Cut The Cord
Before it was a catch phrase used to describe ditching cable companies and cutting off allowances, it was a moment. A touch point in every single one of our lives.
After baby is born we usually think of the umbilical cord as a relic – part a life support system that is no longer needed. But the reality is that the cord has one last job to do, and it’s a big one.
You see, the cord and placenta are a sort of external circulation system: one vein carries oxygen and nutrient-rich blood from the placenta to the baby, and two arteries carry carbon dioxide rich blood and waste away from baby to the placenta for purification. (source 1, source 2) When baby is born, about 1/3 of its blood is in the external part of the circulation system, but quickly makes it’s way to the baby via the umbilical cord. Unless of course, the cord is cut before the transfer is complete.
Why cut the cord early?
Great question. Early cord clamping became standard practice in the 1960’s because it was believed to reduce the likelihood of postpartum maternal hemorrhage. Later research revealed that it does not reduce hemorrhaging or offer any other clear benefit, but the practice continued anyway. (source)
The reluctance to change, which doctors said in this poll is due to “Difficulty with implementation in clinical practice,” – yes, really – has been frustrating for many birth advocates, especially in light of a growing number of studies suggest that delayed cord clamping has compelling benefits. We’ll cover the top five today, but first . . .
What is delayed cord clamping?
It depends on who you ask. According to the World Health Organization, delayed clamping is when the cord is cut 1-3 minutes after birth – a practice they recommend for all births. (source)
However, some practitioners think the one minute mark is too early, and recommend extending the time to approximately three minutes. In this statement, the Royal College of Midwives says that “delaying for even one minute is a welcome change . . providing all babies with one minute of transition from inter-uterine to extra-uterine life. However as transfusion is known to continue during the first 3-5 minutes of life, it is suggested that this process is allowed to complete without being interrupted.”
And then there’s the perspective expressed by the International Childbirth Education Association, which is that “Delayed cord clamping (DCC) is a practice by which the umbilical cord is not clamped or cut until after it stops pulsating. It may also include not clamping or cutting the umbilical cord until after the placenta is delivered.” (source)
So what do they agree on? Why, that delaying is worthwhile, of course!
5 Benefits Of Delayed Cord Clamping
#1: Neurodevelopmental Benefits
“It’s incredible to see what a difference an extra three minutes and one-half cup of blood can have on the overall health of a child, especially four years later,” the lead author of this study, Dr. Ola Andersson, told CNN. (source)
In the study, researchers found that “A couple of extra minutes attached to the umbilical cord at birth may translate into a small boost in neurodevelopment several years later . . . Children whose cords were cut more than three minutes after birth had slightly higher social skills and fine motor skills than those whose cords were cut within 10 seconds. The results showed no differences in IQ.” (source)
There is one caveat to these findings: The benefits only applied to boys. “We don’t know exactly why, but speculate that girls receive extra protection through higher estrogen levels whilst being in the womb,” Dr. Heike Rabe, a neonatologist at Brighton & Sussex Medical School in the United Kingdom, told NPR. (source)
#2: Decreased Risk Of Anemia
Breast milk is naturally low in iron, which has led some to suggest that breast fed children need to be supplemented with iron to prevent anemia. “At first glance, this seems like an error, given that all living things need iron,” writes Nina Planck in Real Food For Mother And Baby.
She add that “we must suspect a deliberate strategy on nature’s part. Sure enough, there is logic to the missing iron. E. coli, the most common source of infant diarrhea in all species, depends on iron, as do other pathogens.”
Now here’s where things get really interesting. Though excess iron in the digestive tract may not be a good thing, iron stored elsewhere in the body is critical for healthy brain development. (source) The natural transfusion of blood via delayed cord clamping delivers a substantial amount of iron – one study found that waiting two minutes increased iron stores by 27-47 mg! (source)
According to the American College of Obstetricians and Gynecologists, waiting three minutes may prevent iron deficiency during the first year of life:
“Physiologic studies in term infants have shown that a transfer from the placenta of approximately 80 mL of blood occurs by 1 minute after birth, reaching approximately 100 mL at 3 minutes after birth (16, 31, 32). This additional blood can supply extra iron, amounting to 40–50 mg/kg of body weight. This extra iron, combined with body iron (approximately 75 mg/kg of body weight) present at birth in a full-term newborn, may help prevent iron deficiency during the first year of life (33).” (source)
Can I just say that I am blown away by the intrinsic wisdom of our bodies? For the past few decades, we’ve assumed that nature made a mistake and therefore started children on iron fortified foods early. Meanwhile, we left polysaccharides out of infant formula because they’re indigestible to baby and therefore useless. Only it turns out they’re not, they feed the beneficial bacteria in our digestive tracts, while excess iron may feed unwanted E. coli. So interesting!
#3: Increased Blood Volume / Smoother Cardiopulmonary Transition
According to Mark Sloan, M.D., whether a baby “is premature or full term, approximately one-third of its total blood volume resides in the placenta. This is equal to the volume of blood that will be needed to fully perfuse the fetal lungs, liver, and kidneys at birth.
In addition to the benefits that come with adequate iron stores . . . babies whose cords are clamped at 2 to 3 minutes—and thus, who have an increased total blood volume compared with their immediately-clamped peers—have a smoother cardiopulmonary transition at birth.” (source)
According to this article, “Another potential benefit of delayed cord clamping is to ensure that the baby can receive the complete retinue of clotting factors.” In other words, the increased volume of blood will naturally increase blood platelet levels, which are needed for normal blood clotting.
#4: Increased Levels Of Stem Cells
Delayed clamping also results in an infusion of “stem cells, which play an essential role in the development of the immune, respiratory, cardiovascular, and central nervous systems, among many other functions. The concentration of stem cells in fetal blood is higher than at any other time of life. ICC [immediate cord clamping] leaves nearly one-third of these critical cells in the placenta.” (source)
Stem cells may also “help to repair any brain damage the baby might have suffered during a difficult birth,” Dr. Rabe (mentioned above) told NPR. (source)
#5: Better Outcomes For Pre-Term Infants
“Preemies who have delayed cord clamping tend to have better blood pressure in the days immediately after birth, need fewer drugs to support blood pressure, need fewer blood transfusions, have less bleeding into the brain and have a lower risk of necrotizing enterocolitis, a life-threatening bowel injury,” continued Dr. Rabe. (source)
Is Delayed Cord Clamping Possible For Cesarean Births?
In some cases, yes. According to The American College of Nurse-Midwives,
“The usual practice at cesarean delivery is immediate cord clamping; however, infants born by cesarean can benefit from placental transfusion resulting from delayed cord clamping or umbilical cord milking. Researchers initially reported that placental transfusion did not occur at the time of cesarean delivery, but this was most likely associated with uterine atony and the use of general anesthesia.(21) In a small observational study, Farrar and colleagues recently demonstrated that a full placental transfusion does occur at cesarean delivery, but the optimal timing of delayed cord clamping remains unclear.(22) Ogata et al. reported that a 40-second delay in clamping provided the infant with a partial placental transfusion.23 Concerns were raised that blood would flow back to the placenta if the cord was clamped after 40 seconds, but this reverse flow has not been demonstrated.(23)
Another approach at the time of cesarean delivery is to milk the umbilical cord. This approach is ideal for cesarean birth when time and speed are important factors. In a small, randomized controlled trial, Erickson-Owens et al. compared immediate cord clamping with umbilical cord milking. They found less placental residual blood volume and higher newborn hematocrit levels at 48 hours of age in infants who received umbilical cord milking. (9) Delayed cord clamping and umbilical cord milking are approaches the clinician may consider at the time of cesarean delivery to facilitate placental blood transfer to the newborn.” (source)
What About Babies Who Need Intervention?
According to several sources (like this one and this one), resuscitation is less likely to be needed if cords are left intact. Many practitioners, such as neonatologist Anup Katheria, are actively looking for ways to resuscitate when needed without prematurely cutting the cord in order to move the baby. (source)
“The practice of helping babies breathe while waiting to clamp the umbilical cord has been around for a long time; it makes sense for the sickest infants,” she told CNN. “We’re focused on producing evidence that shows the benefits. We think this could become the foundation for practice changing resuscitation techniques, transforming outcomes for the most critical of newborns nationwide.” (source)
Regarding this trend toward keeping the cord intact when resuscitation is needed, Midwifery Today writes:
“The requirements of medicalized neonatal resuscitation are warmth, a firm surface, suction and access to the umbilicus. Other priorities include comfortable position for staff and the ability to draw umbilical blood for cord gas analysis. A warm firm surface can be the bed or surface where baby is born. In this author’s 2011 poll of 34 midwives from around the world, most reported that they perform resuscitation with the cord intact using the bed, side of a pool designed for waterbirth, part of an adult human body (mother or midwife) or a portable board with a warm pack.
Suction can be from a main hospital line, resuscitation machine or a portable unit such as those used at homebirths. The umbilicus is accessed to provide drugs and fluids. If the cord is left intact, then fluids are already being provided. Drugs are rarely required for resuscitation, and it’s likely they would be required far less often if cords were intact. Since extensive resuscitation is rarely required, can we not be uncomfortable once in a while, bending over the baby rather than performing resuscitation at our standing height? Even if one requires cord gases for medical reasons rather than protection from litigation, they can wait. Cord gas results don’t change significantly if taken immediately after birth or after two minutes of delayed clamping (De Paco et al. 2011; Asfour and Bewley 2011).” (source)
Are there times when providers need to cut the cord to initiate lifesaving interventions? Yes, says one of the most respected researchers on delayed cord clamping. (source)
However, some care providers believe that the cord and placenta have innate “resuscitation equipment” qualities worth considering as well. You can read about some of them here.
Are There Any Risks Of Delayed Cord Clamping?
One analysis found a very slight (2%) increase in jaundice among babies who received delayed cord clamping. However, according to the Thinking Midwife, “The only studies available involve the administration of an artificial oxytocic (syntocinon or syntometrine) in the ‘delayed clamping’ group. IV syntocinon is associated with jaundice. Therefore, it could be the oxytocic making a difference here – not the clamping.” (source)
Another concern sometimes mentioned is polycythemia, or blood that is too thick to properly oxygenate tissues. Researchers also looked at this issue in the Cochrane analysis just mentioned and did not find anything statistically significant.
What About Cord Blood Banking?
“Delayed cord clamping is not often compatible with cord blood donation or storage. The reason being is that in order for them to collect the amount of blood they want to store, some collectors will say that they need the cord cut immediately, and some (as confirmed by one of the biggest Australian cord blood collection companies, as recently as September 2013) will only allow up to 60 seconds before they want the cord clamped. This is not long enough for most of the benefits to reach your baby. If you would like your baby to have it’s full supply of cord blood, you may need to reconsider you plans to donate or store cord blood.
From the above recent study (2010) the following comments were made on cord collection:
‘There remains no consensus among scientists and clinicians on cord clamping and proper cord blood collection,’ concluded co-author and obstetrician Dr. Stephen Klasko, senior vice president of USF Health and dean of the USF College of Medicine. “The most important thing is to avoid losing valuable stems cells during and just after delivery.” So prevention is clearly better than cure – your baby will be better off keeping what is rightfully theirs.” (source)
Adding Delayed Cord Clamping To Your Birth Plan
As birth advocate Diana Korte once wrote, “If you don’t know your options, you don’t have any.”
Here is a birth plan template that you can customize to fit your desires. Because cord clamping is often done automatically, care providers sometimes forget and cut the cord as a reflex despite previous conversations. It’s often a good idea to have an advocate such as a spouse or doula present to keep an eye on the cord just after the baby is born and remind the doctor if necessary.
Want to learn how to have an awesome birth without leaving your couch?
If you’re looking for an evidence-based, naturally-minded resource, I highly recommend the Mama Natural Birth Course and/or The Mama Natural Week-by-Week Guide to Pregnancy and Childbirth.
You’ll learn about:
- Delayed cord clamping, which boosts baby’s iron stores by 30% and improves fine motor skills and social development later in life.
- Skin-to-skin contact, which regulates baby’s body temperature and blood pressure, reduces stress hormones, and helps initiate early breastfeeding.
- Gentle cesarean, which can “seed” baby’s microbiome, eliminate fluids from baby’s lungs, while empowering the mama.
- The importance of eating during labor, and so much more.
Click here to check out the Mama Natural Birth Course, and here to check out The Mama Natural Week-by-Week Guide to Pregnancy and Childbirth.
Did you/would you delay cord clamping? Why or why not?
Gorgeous cord photos published with permission from Monet Nicole Photography (based in Colorado if you’re looking for an amazing birth photographer) and the mama photographed. ♥