As more pregnant women are becoming educated about the many childbirth choices they have, experts agree they’re adding one more preference to their birth plans: delayed cord clamping.
When Anna Lane of Los Angeles, Calif., was pregnant with her first child, the only thing her doctor pushed back on was her desire to wait a few minutes before cutting her baby’s umbilical cord. He told her if she was going to do cord blood banking, it didn’t matter when the cord was clamped. “I don’t think he knew much about it,” Anna said.
Although she left it on her birth plan, after her son was born he was put on her chest and the cord was cut immediately. Although Anna was happy that her doctor followed through on most of her other preferences, she was a bit disappointed. “Because my son was so cold when he came out, I really wished he would have waited because I think it would have helped,” she said.
Delayed cord clamping benefits
According to the American College of Obstetricians and Gynecologists (ACOG), most umbilical cord clamping happens with 15 to 20 seconds. Yet in recent years, more research points to the benefits of delayed cord clamping, or waiting a few minutes after delivery to cut the cord.
Studies show that 25 to 30 percent of fetal-placental blood is still in the placenta at the time of delivery.
Although ACOG says that it’s unclear how much time is best, the World Health Organization (WHO) recommends one to three minutes. Although babies will get the highest amount of blood volume within the first minute, “any length of time beyond immediate clamping is going to afford some benefit to the infant,” said Jenna LoGiudice, PhD, a certified nurse midwife, registered nurse and assistant professor at Fairfield University’s School of Nursing.
One of the most significant benefits of delayed cord clamping is that babies receive hemoglobin, which delivers iron, as well as oxygen to their bodies, muscles and organs. In fact, a Cochrane review found that delayed cord clamping in term infants was associated with higher birth weight, hemoglobin concentration, and increased iron until six months of age, which can prevent anemia. “The infant will receive about half the iron and stem cell-rich blood that was left in the placenta,” LoGiudice said.
Delayed cord clamping has also been shown to increase the antioxidant capacity and reduce the inflammatory signal induced during labor, which could improve baby’s development within the first few days after being born, according to a study in the journal Pediatrics.
Another reason women decide to wait has less to do with blood and more to do with bonding. “They still feel a connection, and they don’t want the process to end,” said Dr. Sheryl Ross, an OB/GYN and women’s health expert at Providence Saint John’s Health Center in Santa Monica, Calif.
Should every baby wait?
The World Health Organization (WHO) and the American College of Nurse-Midwives (ACNM) recommend delayed cord clamping for term and premature babies.
But according to a position statement released by ACOG in 2012, there is not enough evidence to recommend it for term infants. “In a community where you’re getting good prenatal care and you have healthy moms, these term babies probably aren’t missing out,” Ross said. Premature babies who have a 50 percent reduced risk of intraventricular hemorrhage, or what’s commonly referred to as brain bleed, benefit most from delayed cord clamping.
When it may not be an option
There are situations where experts say waiting isn’t a good idea, such as if a mom has a risk for postpartum hemorrhage. “The sooner you deliver the placenta, the sooner the uterus will clamp down and there will be less of a concern,” Ross said.
Things that may increase the risk for hemorrhage include infection, abnormalities with the placenta, a drop in fetal heart rate, or meconium aspiration, Also, an extended amount of time using Pitocin, a long labor, a large baby or multiples can up the risk.
Another thing to consider is that because about70 percent of women are anemic during pregnancy, it may not be the best idea to have a delay in transferring the blood to the baby, Ross said.
The risk for jaundice in newborns has also been a concern, but it’s a small one, according to a Cochrane meta-analysis published in 2008.
In babies who need resuscitation, a practice known as “cord milking” can be done. So the doctor will grab as much of the cord as possible and push the cord blood toward the baby.
What you need to know
If you opt for delayed cord clamping and want to have skin-to-skin contact immediately, it can take longer for the blood to transfer because of gravity, so waiting five minutes is ideal, LoGiudice said. Yet a study published last year in the Lancet that found the position may not affect blood volume could change the practice.
If you have a cesarean section, no adverse outcomes have been reported by waiting 40 seconds after delivery, according to ACNM. What’s more, women who opt for delayed cord clamping can still bank their baby’s cord blood.
Although more women are asking for the practice, some physicians may be opposed to it, either because of time or lack of education. “I think the doctors should be somewhat open to it but also explain why it wouldn’t be safe to do,” Ross said. “If you have the conversation before and the couple is informed, there will be no surprises or disappoints in the end.”