all births where the baby is spontaneously breathing. The New Zealand College of Midwives recommendation is that the cord is not clamped for at least 3 minutes in healthy term or preterm babies.

WHY IS DELAYED CORD CLAMPING IMPORTANT?

There is now substantial evidence to suggest that immediate cord clamping – where the cord is clamped and cut within the first 60 seconds after birth – is actually harmful to a healthy baby. At birth there is somewhere between 25-50% of the baby’s blood volume still in the placenta. By doing immediate cord clamping we are denying the baby this blood volume, which can lead to low iron stores and anaemia and affect brain myelin and neurodevelopment.

In premature babies, studies have found that giving them at least 60 seconds of delayed cord clamping significantly increases their chances of survival. One study claimed that it cut their relative risk of death in hospital by a third. Those crucial seconds allowed premature babies to receive extra red and white blood and stem cells from the placenta which helped them to maintain healthy levels of oxygen, control infection better and repair injured tissue. It gave them more time to start breathing on their own and avoid invasive procedures including blood transfusions.

There has been some concern in the past that delayed cord clamping can increase the risk of the mother having a postpartum haemorrhage, but many studies have now concluded that this in fact is not the case, nor does it have any other adverse effects on the mother.

WHEN IS DELAYED CORD CLAMPING NOT APPROPRIATE?

Delayed cord clamping may not be appropriate if the baby is born severely asphyxiated, not breathing, with a low heart rate or if there is concern over the condition of the baby. In these cases it's more important to start resuscitating or giving the baby whatever medical attention it needs, than to give it delayed cord clamping.

Equally, if the mother is severely compromised, the baby might have immediate cord clamping in order to increase the outcomes for the mother.

WHAT IF I HAVE A CAESAREAN?

Delayed cord clamping should still be practised during a Caesarean section and the cord should not be immediately clamped unless medically necessary – where the mother or baby needs immediate medical intervention. In New Zealand hospitals it is standard practise to have 1-2 minutes of delayed cord clamping during a C-section.

The doctor will deliver the baby and then either place the baby between the mothers legs or on her upper abdomen and cover it with a sterile cloth, or they will hold the baby in their arms for 1-2 minutes whilst keeping the baby attached to the cord and the cord attached to the placenta. Once the time is up then the doctor will clamp and cut the cord and pass the baby over to the midwife and then they will deliver the placenta.

CAN I DO DELAYED CORD CLAMPING AS WELL AS CORD BLOOD BANKING?

According to one cord blood banking company in New Zealand, your baby can have 30-60 seconds of delayed cord clamping before the cord needs to be clamped and cut. The rest of the remaining blood in the cord can then be collected and stored.

Your wishes regarding delayed cord clamping should be discussed with your lead maternity carer at your birth plan appointment which is usually around the 36 week mark. Don't be afraid to ask them lots of questions about how they practise and about how your wishes will be incorporated into your birth.

Grace Strange is a midwife and creator of Antenatal Co. – independent antenatal classes that were born out of a desire to ensure parents have access to the very best antenatal education and head into labour, birth and beyond fully prepared. Find out more at antenatal.co.nz or on Instagram @antenatalco.