Delayed Cord-Clamping: Benefits, Risks And Variations

Delayed Cord-clamping Benefits, Risks And Variations

Delayed cord clamping has become very popular in recent years, with many women including it in their birth plan. Optimal timing of the delayed cord clamping has not yet been fully established. However, several systematic reviews (studies which pool data together) support delaying cord clamping for at least 30 to 60 seconds and positioning the baby below or at the same level of the placenta.

Benefits:

It has been well established that delaying clamping of the cord can provide particular health benefits for a preterm baby (<37 weeks).

These include:

  • Increased blood flow
  • Reduced risk of low blood pressure
  • Reduced need for a blood transfusion
  • Reduced risk of intracranial hemorrhage
  • Upto 50% reduced risk of intraventricular hemorrhage

Another benefit includes the possible transfer of immune system factors and stem cells from the placenta to the baby, which may be especially beneficial for a preterm infant who has suffered from organ damage or other preterm birth-related conditions.1

For babies who are full-term and who are born in developed countries, the benefits are less clear but include increased iron intake, resulting in a lowered risk of iron deficiency and, consequently, improved neurodevelopmental outcomes.1,2 However, the American College of Obstetricians and Gynecologists has stated that there is insufficient evidence to support or to refute the benefits from delayed umbilical cord clamping for term infants that are born in settings with rich resources.1

Risks associated with delayed cord clamping:

There appears to be a significantly increased risk of jaundice requiring phototherapy in newborn babies who undergo delayed cord clamping compared with babies who undergo immediate cord clamping. There is some evidence that suggests an increased risk of a disorder called “neonatal polycythemia”, particularly if the mother had gestational diabetes. Babies may also experience intra-uterine growth restriction if the pregnancy and birth occurred at high altitudes. Neonatal polycythemia is when the hematocrit (the percentage of red blood cells in the total blood volume) is greater than 65%. This can lead to overly sticky blood which can block blood flow and damage organ tissue.3  However, other studies have not identified differences in rates of polycythemia between delayed and immediate cord clamping.4

With respect to the mother, there doesn’t seem to be an increased risk of hemorrhage.1,4

Lotus birth:

Lotus births are an extreme version of delayed cord clamping where the baby remains attached to the placenta until it naturally breaks off. There are no proven medical benefits of this practice for the baby and, conversely, there is a very real risk of infection since the placenta is essentially dead tissue after birth, making it particularly prone to infection which can then get transferred to the baby.5 Read more about Lotus birth here.

Umbilical cord milking:

This is a variation of delayed cord clamping where a segment of the umbilical cord is milked for a short period of time. One study found that, compared with immediate cord clamping, milking of a 20 cm segment of the umbilical cord 2 or 3 times resulted in:

  • higher hemoglobin concentrations
  • higher systemic blood pressure
  • reduced need for transfusions
  • greater out put of urine over 72 hours in preterm babies (24-28 weeks)6

Another study found that umbilical cord milking improved cardiovascular function in stable preterm babies (<29 weeks).4 However, more studies are needed to evaluate the potential benefits and risks of umbilical cord milking, especially in comparison with delayed cord clamping.

Conclusion:

The benefits of delayed cord clamping for 30-60 seconds appear to be quite clear with preterm babies and the benefits of milking the umbilical cord are also starting to become apparent. These benefits are not so obvious in full-term infants. However, since cord clamping carries little overall risk, it is a procedure you may want to consider it in your birth plan. Talk to your doctor, midwife, or nurse about it.

Sources:

  1. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Timing-of-Umbilical-Cord-Clamping-After-Birth
  2. http://www.ncbi.nlm.nih.gov/pubmed/26734815
  3. https://www.nlm.nih.gov/medlineplus/ency/article/000536.htm
  4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835342/
  5. https://www.rcog.org.uk/en/news/rcog-statement-on-umbilical-non-severance-or-lotus-birth/
  6. http://pediatrics.aappublications.org/content/136/1/61
Melody Watson
Melody Watson holds Bachelors degrees in Biochemistry and Microbiology. She works as a medical writer for a medical communications agency in Berlin, Germany, where her work ranges from medical translation to writing publications for medical journals. Melody is passionate about promoting science, including evidence-based medicine, and debunking pseudoscience.

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