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What exactly is delayed cord clamping?
Delayed cord clamping is an increasingly common birth practice wherein there is a delay between the birth of a newborn and the clamping and cutting of the umbilical cord.
There are many benefits to this practice ranging from higher iron stores which can help prevent anemia in infancy, to sustaining your child during resuscitative efforts.
Timing of delayed cord clamping
Early cord clamping (ECC): Less than 1 minute after birth
Delayed cord clamping (DCC): 1-3 minutes (according to the WHO)
Late cord clamping (LCC): More than 5 minutes after birth (according to the ACOG)
How long exactly should I wait to clamp and cut the cord?
Ideally the cord should be left untouched until it has stopped pulsating and is completely white, thin, and limp. This can take upwards of 15 minutes.
Image source: NurturingHeartsBirthServices
What are the benefits of delayed cord clamping?
*Higher blood volume in infant
Delayed cord clamping provides up to a 60% increase of red blood cells and a 30% increase in neonatal blood volume. (source) By 12 months of age, hemoglobin levels are also higher.
By 1 minute of age, 50% of the blood stored in your placenta will be transfused to your baby.
By the 3 minutes mark, your baby will have received over 90% of that blood! (source)
*Delayed Cord Clamping Helps Prevent Anemia During Infancy
The extra iron is a direct result of the increase in placental transfusion. Research shows that DCC can improve your child’s iron status for up to 6 months after birth, lowering the chance of developing anemia during infancy.
Higher iron stores are also vital for neurological development. In one study it was found that a group of DCC children had better fine-motor and social skills, in comparison to the children whose cords were clamping early at birth.
*Facilitates smoother and more gentle cardiopulmonary transition
In transitioning from the womb the outside world, delayed cord clamping facilitates a smooth and gentle transition to baby breathing on his/her own. In utero, the placenta is what sustains your baby by providing oxygen and nutrition. After the baby is born and the cord is clamped, baby needs to start breathing using his/her lungs. Contrary to popular belief, not all babies breathe spontaneously.
According to this study, over 5% of babies born around the world will need help breathing after birth. In the event that your baby fails to breathe on their own, the same study advises that it is possible to begin bedside resuscitation efforts while the cord is still attached, until the baby is vigorous and physiologically able to breathe on his/her own.
In a study conducted by 2 medical facilities in Australia, it was found that the oxygen levels and heart rates of babies who were being resuscitated, remained stable even though they were not yet breathing on their own. As long as the cord is still pulsating, it is still sustaining your baby the same way it was in utero.
Delayed cord clamping is especially crucial for the survival of preterm infants. Research shows that in preterm infants DCC appears to reduce the risk of intraventricular hemorrhage (bleeding in the brain) and the need for neonatal blood transfusion. The delay in clamping the cord allows for a smoother cardiopulmonary transition, helping sick and/or premature neonates achieve better outcomes.
*Facilitates transfer of stem cells which is important for tissue and organ repair
Placental transfusion post after birth also facilitates the transfer of stem cells which are crucial for repairing any damage done to tissues and organs during the delivery process.
Note: In case you are considering cord blood banking, keep in mind that it will require early clamping. You will have to weigh the potential risks and benefits of ECC and DCC.
Are there any risks associated with delayed cord clamping?
2 of the most commonly talked about risks associated with delayed cord clamping are jaundice and neonatal hyperviscosity. The effects of jaundice due to DCC have been shown to be of no greater significant difference than with ECC. In regard to hyperviscocity, studies have not found that DCC is the sole cause of those side effects. Many studies indicate that the benefits of DCC far outweigh those of ECC.
Under what circumstances should early cord clamping be considered?
Maternal: Hemorrhage, hemodynamic instiability, placenta previa, and placental abruption.
Neonatal: Need for immediate resuscitation (consider umbilical cord milking and bedside resuscitation if possible), cord aversion, tight nucal cord, placenta previa, placental abruption, IUGR (with abnormal cord Doppler evaluation).
*Cord milking: Where the doctor holds the umbilical cord and gently squeezes and pushes the contents of the umbilical cord into the baby’s abdomen. This is usually done in the urgent situations where DCC is not possible.
If you choose to do delayed cord clamping, it is important that your birth team know as soon as possible. If you plan on having a hospital birth, let your birth team know verbally and be sure to include it in your birth plan.
Compared to home and birth center births, hospital births are generally more fast-paced and your healthcare provider (HCP) may forget to wait before clamping the cord.
It also helps to remind your birth partner(s) (husband, mom, sister, doula, etc…) just in case you aren’t able to remind your HCP.
This is a decision that will have a significant, positive long-term impact on the life and well-being of your baby.
Until next time,
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