For Expectant Parents–Should We Delay Cord Clamping?

Perhaps nowhere is the task of separating important, new medical recommendations from the latest hype more unsettling than for expectant parents. You can guess that, in my thirty-plus years as an obstetrician, I have watched trends come and go. Through our association with the American College of Obstetricians and Gynecologists, continuing medical education, and annual professional re-certification, your physicians here at Sparks & Favor stay informed about changes in obstetric practice. We want to help you distinguish recommendations based on new medical knowledge from fads (some harmless, but some risky).

One issue about which you may have heard different thoughts from family, friends, or the media concerns the clamping of your baby’s umbilical cord. The umbilical cord provides your baby with oxygen and nourishment from mother’s blood supply before birth. Within a few moments after birth, a newborn begins to breathe independently. We clamp and cut the umbilical cord and place your baby in your arms. This usually happens within the first 15 or 20 seconds after birth.

Does the timing of cord clamping affect your baby’s well-being?

Much has been written about the benefits of delayed cord clamping (defined as more than 30 seconds after delivery up to when the cord has no pulse). Some studies have indicated that infants may benefit from slight delays in cord clamping, allowing umbilical cord blood to continue to flow toward the baby. Many groups who advocate for childbirth with the least possible medical intervention promote this practice. Let us consider the advantages and disadvantages for your newborn of delayed cord clamping.

Delayed cord clamping may increase your baby’s total blood volume (protecting organs against shock), allow more time for breathing to begin, and allow him or her to receive more stem cells from the cord blood. Stem cells have a role in immunity and tissue repair. Receiving a boost of red blood cells from the cord may improve your baby’s iron stores, reducing the risk of iron-deficiency anemia. Anemia can harm a newborn’s development. Infant’s whose cords are clamped early are more than twice as likely to have iron deficiency at 3 to 6 months.

The downside of delayed cord clamping is an increased risk of newborn jaundice. When the newborn breaks down excess or old red blood cells, the waste product (a pigment called bilirubin) is cleared by the liver. If the liver cannot keep up with the job, excess bilirubin is deposited in the skin. The newborn’s skin develops a yellowish color (jaundice). Newborn jaundice is treated by placing the baby under special lights (phototherapy) to break down the bilirubin in the skin. Because excess bilirubin is also deposited in the brain, very high bilirubin levels can damage the infant’s development. Infants who have delayed cord clamping are 40% more likely to need phototherapy.

Delayed cord clamping may increase the infant’s risk for low body temperature (a serious problem for newborns). The infant can potentially have too large a boost of red blood cells (polycythemia). Blood is thicker and may not flow well. Delayed cord clamping also delays bonding with mom.

More research is needed since there is little reliable information comparing the long term well-being of the two groups of babies. Our professional organization (ACOG) and the American Academy of Pediatrics state that “insufficient evidence exists to support or refute the benefits from delayed umbilical cord clamping for term infants that are born in settings with rich resources.” (“Rich resources” refers to the availability of good health care).

For now we base our decision on the two risks we can measure with some accuracy. We balance the risk of iron-deficiency anemia against the risk of newborn jaundice. In the United States we have the resources to treat both conditions successfully. Neither risk is high. From 3 to 5% of newborns require treatment for jaundice. Infant formula is iron fortified, and breastfed babies receive iron supplements when they begin iron-fortified infant cereal. However, newborn jaundice requires prompt treatment. Phototherapy can interfere with parents’ early interactions with their newborn and possibly delay homecoming. Considering all these facts, we do not recommend delayed cord clamping for full-term newborns at this time.

We do however support delayed cord clamping for pre-term infants because medical research shows clear benefits including better transition to newborn circulation (life outside the uterus), reduced need for blood transfusion, and possibly a 50% less risk for bleeding inside the brain (a significant risk for very premature newborns). Exceptions include abruptions of the placenta and multiple births.

I hope this provides some clarification about cord clamping. We are always happy to discuss your concerns about this or any issue affecting your obstetric care.