Delayed Cord Clamping

Author: Hayley McGrath, Midwife.

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So, your baby has been born, and at this point, you’re probably experiencing skin to skin contact. You will be probably be enjoying the euphoric moment of greeting your baby for the first time, finding out the sex of the baby if you didn’t already know, relieved that you baby is born and that you are holding your baby in your arms.

What happens next?

Your placenta needs to be expelled from the uterus and this is known as the third stage of labour. You and your baby are linked to the placenta via the umbilical cord. The placenta has provided oxygen and nutrients to your developing baby while in your uterus via the umbilical cord.

The clamping and cutting of the cord immediately after the birth of your baby has been routine practice for 50 to 60 years. There is evidence to suggest that babies that have their cords clamped and cut straight after birth are more likely to be anaemic at four months of age and more likely to have decreased fine motor skills and decreased social skills at four years of age (especially boys).

One-third of your baby’s circulating blood volume is still contained within the placenta and umbilical cord at birth, which your baby will continue to receive while the cord continues to pulsate. This can provide significant advantages to your baby. These include help with establishing your baby’s breathing and circulation. This can be a particular advantage to babies who are compromised at birth or born prematurely.

Research now suggests that there are many benefits of delaying the clamping and cutting of the cord and this is supported by the Royal College of Obstetricians and Gynecologists, the Royal College of Midwives (RCM), the World Health Organization (WHO)and the National Institute for Health and Care Excellence. WHO and the RCM suggest that the optimal time to clamp the cord is when it stops pulsating, usually between 1-3 minutes. Your midwife will be able to tell when this has happened, simply by feeling the cord.

What other benefits of delayed cord clamping and cutting (DCC) are there for you baby?

· Increased iron levels for your baby which will be of benefit for up to the first six month of your baby’s life. This helps with growth and physical development

· Increase the amount of stem cells – beneficial for growth and boosting the immune system

· Can reduce the likelihood of severe infection (sepsis) in pre-term babies

There are some occasions when DCC is not so beneficial. These include if you were bleeding heavily after the birth or when there is a possible issue with your placenta (placenta abruption, placenta praevia or the cord is bleeding and therefore blood would not be transferring to your baby).

If your baby needs some help with breathing after the birth, then the cord maybe clamped early if resuscitation cannot take place at the bedside. However, research has shown that better outcomes are achieved if the cord remains uncut and many more hospitals are able to facilitate resuscitation techniques without the need to cut the cord.

Approximately 60% of babies will develop jaundice in the first few days of life. For some of these babies treatment for jaundice will involve phototherapy treatment. Some research does suggest that babies are more at risk of increased jaundice levels after having delayed cord clamping. However, the research that has been conducted have been small studies and the evidence does suggest that the benefits of your baby having delayed cord clamping outweighs the slight increase of jaundice requiring phototherapy.

You can still have delayed cord clamping if you are having a Caesarean section whether this is planned or an emergency or with an instrumental birth (forceps or ventouse)

It is also available to you regardless of whether you have an actively managed or physiological delivery of your placenta.

Things for you to consider:

· Do discuss delayed cord clamping with your midwife. It can be written on your birth plan or preferences.

· Discuss with your birth partner – would they like to cut the baby’s cord after pulsations have stopped? This is a way your birth partner can bond with your baby at this time. Your midwife will guide and instruct them on what to do.

· Do let your midwife know if you would like to see your placenta once the 3rd stage is complete.

· Do let your midwife know if you are planning on encapsulating your placenta or wish to take it home with you.

· Check to see if cord blood donation is available to you at your chosen birth center or obstetric unit.