Delayed Cord Clamping: The New Recommendations

The American College of Obstetricians and Gynecologists (ACOG) recently updated their recommendations concerning the timing of clamping and cutting the umbilical cord after birth. While their previous recommendations had included delaying cord clamping for preterm infants, newer research has highlighted the benefits gained by term infants as well. 

ACOG now recommends that cord clamping be delayed for at least 30-60 seconds after the birth in all healthy term and preterm infants. 


So what are the benefits? 

- Increased Hemoglobin levels. Hemoglobin is the part of the blood responsible for carrying oxygen.

- Increased Iron levels during the first few months. This is thought to also improve development. 

- Especially in preterm babies, delayed cord clamping has been shown to prevent the need for blood transfusion and lower the risks of hemorrhage. Also in preterm babies, delaying cord clamping can improve circulation and increase the amount of circulating red blood cells. 


How does this happen?

- Studies in term infants have shown that approximately 80mL of blood flows from placenta to baby in the first 60 seconds after birth. This increase in blood volume brings Hemoglobin and Iron as well as simply more volume. 80mL may not sound like a whole lot, but consider how small the baby is. Most term infants have a blood volume of under 300mL. That 80mL could represent more than a quarter of that baby's entire circulating volume! 


Are there any risks? 

- In a small percentage of babies, there may be a higher incidence of developing Jaundice. Jaundice is a condition that develops when the liver has trouble dealing with high levels of bilirubin accumulating in the body. Bilirubin is a yellow pigment, and symptoms of Jaundice include yellowing of the skin and eyes. Usually, Jaundice can be treated relatively simply by using special lights to help the body flush out the extra bilirubin. 

- Previous theories were concerned that delaying cord clamping may increase the mother's risk of hemorrhaging. New research has confirmed that this is not the case; delaying cord clamping does not increase the risk of the mother developing a hemorrhage. 


There are some cases in which delayed cord clamping may not be possible. If the baby needs to be taken to another area for resuscitation, then there may not be time to allow delayed clamping. In some of these cases, the umbilical cord may be "milked" instead if time allows. Cord milking includes using a hand to push blood through the cord and into the baby. This process only takes 10-15 seconds, so it can be accomplished much more quickly. Not as much research has been done on umbilical cord milking, so the full extent of any risks and benefits is not yet known. 


If you are interested in delayed cord clamping, pregnancy is a great time to find more information! Ask your medical provider what his or her normal protocol is in that situation, and you can learn what kinds of situations could lessen the possibility of delaying the cord clamping. By having this discussion before you go into labor, you can form a plan both you and your provider can be aware of and on board with.