What is Delayed Cord Clamping?
THE UMBILICAL CORD
First, let’s make sure we understand the function and purpose of the umbilical cord before we dive into what is delayed cord clamping. The umbilical cord is connected to your baby through its navel and to your placenta. Umbilical cord length is generally 50-60cm in length for a term birth and variations in length are common. Filtered by the placenta, blood flows through the umbilical cord to your baby to provide nutrients vital for growth and development, and oxygen, so that all their cells are functioning properly. Blood returns back to the placenta through the umbilical cord to become re-oxygenated (once your baby is born, they oxygenate their own blood through respiration by using their lungs).
Cutting the umbilical cord is a universal event, but may look different based on location, culture, westernized vs. traditional medicine, and species. All mammals produce a placenta and umbilical cord to take care of their babies during pregnancy. Many mammals, including dogs, use their teeth to “cut” the umbilical cord. Thankfully, modern medicine and technology allow us to use special surgical scissors and cord clamps rather than relying on our teeth, but feel free to talk with your provider if teeth seem like a better fit.
Placenta with delayed cord clamping
The umbilical cord has a little bit of blood left. You can see this as the candy cane like blue twists within the white cord. If there was not delayed cord clamping, the umbilical cord would have limited white space.
UMBILICAL CORD STRUCTURE
The umbilical cord is attached to the placenta on the side that faces the baby and is attached to your baby at their navel (where the belly button is). The umbilical cord commonly has 3 vessels inside of it, 2 arteries and 1 vein, surrounded by a substance called Wharton’s jelly. It is not like the jelly you think of when picturing your morning toast, Wharton’s jelly is thick, firm, and rubbery (it is the white/ translucent covering you see above). It protects the vessels that provide oxygen, nutrients, and blood to your baby.
Delayed cord clamping is the process of extending the amount of blood that a baby receives from the umbilical cord after being born. Essentially, it is a change in the timing of cutting the cord to allow more blood to reach the infant.
WHAT DOES THE RESEARCH SAY?
According to a review conducted by the American College of Obstetrics and Gynecology (ACOG), delayed cord clamping, between 30 secs -60 secs, after the birth of a term or preterm infant increases positive outcomes. With delayed clamping, babies tend to have higher levels of hemoglobin and months later, have increased iron storage. In preterm infants, there is a decreased risk for blood transfusions, lower instances of hemorrhaging, and improved transitional circulation.
For term infants, some studies have shown that delayed cord clamping increases the incidence of phototherapy correcting jaundice; Providers recognize and treat jaundice when it does occur, however, not all studies believe that delayed cord clamping relates to the phenomenon of jaundice. The American College of Nurse-Midwives published a positional statement on delayed cord clamping that argues the procedure should be extended up to 5 minutes after birth with a minimum of a 2 minute delay. In all studies, there were no negative maternal outcomes in consequence to delayed clamping.
In my previous role as a perinatal researcher, we had a study that was looking at delayed cord clamping and preterm infants who required assisted breathing. The study is still collecting data, but the general question being asked is: Could ventilating a preterm infant while performing delayed cord clamping improve their outcomes in the NICU? Or rather, should we focus on interventions over delayed cord clamping for preterm infants? The question is yet to be answered, but I am excited to see the results.
At the end of the day, how long you wait to cut the umbilical cord and who cuts it, should be up to you and your family. Make sure to have these discussions with your care provider and their teams before getting to the hospital or your birth location. Some providers will have strong opinions one way or the other, so it is important to determine if your birth preferences align with their practices.
QUESTIONS TO ASK AT A PRENATAL VISIT:
Who can cut the umbilical cord?
Some birth locations may have rules or regulations in place that allow only the provider to cut the cord.
How long do you (the provider) typically wait to cut the umbilical cord?
Providers will have their preference. Many practices will have guidelines for all their providers, some based on evidence and others not.
Would you be open to extending that time if it was my wish?
This is a personal question and each provider may have a different response. If you have prenatal care at a practice where any number of providers might be caring for you during your labor, it might be best to ask all of them!
What are the risks and benefits of delaying cord clamping to X number of minutes?
Science is always changing! It is best to always get the updated risks and benefits from new research and understand where that research is coming from.