Guest Post by Village Ob,
Once the baby is born the common practice in the United States for decades has been to quickly clamp the umbilical cord, cut it and hand the baby off. However, there has been renewed interest in understanding what the optimal time to clamp the cord is. Could it be that there is benefit from not clamping right away?
The umbilical cord connects to the baby at the “belly button” and to the placenta disc at the other end. There is a significant amount of fetal blood that is contained in the umbilical cord that may be helpful to the baby and therefore research has begun to try and investigate what happens to the blood in the cord after delivery if the clamping is delayed.
Although more studies are needed in delayed cord clamping, it appears that 75% of the available cord blood goes to the baby in the first minute after birth. In the full term infant this extra blood volume is associated with higher iron levels when the baby is 6 months old. This is especially helpful if the mom is anemic or if the infant is breastfed without supplementing iron. In preterm infants the extra blood seems to be even more important and is associated with not only improved blood volume and iron stores, but also decreased rates of brain bleeding or bowel inflammation, which can be major complications of being born prematurely.
What’s more, clamping the cord before the baby has taken its first breath (usually done in 10 to 25 seconds after birth), can adversely affect the transition from fetus to neonate.
There are however, possibly disadvantages to delayed cord clamping. Increased newborn blood volume can be associated with higher levels of neonatal bilirubin, which can cause jaundice and may need treatment such as phototherapy. Phototherapy sometimes delays the baby’s discharge home or worse may require the baby to get readmitted to the hospital after being discharged home. In addition, when the fetus has not been growing adequately, a condition known as intrauterine growth restriction, delayed cord clamping may lead to too many red blood cells in circulation.
Finally, it is possible that delaying cord clamping may result in not enough blood left in the cord to collect for stem cells. Despite these possible concerns however, our clinical experience has not found increased rates of jaundice or inadequate stem cell collections with delayed cord clamping of about a minute.
In 2017 both the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics have endorsed that a delay of 30 -60 seconds after birth of a vigorous infant is recommended.