We all hope that our doctors are ‘up’ on the latest research and are all about best practise. However, they are also human too. Stress, resource constraint and lots of other potential reasons mean that it is always best to be on top of your own situation. To be your own educated advocate. Particularly when it comes to communicating with your doctor to ensure the absolute best interest for you and your baby. No downside! The timing of Umbilical Cord Clamping at birth is an interesting one. Over the last few decades thinking has shifted from very quick clamping (below 30 seconds) to delaying it more from anywhere to 30 seconds to up to five minutes. More recent research suggests benefits from discussing delayed cord clamping. Of course everyone’s situation is different. Here are a few things you need to know about discussing it with your doctor. 

So what is cord clamping?! 

Taking a step back. The umbilical cord connects your baby to the placenta. This is what has helped your baby develop and grow through pregnancy. Carrying nutrients and oxygen directly to it. Cutting this cord at birth frees the baby from the placenta. Which should be delivered soon after the baby is born. The timing of when this is cut is the interesting question here….

So what are the potential benefits to delayed cord clamping? 

First and foremost, everyone is an individual and has their own unique set of circumstances. Birth is unpredictable. When it comes to higher risk and multiple babies it is a more complex discussion. However for single babies and low risk pregnancies the evidence suggests several benefits to delayed cord clamping that make it worth considering. 

Delayed cord clamping and iron: key for brain development: 

By delaying umbilical cord clamping you’re allowing more time for transfer of blood from the placental from the baby. Specifically the evidence suggests improved iron storage/lower risk of iron deficiency in babies who have had a delay. 

‘increasing evidence had shown the benefits of Delayed Cord Clamping in term and preterm infants including higher haemoglobin levels and iron status’. (1) 

In fact with a 1 minute delay a newborn will receive 80ml of blood. 

At 2-3 minute delay he or she will receive 100ml. (2)

In terms of iron specifically, at birth babies born at full term have a 75mg/kg store. With delayed cord clamping they receive an additional 40mg of iron at 1 minute and 50mg at 3 minutes. That is ‘enough to prevent iron deficiency in the first 6 months of life and probably until a year old.’ (2) 

Why does iron matter so much for my new baby? 

A deficiency can impair neurodevelopment and impact the central nervous system in a baby (1, 3, 5). In fact, iron deficiency globally is the most common nutrient deficiency and is the only nutrient deficiency with a significant prevalence in developed countries. (5) 

One study suggested that as many as 15% of children between 12 and 23 months are deficient in the US. (5) 

So, to give growing brains and developing central nervous systems a helping hand, getting plenty of iron is a good start. 

Other potential benefits to delayed cord clamping: 

It is now actually recommended by the American College of Obstetrics and Gynaecology (ACOG) for preterm infants (1) with additional benefits like a reduction in Necrotising Enterocolitis and late onset sepsis. It can be particularly helpful for premature babies whose development may need a helping hand. 

Delayed cord clamping and immunity? 

Umbilical cord blood also contains various stem cells that play an essential role repairing tissue and building immunity. Plus there is evidence that it can potentially reduce inflammation (click here for why this is important). Further, in 2014, the well respected journal ‘Paediatrics’ published the first study that looked at the impact of early vs delayed clamping on oxidative stress which we know at high levels can damage cells. (6) 

Click here for more on both oxidative stress and inflammation and why we should seek to minimise it! 

Risks around delaying cord clamping:  

An emergency situation is obviously a totally different scenario. However, one of the main question marks historically is around the risk of bleeding. However, most studies have concluded there is no additional risk associated with it:

‘Delayed Cord Clamping was not associated with increased risk of postpartum hemorrhage and maternal blood transfusion whether in Cesarean or vaginal delivery.’ (1) 

So how long do you delay? 

This is a bigger question mark. The ACOG has called for more research to be done as to what is ‘optimal’. The World Health Organisation currently recommends between 1-3 minutes (5). However, more work needs to be done and your doctor will likely have his/her own opinion on this. Once again it is worth a discussion. More broadly however ‘early’ cord clamping’ is defined as clamping in the first 30 seconds, ‘delayed’ is at least + 30 seconds but some literature goes up to as long as 5 minutes. 

‘Some experts recommend a minimum of 2 minutes as it is the time by which most (approximately 55%) of the placental blood has been transfused to the infant.’ (5) 

Conclusion: 

Birth is by its very nature unpredictable. So there may be a situation where this is not possible. However, in preparation for birth, the evidence suggests that this simple, safe and inexpensive procedure is absolutely worth discussing with your doctor. Specifically relating to benefits from greater iron (for brain development) and immune support. So, worth a chat! 

References: 

1) Qian Y, Ying X, Hua Y: Early versus delayed umbilical cord clamping on maternal and neonatal outcomes: Archives of Gynecology and Obstetrics: 2019; 300(3): 531-543

2) Fogarty M, Osborn DA, Askie L, Seidler AL, Hunter K: Delayed vs Early Umbilical Cord Clamping for preterm infants: A systematic Review and Meta-Analysis: American Journal Obstetrics and Gynaecology: 2018: Jan; 218(1): 1-18

3) Ceriani Cernadas JM: Timing of umbilical cord clamping of term infants: Arch Argent Pediatrics 2017;115(2):188-194

4) American Academy of Pediatrics: Delayed Umbilical Cord Clamping After Birth. 

5) Chantry C, Blanton A, Tache V, Fontana L: Delayed Cord Clamping During Elective Cesarean Deliveries: Results of a Pilot Safety Trial: Maternal Health Neonatal Perinatal: 2018 Jul 4;4:16

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