There are many questions that come up in conversations with our patients during the third trimester, as we approach delivery and discuss birth plans. Choices for anesthesia, induction or augmentation of labor, reasons for Cesarean delivery, and cord blood banking are often hot topics. Another topic that has been coming up a lot recently is delayed cord clamping. Often, after delivery, the baby’s umbilical cord is immediately clamped so that the baby can be resuscitated or handed to the mother for skin to skin contact. There are many patients who ask if there could be a delay in the timing of the clamping of the umbilical cord either for a few minutes or until it stops pulsating. The request is supported by many blogs and pregnancy websites that encourage the practice. So should we be doing it and is there any scientific data to support or deny the practice of delayed cord clamping?
The research into delayed cord clamping is often divided into two groups depending on the timing of delivery: term infants and preterm infants. For term infants there does appear to be some benefits to delaying cord clamping by 30-60 seconds. This delay may benefit the baby in several ways including increased blood volume, increased iron stores for up to 6 months after delivery, and maybe some immune benefits as well from the increased number of immunoglobulins and stems cells that can be passed on. However, there is a higher incidence of the need for phototherapy after delivery for those infants who underwent delayed clamping. The other concern is that for the delay in clamping to be beneficial the baby must be kept at or below the level of the placenta thus limiting access for resuscitation if needed and the ability to place the baby on the mothers chest for immediate skin to skin contact.
In preterm infants delayed clamping has been shown to have many benefits to the baby. Studies have shown reduced need for blood transfusion, anemia, and a reduction in the incidence of intraventricular hemorrhage, a type of bleeding in the brain that premature infants are prone to experience. There has also been a study that shows that “milking the cord” can have the same result as delayed clamping in premature infants without the same time delay. The study showed infants after milking of the cord had higher blood pressures, less need for transfusion, and higher urine output than those preterm babies whose cord was clamped immediately.
In 2014 the World Health Organization came out with guidelines that favored delayed cord clamping except in specific conditions where the need for infant resuscitation is high or there are other particular concerns. If delayed cord clamping is performed then the baby must be kept at the level of the placenta or lower and that should be a consideration as well. It should be pointed out that the risk of increased maternal hemorrhage can be increased in certain pregnancies and that would also argue against delayed clamping in those situations. Those situations include placenta previa, placental abruption, and maybe even any Cesarean delivery.
There are many areas that still require more research including cord milking in term pregnancies, ideal time for clamping in cesarean delivery versus vaginal delivery among others. We hope this has made some of the issues more clear and would be glad to discuss this and any other concerns you have about your delivery as we meet with you at your office visits.