Delayed cord clamping is beneficial for ALL babies!
I've recently heard quite a few maternity care providers claim that delayed cord clamping is only beneficial for pre-term babies, if at all, so the aim of this blog post is to set the record straight — delayed cord clamping should be the norm for every baby, at every birth.
A fantastic visual from the legendary Penny Simkin.
What is delayed cord clamping?
The World Health Organization (WHO) defines delayed cord clamping as waiting for a minimum of one minute following the birth of the baby before the umbilical cord is clamped and cut, and recommends that this should be implemented whenever possible to improve maternal and infant health outcomes. Delayed cord clamping is also referred to as optimal cord clamping.
Where has this practice come from?
Whilst delayed cord clamping is a relatively new clinical practice, it certainly isn't a new idea. The first mention of delayed cord clamping dates back to 1796, by a physician called Dr Erasmus Darwin. He recognised that the residual blood in the placenta belonged to the baby, and recommended waiting until the umbilical cord had ceased pulsating before cutting, in order to allow the remaining blood to transfuse.
Fast forward to the middle of the 20th century, when birth moved from home into the hospital and the biomedical model of obstetrics became the standard maternity care pathway. Immediate cord clamping became the norm alongside active management of the placenta, as it was simply easier and more efficient.
WHO have been recommending delayed cord clamping for over 10 years but there are still wide variations across clinical institutions and immediate cord clamping is still frequently practised.
What are the benefits of delayed cord clamping?
Increased blood volume and improved iron stores. Delayed cord clamping allows the baby to receive up to 30% more blood from the placenta, significantly increasing the infant's blood volume. This additional blood contains vital iron, which is crucial for brain development and reducing the risk of iron deficiency during infancy. Studies show that infants who undergo delayed cord clamping have higher haemoglobin levels and better iron stores at 4-6 months of age.
Enhanced oxygen supply. The extra blood received through delayed cord clamping provides a richer oxygen supply, which supports the baby's transition from fetal to neonatal circulation. This is particularly beneficial in preventing respiratory distress in newborns.
Improved developmental outcomes. Research indicates that delayed cord clamping may contribute to better neurodevelopmental outcomes. Babies with higher iron levels due to delayed cord clamping tend to perform better in cognitive and motor development tests later in infancy.
Benefits for preterm infants. Preterm infants can benefit significantly — delayed cord clamping reduces the risk of intraventricular haemorrhage (bleeding in the brain) and necrotising enterocolitis (a serious intestinal disease). These babies also show better cardiovascular stability and reduced need for blood transfusions.
Lower risk of anaemia. By enhancing the infant's iron stores, delayed cord clamping helps lower the risk of anaemia in the first year of life.
Are there any risks to delayed cord clamping?
While delayed cord clamping is generally considered safe and beneficial, there are some potential risks to be aware of:
- Jaundice. Delayed cord clamping can increase the risk of neonatal jaundice, as higher blood volumes may lead to higher bilirubin levels.
- Polycythemia. There is a slight risk of polycythemia (an increased number of red blood cells), which can make the blood thicker.
- Respiratory issues. In rare cases, delayed cord clamping might cause respiratory difficulties due to increased blood volume.
These risks are generally outweighed by the benefits, but it's important to know the facts so that you can make an informed choice. I've included additional information sources at the end of the post.
With such a mountain of evidence to support delayed cord clamping, why are some practitioners reluctant to implement it?
- Lack of awareness and/or training. Some healthcare providers may not be fully aware of the latest guidelines or benefits due to insufficient training or continued education.
- Habit and routine. The practice of immediate cord clamping has been standard for many years, and changing culturally embedded routines can be challenging.
- Concerns about jaundice and polycythemia. Practitioners may be cautious about the potential risks, despite evidence showing these risks are generally manageable and outweighed by the many benefits.
- Time constraints. In busy clinical settings, the extra time required might be seen as impractical, especially during emergency situations.
- Varied guidelines. Differences in guidelines and recommendations across medical organisations can create confusion and hesitation in adopting the practice uniformly.
- Institutional policies. Hospital policies and protocols may not yet be updated to support delayed cord clamping, making it difficult for individual practitioners to implement it.
Where can I go for more information?
There is a wealth of information online about delayed cord clamping, and it can feel quite overwhelming digging through all of the research studies and clinical evidence, so I've done the hard work for you:
- WHO guideline published in 2014
- Dr Sara Wickham's summary of the evidence on delayed cord clamping — Dr Wickham is a highly respected research midwife and one of my favourite sources of information.
- Wait for White
- Blood to Baby — Optimal Cord Clamping
- All4Birth factsheet on delayed cord clamping
- King Edward Memorial Hospital guidelines for the third stage of labour — which recommend waiting 2-3 minutes before clamping and cutting the cord.