Delayed cord clamping (DCC) is a practice that involves waiting a short period after birth before clamping and cutting the umbilical cord. This contrasts with immediate cord clamping, common in modern obstetric practice for decades. The re-emergence of DCC is driven by growing research highlighting its benefits for newborns.
How Delayed Clamping Works
Delayed cord clamping facilitates “placental transfusion,” a natural process where blood continues to flow from the placenta to the infant after birth. This occurs as the umbilical arteries, which carry blood from the baby to the placenta, constrict shortly after birth, while the umbilical vein, which carries blood back to the baby, remains open for a longer period.
The blood transferred during this time is rich in various beneficial components. It includes red blood cells, which increase the infant’s overall blood volume and red blood cell mass. This transfer also provides a substantial amount of iron, which is stored in the baby’s body. Additionally, the blood contains stem cells and immunoglobulins, which aid in tissue repair, organ development, and establishing an immune system.
Significant Advantages for the Newborn
Delayed cord clamping offers several advantages for the newborn. A primary benefit is an increased blood volume and improved red blood cell mass. Studies indicate that a delay of at least one minute can transfer approximately 80 milliliters of blood, while a three-minute delay can increase this to about 100 milliliters. This additional blood volume helps the baby’s circulatory system adapt more smoothly to life outside the womb.
The higher volume of iron-rich red blood cells significantly boosts the infant’s iron stores. This increase in iron helps reduce the risk of iron deficiency anemia during the first six months of life, a condition that can have lasting effects on a child’s development. Adequate iron is particularly important for healthy brain development and the formation of myelin, a substance that insulates nerve fibers.
Research suggests positive impacts on neurodevelopmental outcomes. Children whose cords were clamped after three minutes or more have shown slightly higher scores in fine motor skills and social abilities when assessed at four years of age. The enhanced iron stores contribute to better brain myelin development, which supports early-life functional development.
DCC also enhances the transfer of stem cells from the placenta to the baby. These pluripotent stem cells can develop into various cell types and support organ repair and development. For preterm infants, DCC has been linked to improved cardiovascular stability, reduced need for blood transfusions, and a lower incidence of serious complications such as intraventricular hemorrhage (bleeding in the brain) and necrotizing enterocolitis (a severe intestinal condition). It can also lead to higher oxygen saturation levels and more stable heart rates in the initial minutes after birth.
Guidelines and Implementation
Organizations like the Neonatal Resuscitation Program (NRP), the American College of Obstetricians and Gynecologists (ACOG), and the World Health Organization (WHO) provide guidelines for delayed cord clamping. These bodies recommend delaying cord clamping for at least 30 to 60 seconds for most vigorous term and preterm newborns. Some recommendations extend this delay to one to three minutes or until cord pulsations cease.
These professional bodies agree that DCC should be routine for term and preterm infants, unless immediate clamping is medically necessary. Implementation often involves the delivering clinician wrapping the infant in warm blankets, drying, suctioning, and stimulating the baby while waiting for the recommended time to pass. This allows for the full placental transfusion to occur, supporting the baby’s transition from fetal to neonatal circulation.
When Immediate Clamping Is Necessary
Despite DCC’s benefits, immediate cord clamping is necessary in specific medical situations. These situations involve conditions that compromise the mother’s or baby’s stability or require immediate medical intervention.
Immediate clamping may be necessary in cases of placental abruption or placenta previa with active maternal hemorrhage, where rapid delivery of the placenta or control of bleeding is paramount. Maternal conditions like severe maternal anemia or the need for maternal resuscitation at delivery also necessitate immediate clamping. Fetal distress requiring immediate resuscitation, such as a very low heart rate or absent breathing, also warrants quick clamping for prompt intervention. Other scenarios include cord avulsion (tearing of the umbilical cord) or suspected twin-to-twin transfusion syndrome in multiple gestations.