Benefits of Delayed Cord Clamping

This was an assignment this term, to write an info sheet on delayed cord clamping.I wrote it with first-person pronouns, even though I am not a midwife yet, so that it will be easy to use when I do have a practice.It still needs some revision, but I thought I'd put it up here and update here when I do revise it.

Information Sheet: Delayed Cord Clamping

In hospitals, the practice is to clamp and cut the cord within seconds of a baby’s birth. Many midwives prefer to delay cord clamping. This document is to inform you of my practices and why I choose to delay cord clamping.

What is the function of the cord? The umbilical cord is the baby’s attachment to the placenta, and to the nutrients the mother provides for the baby. Oxygen and nutrients exchange with the baby’s waste at the placenta, and the cord transports them to the baby. The baby’s blood is in the cord, moving nutrients to the baby and wastes away from the baby.

Why do hospitals cut the cord right away? The practice originally came about as a way to minimize the amount of anesthetic transferred to the baby through the cord. This was in the days where mothers were unconscious during birth and so a pretty high dose of anesthetic was in her system. Hospitals continue the practice for convenience. If the cord is uncut, baby cannot be taken across the room for surveillance or to perform any special procedures.

Why do midwives choose to delay cord cutting? After the birth, in an uncut cord, blood is still transferring from the placenta and the cord to the baby. The cord pulses with the baby’s blood for quite some time after birth. Even if it seemingly stops pulsing, it will resume after the separation of the placenta. The pulsing in the cord is the baby’s pulse, bringing blood into the baby’s body.

The blood inside the placenta and the cord is the baby’s blood. Up to 40% of the baby’s blood could be inside the cord and/or placenta just after birth. When the baby is born, she will need that blood to bring oxygen to her organs. If the cord is cut just after birth (or even before the baby is fully born, in some cases) then much of this blood is cut off from the baby. If breathing is delayed for any reason, having the cord attached becomes more crucial than ever.

Babies whose cords are cut just after birth often are anemic from the loss of this blood source, and hospitals must then take steps to solve that problem. NICU stays for newborns are not uncommon for all kinds of small problems that could have been prevented.

Even if oxygen is given to the baby, she still needs her hemoglobin to carry the oxygen to the organs, and there is no replacement for the baby’s hemoglobin in her blood.

The delivery of the placenta is another reason to delay cord clamping. When the blood is transfused from placenta into the baby, the placenta will become depleted of blood. This makes for a smaller placenta, which is easier to birth and takes less time. This expedited placental birth makes for less bleeding.

My Practice: Unless there is very good reason, I usually wait about an hour to an hour and a half after the birth to cut the cord. If you prefer, I can cut it after the placenta is born. This means that until the placenta is born, the baby will need to stay close to the mother—within cord length, which varies from around 12 inches to 30 inches. For the first minute or two, it is optimal for the baby to stay at a lower level than the placenta for good blood flow to the baby. After the birth of the placenta with an uncut cord, if others in the room would like to hold the baby the placenta will need to travel with the baby. I can do the newborn exam with the cord intact right on the bed or other surface near the mother.

Some parents wish to practice a lotus birth. This is where the cord is not cut, and the placenta is attached until the cord breaks on its own. I do not practice this regularly but can accommodate it if desired. Lotus birth requires its own preparation, so if you wish to use this method please research it to find out what supplies you will need.

Why I would cut the cord earlier: There are cases where I will cut the cord earlier because I feel it is necessary. If there is Rh sensitization (not just an incompatibility, but an actual sensitization where any blood transfer could result in a blood illness), if the baby needs resuscitation (but only after the first 2-3 minutes, as the cord blood is the best source of oxygen at that point), if there is a tight cord around the neck that just cannot be resolved any other way (I have many ways of resolving a cord around the neck), twin to twin transfusion (I have more info on this if you need it), or if there is hyperviscosity of the newborn, also known as polycythemia).