“Cut the cord.” Before it was a catch phrase used to describe ditching cable companies and cutting off allowances, it was a moment. A touch point in every single one of our lives.
After a baby is born, we usually think of the umbilical cord as a relic – part a life support system that is no longer needed. But the reality is that the cord has one last job to do, and it’s a big one.
You see, the cord and placenta are a kind of external circulation system: one vein carries oxygen and nutrient-rich blood from the placenta to the baby, and two arteries carry carbon dioxide rich blood and waste away from baby to the placenta for purification. (1)
When baby is born, about 1/3 of its blood is in the external part of the circulation system, but quickly makes its way to the baby via the umbilical cord.
Unless of course, the cord is cut before the transfer is complete.
Great question. Early cord clamping became standard practice in the 1960’s because it was believed to reduce the likelihood of postpartum maternal hemorrhage. Later research revealed that it does not reduce hemorrhaging or offer any other clear benefit, but the practice continued anyway. (2)
The reluctance to change, which doctors said in this poll is due to “Difficulty with implementation in clinical practice,” – yes, really – has been frustrating for many birth advocates, especially in light of a growing number of studies suggest that delayed cord clamping has compelling benefits.
We’ll cover the top five today, but first you might be wondering . . .
It depends on who you ask. According to the World Health Organization, delayed clamping is when the cord is cut 1-3 minutes after birth – a practice they recommend for all births.
However, some practitioners think the one minute mark is too early, and recommend extending the time to approximately three minutes.
In this statement, the Royal College of Midwives says that:
And then there’s the perspective expressed by the International Childbirth Education Association, which is that “Delayed cord clamping (DCC) is a practice by which the umbilical cord is not clamped or cut until after it stops pulsating. It may also include not clamping or cutting the umbilical cord until after the placenta is delivered.” (3)
So what do they agree on? Why, that delaying is worthwhile, of course!
Waiting to cut the cord can impact development, anemia risk, and more. Here are the most significant benefits we know of so far.
“It’s incredible to see what a difference an extra three minutes and one-half cup of blood can have on the overall health of a child, especially four years later,” the lead author of this study, Dr. Ola Andersson, told CNN. (4)
In the study, researchers found that:
There is one caveat to these findings: The benefits only applied to boys. “We don’t know exactly why, but speculate that girls receive extra protection through higher estrogen levels whilst being in the womb,” Dr. Heike Rabe, a neonatologist at Brighton & Sussex Medical School in the United Kingdom, told NPR. (5)
Breast milk is naturally low in iron, which has led some to suggest that breast fed children need to be supplemented with iron to prevent anemia. “At first glance, this seems like an error, given that all living things need iron,” writes Nina Planck in Real Food For Mother And Baby.
She add that “we must suspect a deliberate strategy on nature’s part. Sure enough, there is logic to the missing iron. E. coli, the most common source of infant diarrhea in all species, depends on iron, as do other pathogens.”
Now here’s where things get really interesting. Though excess iron in the digestive tract may not be a good thing, iron stored elsewhere in the body is critical for healthy brain development. (5)
The natural transfusion of blood via delayed cord clamping delivers a substantial amount of iron – one study found that waiting two minutes increased iron stores by 27-47 mg! (6)
According to the American College of Obstetricians and Gynecologists (ACOG), waiting three minutes may prevent iron deficiency during the first year of life:
Can I just say that I am blown away by the intrinsic wisdom of our bodies? For the past few decades, we’ve assumed that nature made a mistake and therefore started children on iron fortified foods early.
Meanwhile, we left polysaccharides out of infant formula because they’re indigestible to baby and therefore useless. Only it turns out they’re not, they feed the beneficial bacteria in our digestive tracts, while excess iron may feed unwanted E. coli. That’s absolutely fascinating.
According to Mark Sloan, M.D., whether a baby “is premature or full term, approximately one-third of its total blood volume resides in the placenta. This is equal to the volume of blood that will be needed to fully perfuse [permeate] the fetal lungs, liver, and kidneys at birth.
In addition to the benefits that come with adequate iron stores . . . babies whose cords are clamped at 2 to 3 minutes—and thus, who have an increased total blood volume compared with their immediately-clamped peers—have a smoother cardiopulmonary transition at birth.” (2)
Also according to this article, “‘Another potential benefit of delayed cord clamping is to ensure that the baby can receive the complete retinue of clotting factors.’ In other words, the increased volume of blood will naturally increase blood platelet levels, which are needed for normal blood clotting.”
Delayed clamping also results in an infusion of “stem cells, which play an essential role in the development of the immune, respiratory, cardiovascular, and central nervous systems, among many other functions. The concentration of stem cells in fetal blood is higher than at any other time of life. ICC [immediate cord clamping] leaves nearly one-third of these critical cells in the placenta.” (2)
Stem cells may also “help to repair any brain damage the baby might have suffered during a difficult birth,” Dr. Rabe (mentioned above) told NPR. (5)
“Preemies who have delayed cord clamping tend to have better blood pressure in the days immediately after birth, need fewer drugs to support blood pressure, need fewer blood transfusions, have less bleeding into the brain and have a lower risk of necrotizing enterocolitis, a life-threatening bowel injury,” continued Dr. Rabe. (5)
In some cases, yes. According to The American College of Nurse-Midwives:
According to several sources (like this one and this one), resuscitation is less likely to be needed if cords are left intact. Many practitioners, such as neonatologist Anup Katheria, are actively looking for ways to resuscitate when needed without prematurely cutting the cord in order to move the baby.
“The practice of helping babies breathe while waiting to clamp the umbilical cord has been around for a long time; it makes sense for the sickest infants,” she told CNN. “We’re focused on producing evidence that shows the benefits. We think this could become the foundation for practice changing resuscitation techniques, transforming outcomes for the most critical of newborns nationwide.” (4)
Regarding this trend toward keeping the cord intact when resuscitation is needed, Midwifery Today writes:
Are there times when providers need to cut the cord to initiate lifesaving interventions? Yes, says one of the most respected researchers on delayed cord clamping. (10)
However, some care providers believe that the cord and placenta have innate “resuscitation equipment” qualities worth considering as well. You can read about some of them here.
One analysis found a very slight (2%) increase in jaundice among babies who received delayed cord clamping. (11) Jaundice occurs when red blood cells break down faster then the liver can process bilirubin, leading to excess levels of bilirubin in the blood (hyperbilirubinemia). It’s treated by placing a phototherapy light over the baby to help break down bilirubin.
With that said, the very slight (again, 2%) increase in jaundice could potentially relate to other factors. According to the Thinking Midwife, “The only studies available involve the administration of an artificial oxytocic (syntocinon or syntometrine) in the ‘delayed clamping’ group. IV syntocinon is associated with jaundice. Therefore, it could be the oxytocic making a difference here – not the clamping.” (12)
Other studies, such as this Cochrane analysis, found “that the difference between early and late cord clamping for clinical jaundice did not reach statistical significance.”
Another concern sometimes mentioned is polycythemia, or blood that is too thick to properly oxygenate tissues. Researchers also looked at this issue in the Cochrane analysis I just mentioned – they did not find anything statistically significant.
“Delayed cord clamping is not often compatible with cord blood donation or storage. The reason being is that in order for them to collect the amount of blood they want to store, some collectors will say that they need the cord cut immediately, and some . . . will only allow up to 60 seconds before they want the cord clamped. This is not long enough for most of the benefits to reach your baby. If you would like your baby to have it’s full supply of cord blood, you may need to reconsider you plans to donate or store cord blood.
From the above recent study (2010) the following comments were made on cord collection:
‘There remains no consensus among scientists and clinicians on cord clamping and proper cord blood collection,’ concluded co-author and obstetrician Dr. Stephen Klasko, senior vice president of USF Health and dean of the USF College of Medicine. “The most important thing is to avoid losing valuable stems cells during and just after delivery.” So prevention is clearly better than cure – your baby will be better off keeping what is rightfully theirs.” (13)
As birth advocate Diana Korte once wrote, “If you don’t know your options, you don’t have any.”
Creating a birth plan has many benefits, which I’ve covered here along with a resource for writing your own.
It’s a good idea to have a printed copy to go over with your provider before the big day, plus one to have on hand for your team during labor.
However, because cord clamping is often done automatically, care providers sometimes forget and cut the cord as a reflex despite previous conversations and/or written instructions. For that reason, it’s often a good idea to have an advocate such as a spouse or doula present to keep an eye on the cord just after the baby is born and remind the doctor if necessary.
If you’re looking for an evidence-based, naturally-minded resource, I highly recommend the Mama Natural Birth Course and/or The Mama Natural Week-by-Week Guide to Pregnancy and Childbirth.
You’ll learn about:
Click here to check out the Mama Natural Birth Course.
Gorgeous cord photos published with permission from Monet Nicole Photography (based in Colorado if you’re looking for an amazing birth photographer) and the mama photographed. ♥
Sources
1. Yuping Wang and Shuang Zhao (2010) Vascular Biology of the Placenta
2. Sloan, Mark (2012) Common Objections to Delayed Cord Clamping – What’s The Evidence Say?
3. International Childbirth Education Association (2015) Delayed Cord Clamping
4. Azadeh, Ansari (2015) The great umbilical cord-cutting debate
5. Haelle, Tara for NPR (2015) Delayed Umbilical Cord Clamping May Benefit Children Years Later
6. Chaparro, Camila et. al. (2006) Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial
7. American College of Obstetricians and Gynecologists (2020) Delayed Umbilical Cord Clamping After Birth
8. American College of Nurse-Midwives (2014) Delayed Umbilical Cord Clamping
9. Evans, Angie (2012) Neonatal Resuscitation with Intact Umbilical Cord
10. Fogelson, Nicholas (2011) An Update on Delayed Cord Clamping, and Thoughts on Internet Expertise
11. Ghirardello, Stefano et. al. (2018) Delayed Cord Clamping Increased the Need for Phototherapy Treatment in Infants With AB0 Alloimmunization Born by Cesarean Section: A Retrospective Study
12. Midwife Thinking (2019) Cord Blood Collection: confessions of a vampire-midwife
13. Winder, Kelly (2018) Delayed Cord Clamping – Why You Should Demand It