What is Delayed Cord Clamping?

In those first crucial minutes immediately after the birth of your baby (during the “Third Stage of Labour”), something important is happening – or rather is suppose to happen. When your baby is born, if all is well, they should be placed immediately on your body for skin to skin care. During this time the placenta is still inside of you and will remain so typically anywhere between 5-30 minutes (sometimes up to 60 minutes). 

Did you know?

Between ​30 – 50% of your infant’s blood volume is still in the placenta and the umbilical cord continues to pulsate, pushing the blood from the placenta into your baby?

Though there are records dating back thousands of years debating when or how the baby’s umbilical cord should or shouldn’t be clamped and severed, it is generally agreed that around 1913 in Western medicine it became standard practice for all Obstetricians and even many Midwives to clamp and cut the umbilical cord immediately within a few seconds after birth and this practice spread across the world. 

The practice of Immediate Cord Clamping “ICC” was based on several beliefs/theories:

• that it would stop baby’s blood from going back into the placenta
• that it Lowered the risk of postpartum hemorrhage in the mother
• that it would stop mother's blood from going into the baby and attacking it (Rh sensitization)
• that it would lower jaundice levels in baby

Unfortunately, these theories (and many more) were not supported by research and evidence!

​Today the research shows us that there are huge benefits for Delayed Cord Clamping (DCC) which many argue should be called “Optimal Cord Clamping” (OCC). 

Delayed Cord Clamping / Optimal Cord Clamping means waiting for the cord to stop pulsating before clamping and cutting.

The research also shows that there are no risks to mother and baby if cord clamping is delayed and in fact, babies are put at risk if the umbilical cord is clamped too early.

So, what has changed?

Well, we now know how the umbilical cord works!  Inside the cord is a substance called Wharton’s jelly that protects the blood vessels within the cord. Once your baby is born the Wharton’s jelly starts to cool down to room temperature the cord pulsations begin to slow down.  The jelly then hardens and clamps the cord itself.  

Photo Courtesy of Stephanie Soderblom LM CPM, Licensed Midwife, Nurturing Hearts Birth Services and used with permission.

Umbilical cords clamp themselves!
​How cool is that?!

Think about it – women have been birthing since the dawn of humanity without clamps and scissors – our bodies know how the Third Stage of Labour should go.

Research has come a long way in the last century. We now know that:

• The pressure from the pulsations push the blood through the umbilical vein into your baby, the blood does not drain backwards back into the placenta.
• There is no increased risk of postpartum hemorrhage if DCC is used
• The placenta’s job is to keep mother and baby’s blood from mixing. In the cases where the mother is Rh incompatible (https://www.acog.org/Patients/FAQs/The-Rh-Factor-How-It-Can-Affect-Your-Pregnancy) with her baby, she can be given a vaccination to protect herself and her baby during her pregnancy and after birth. There is no need for ICC
• Studies have shown only a mild increase in jaundice for some babies that received DCC, and we know that if a baby is feeding early, often and effectively that colostrum (mother’s first milk) is the best treatment to move jaundice out of a baby’s system through their stool
• Research shows that DDC is beneficial for ALL babies, regardless of if they are born preterm or full term (https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Delayed-Umbilical-Cord-Clamping-After-Birth)

Not only has current research debunked the original theories that supported ICC, but the research shows that there are many benefits to leaving the cord intact:

• It can take some babies more time to take their first breath, and some babies may need breathing support or resuscitative measures. We know now that while the umbilical cord is still pulsating, it is moving much needed oxygen into the baby’s body
• Lowers risks of baby having Cerebral Palsy, development delays, epilepsy as well as learning disabilities
• Placental/cord blood is full of extra stem cells which help to build and repair cells in the baby’s whole body
• Placental blood is full of white blood cells and antibodies which help to fight infections

• Baby gets extra iron, which reduces risk of iron anemia in infants even 3+ months later
• Reduces a baby’s need for a blood transfusion
• Important for premature babies - reduces risks of sepsis and intraventricular hemorrhage 

How long should I wait to clamp the cord?

Generally, the cord takes 2-3 minutes to finish its strong pulsations. You will hear different advice but parents can choose for themselves. We know that even letting the cord pulsate just 30 seconds has benefits and lower risks of short and long-term health complications to babies. 

​Some parents choose anywhere between 30 seconds, 2 minutes, 5 minutes, 15 minutes or choosing a Lotus Birth which means not clamping or cutting the cord but birthing a placenta and leaving it attached until the umbilical cord naturally falls off the baby - more research needs to be conducted on the risks/benefits of Lotus Birth (https://www.mamanatural.com/lotus-birth/).  

What if I am planning to do Cord Blood Banking?

Cord blood banking or donation has become a more common choice for families. There is divided professional opinion on this matter. The stem cells that you are saving for later can be given to your baby at birth and may help to prevent many of the childhood diseases that we are using stem cells to treat later. As doulas we leave it to our clients to decide if they would like to bank their baby’s cord blood, we recommend though that you talk to your Blood Bank to find out what collection method they use and if you can let the cord pulsate for 30-60 seconds before collection. It should be noted that Cord Blood Banks in Canada are not regulated and are private businesses, they have their own opinions on DDC shaped by their own interests so do your research.   For more information visit ​http://www.omama.com/en/mid-pregnancy/cord-blood-banking.asp

​Will my health care provider support my choice to do Delay Cord Clamping? 

In Canada, 60% of care providers currently offer DCC.  So much depends on their training, education, comfort on the matter, and also on the hospital or practice’s policies around handling mother/infant fetal health issues. If you would like to have DDC for your baby, then you should be encouraged to know that DCC is recommended by many major health organizations including the:

Society of Canadian Obstetrics and Gynecologists -
https://www.pregnancyinfo.ca/birth/delivery/delayed-cord-clamping/

American Congress of Obstetricians and Gynecologists -
https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Delayed-Umbilical-Cord-Clamping-After-Birth

World Health Organization 
http://www.who.int/elena/titles/full_recommendations/cord_clamping/en/

"Late clamping (or not clamping at all) is the physiological way of treating the cord, and early clamping is an intervention that needs justification. (Care in Normal Birth: A Practical Guide)". 

​So go ahead and put it in your birth plan/preference list and talk to your health care provider about it!

For more reading on this topic and to check out some of the sources used for this blog post you can visit:

Emily Sutton, associate dean of midwifery education at McMaster University:
http://www.cbc.ca/news/canada/hamilton/news/delaying-umbilical-cord-clamping-better-for-baby-mcmaster-expert-1.1302906

Dr. Alan Greene “90 Seconds to Change the World”: https://www.youtube.com/watch?v=Cw53X98EvLQ

History of Cord clamping/cutting: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3423128/
​
Common Objections to Delayed Cord Clamping - What's The Evidence Say?:
https://www.scienceandsensibility.org/p/bl/et/blogid=2&blogaid=526

Penny Simkin on Delayed Cord Clamping:  https://www.youtube.com/watch?v=W3RywNup2CM

When Exactly Should the Cord be Cut after Birth
https://www.theglobeandmail.com/life/health-and-fitness/health/when-exactly-should-the-cord-be-cut-during-birth/article11509283/

Delay Cutting the Cord:  Study
https://www.thestar.com/life/parent/2007/03/21/delay_cutting_the_cord_study.html

​Sarah Baker is a co-owner of Lifetime of Love Doula Services and has been supporting families for 6 years as a birth doula, postpartum & infant care doula and childbirth educator.  She is mom to three boys, twins and a singleton.