Here's why delayed cord clamping is the new normal

For many years, the standard procedure was to immediately clamp the umbilical cord when a baby was delivered. However, over the last decade, researchers are now revealing evidence that supports delayed cord clamping. Research in this area is still growing; and, as of today, the American College of Obstetrics and Gynecology endorses delayed clamping. There are significant benefits to delayed cord clamping and very little risk. The decision of how long to wait depends largely on the status of your newborn, the discretion of the delivery team and your preference.

What is delayed cord clamping?

Delayed cord clamping is waiting any amount of time—from 30 seconds to 10 minutes—before clamping the cord. Most hospitals that practice delayed cord clamping, including Texas Children’s Pavilion for Women, use a standard cut off of one minute, although it can range depending on the situation and patient preferences. As long as your baby is stable, there is no harm in waiting a minute to cut their cord. Below are some reasons why we delay cord clamping.

Boosts blood supply

Babies—especially premature babies—don’t make blood cells efficiently, so anemia is always a concern with a newborn. By keeping your baby attached to the placenta for just one additional minute after birth, more blood from the placenta can course into your baby’s body. It may not sound like much, but since babies are so small, one more minute of blood increases their blood volume by a significant amount. After a minute delay, the benefits start to diminish. Delayed clamping has shown benefits to both full term and preterm babies alike, contributing to higher hematocrit (the percentage of red blood cells) and hemoglobin levels, as well as better iron supply.

Increases oxygenation and survival for preemies

During the first minutes of life, newborns endure a lot of changes in their cardiovascular system. Their blood vessels expand, their lungs open up and blood will start to move into the lungs and back to the heart.

Keeping a premature baby attached to the placenta helps stabilize them because the baby now has access to more oxygenated blood from the placenta during the adjustment period. This is especially beneficial for extremely premature babies—particularly those younger than 31 weeks. In fact, studies show delayed clamping significantly increases their chances of survival.

It is common to think an extremely premature baby will need immediate resuscitation. However, this is not true for the vast majority of preemies. Of course, there are rare occasions when we have to abandon delayed cord clamping to give immediate medical attention, but 75% to 90% of newborns start breathing on their own with a one-minute delay, even our tiniest babies. These babies tend to transition more smoothly than if we detached them from the umbilical cord earlier.

Benefits are growing

As research continues to grow, scientists are discovering even more benefits to delayed cord clamping. In multiple studies, there is evidence to support that delayed clamping may reduce the risk for brain bleeds in very premature babies. In addition, two recent studies showed 4-month-old babies who received delayed cord clamping had increased brain development in certain areas of the brain and 12-month-old babies had better neurologic outcomes and developmental scores.

Are there risks?

When cord clamping is delayed, there is a slightly higher risk the baby will develop jaundice. This can happen because the overall amount of blood products are increased through the placenta supply, elevating bilirubin, and could potentially overwhelm the liver. Jaundice is not difficult to treat, and babies are routinely monitored for it after birth. Blood tests are typically done at 24 hours and then later as needed to compare bilirubin levels. If it is considered too high, the baby may be treated with phototherapy or “bili lights” (light that helps break down bilirubin into a more easily processed component). In some cases, this will prolong hospitalization to treat the jaundice.

Delayed cord clamping poses no risks to mom. However, if a mom begins to show signs of an emergent issue, like a placental abruption or excessive bleeding, we will clamp the cord quickly to address the problem. Our top priority is the health of you and your baby.

Cord blood banking and delayed clamping

When clamping is delayed, it reduces the amount of blood available for cord blood banking, and may even eliminate the ability to bank altogether. However, the benefit of delayed clamping—especially in the case of a very premature baby—far outweighs the benefit of banking the blood. With a full-term baby, the decision to delay clamp versus banking the blood is totally up to you and your care team.

Case-by-case discretion

Delaying the clamping of the umbilical cord poses many benefits for the unborn baby. However, each situation is unique and must be judged individually, regardless of the baby’s age. At Texas Children’s, our experienced team of obstetricians and neonatologists will work together to determine the best outcome for your baby. The moment you deliver, we will assess your baby to determine if, or how long, we can wait to clamp. If at any time your baby shows distress, we will clamp the cord and move them to neonatology.

What about lotus birth?

There is a movement on the extreme end of delayed clamping known as lotus birth. In lotus birth, the placenta is left attached to the baby until it falls off naturally. Since there is no scientific evidence to suggest any benefit after a few minutes of placental attachment, Texas Children’s does not recommend this method. In fact, we discourage it because it puts the baby at risk of infection.

The bottom line

The standard of care at Texas Children’s Pavilion for Women is to delay cord clamping by one minute. We believe the benefits of an extra minute of placental attachment far outweigh any risk. However, since each situation is unique, our team of experts are trained to evaluate you and your baby in order to make the best decision for the best outcome possible.