Umbilical Cord Clamping

October 28, 2021

Generally speaking, during pregnancy, the umbilical cord supplies nutrients and oxygen to your developing baby. After birth, the umbilical cord gets clamped and then snipped.  This is just one step of the labor and delivery process, right?  But wait… before we cut the cord… should we be in such a rush? Are there any benefits of delaying the umbilical cord clamping process? 

A Little History In Cord Clamping

The American College of Obstetricians and Gynecologists states, before the mid-1950s, the term early clamping was defined as umbilical cord clamping within 1 minute of birth. Late clamping was defined as umbilical cord clamping more than 5 minutes after birth. In a series of small studies of blood volume changes after birth. It was reported that 80–100 mL of blood transfers from the placenta to the newborn in the first 3 minutes after birth. Up to 90% of that blood volume transfer was achieved within the first few breaths in healthy term infants.

After some time, because of some of these early observations and the lack of any guidelines regarding optimal timing, the time between birth and umbilical cord clamping began to shorten.  In most cases, 15-20 seconds after birth, the umbilical cord is clamped.

However, during recent randomized controlled trials of term and preterm infants, as well as physiologic studies of blood volume, oxygenation, and arterial pressure, have evaluated the effects of immediate vs. delayed cord clamping. As far as the timeline, delayed umbilical cord clamping generally takes place at least 30-60 seconds after birth.

Benefits Of Delayed Cord Clamping

  • Delaying the cord clamping process increases hemoglobin levels at birth. It also improves iron stores in the first several months of life, in term infants.  This may also be beneficial in terms of developmental outcomes.
  • There are significant neonatal benefits in preterm infants. Including improved transitional circulation. Better establishment of red blood cell volume. Decreased need for blood transfusion. A lower incidence of necrotizing enterocolitis and intraventricular hemorrhage.
  • There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing delayed umbilical cord clamping. Consequently, obstetricians–gynecologists and other obstetric care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor and treat neonatal jaundice.
  • Delayed cord clamping doesn’t increase the risk of a postpartum hemorrhage.
  • When a longer duration of placental transfusion is permitted after birth it also facilitates the transfer of immunoglobulins and stem cells. Which are essential for tissue and organ repair. That transfer of immunoglobulins and stem cells may be particularly beneficial after cellular injury, inflammation, and organ dysfunction, which are common with preterm births. To truly know the full extent of these benefits it will require further study.  But this physiologic reservoir of hematopoietic and pluripotent stem cell lines may provide therapeutic effects and benefit the infant later in life.

It Is All About The Timing

In 2013 a Cochrane review assessed the effects in regards to the timing of umbilical cord clamping on term neonatal outcomes in 15 clinical trials. These trials involved 3,911 women and their single infant births.  During this particular analysis, early umbilical cord clamping is defined as clamping at less than 1 minute after birth. Late umbilical cord clamping is more than 1 minute or when cord pulsation ceases. The reviewers found that newborns in the early umbilical cord clamping group had significantly lower hemoglobin concentrations at birth (weighted mean difference, –2.17 g/dL; 95% CI, –4.06 to –0.280) as well as at 24–48 hours after birth (mean difference −1.49 g/dL; 95% CI, −1.78 to −1.21). At 3–6 months of age, infants exposed to early umbilical cord clamping were more likely to have iron deficiency compared with the late cord clamping group.

Ultimately, term and preterm infants appear to receive benefits from delayed umbilical cord clamping.  30-60 seconds is recommended in term and preterm infants.  The exception to this would be if there are any emergency-type circumstances that need to be addressed for the mother or infant.

Talk to your healthcare provider to determine the best options for you and your baby during labor and delivery.  At OB-GYN Women’s Centre of Lakewood Ranch, we provide a variety of services. We are here to help you feel comfortable and answer all of your reproductive health-related questions. Call us today to schedule an appointment.