Of ALLLLLLLL the things that are part of the WakeMed labor classes, we get so many questions and requests for delayed cord clamping information. It is usually number 1 or number 2 on that list of questions on patients’ cell phones (right next to questions about episiotomy or epidurals) that they bring up around 34-36 weeks pregnant. I have a feeling the instructors emphasize this concept. If you are a fan of my blogs, you know I like to look at the available medical literature and then use this information to make educated suggestions. So let us now dive into the details of delayed umbilical cord clamping.
What defines delayed umbilical cord clamping?
After the baby is delivered, clamping the cord within 15 seconds is considered “immediate” clamping and clamping between 25 seconds and 5 minutes is considered “delayed”. This delay is thought to increase the baby’s blood volume 8 to 24%. In addition, there does not seem to be a positional impact of the baby during this delay (ie: if the baby is below the maternal heart or on her chest). The risks and benefits of this delay have been studied, and because these risks and benefits differ in preterm verses term newborns, let’s look at each separately.
In the studies on preterm deliveries and delayed cord clamping, the delay varied between 25 and 180 seconds, with most delays between 30 and 45 seconds. (We try, when possible, to delay 90 seconds on early preemies.) Delayed clamping resulted in fewer blood transfusions, more stability of vital signs, fewer bleeds into the brain, and a lower risk of a very serious gastrointestinal problem called necrotizing enterocolitis.
Because babies born at term have markedly fewer immediate risks than preterm babies, the benefits are less. There is a higher blood level (hemoglobin) at birth in the delayed group. This benefit seems to persist, as hemoglobin is also higher at 3-6 months of life. However, delayed clamping at term leads to a higher risk of the baby developing jaundice and requiring phototherapy.
For preterm deliveries it is our practice to delay clamping whenever feasible as the benefits are clear. For term deliveries, the data does not show a clear benefit. HOWEVER, since we encourage immediate skin to skin, there is a built in delay in clamping already present! VERY IMPORTANT NOTE (since I hear it asked and/or requested almost daily), I have found no great medical evidence that “waiting until the cord stops pulsing” is of any benefit to term or preterm newborns. In fact, I feel I can extrapolate that waiting this long to clamp the cord could put your term baby at increased risk of needing phototherapy for jaundice.
There are situations where the presumed benefit of delayed clamping (especially at term) is outweighed by risks. Common examples would be meconium stained fluid, poor respiratory effort or vital signs, or twin deliveries. In these situations, it is better for the newborn(s) to have immediate attention by medical staff.
Hope this helps you out.