Revised Recommendations for Cord Clamping at Birth & Tips for Communicating Your Preferences

Immediately after a baby is born, the umbilical cord -- the lifeline that connects baby to your placenta and allows for vital oxygenated, nutrient-rich blood flow -- is still filled with blood. The remaining blood, as it turns out, isn't just insignificant leftovers, but very beneficial for baby to receive. For many years (and still today in some places), doctors have been taught to clamp the cord immediately to prevent maternal hemmorrhage and reduce jaundice for baby. We now know better. Delaying cord clamping does not cause maternal hemmorrhage and only slightly increases jaundice (which can easily be treated).

Last month, The American College of Obstetricians and Gynecologists (ACOG) released an updated Committee Opinion called "Delayed Umbilical Cord Clamping After Birth," which provides an updated recommendation to the practice of cord clamping after a baby is born (the last statement was released in 2012). ACOG now recommends waiting "at least 30-60 seconds after birth" to clamp baby's umbilical cord, for both healthy and preterm (premature) newborns. The basis for following this practice (a practice that several other maternal health organizations in the United States and abroad also promote, and have promoted for some time) are the following documented benefits:

• increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may positively affect baby's development
• for preterm infants, it improves transitional circulation, better establishes red blood cell volume, decreases need for blood transfusion, and lowers risk of the severe illnesses, necrotizing enterocolitis and intraventricular hemorrhage

Side effects of the practice include one, which is minor and far outweighed by the benefits. Delayed cord clamping can slightly increase the incidence of jaundice in full-term infants, for which phototherapy can be used to treat successfully. Jaundice is common and can also occur without delayed cord clamping.

Despite the benefits of delayed cord clamping, there remain a few barriers to receiving the practice at every birth. If a newborn is experiencing complications and requires resuscitation, it may not be advised to wait the extra 30-60 seconds to allow the blood to transfer. While these infants may benefit even more from the transfer of blood, it is complicated to both allow for remaining blood flow and provide necessary emergency aid. Researchers are currently exploring special equipment to allow for resuscitation at bedside, while the umbilical cord is still attached. Cord "milking," a practice in which the umbilical cord is manually stripped to speed up the transfer of blood to the infant, requires significantly less time and may be a beneficial practice for infants requiring extra assistance, but has not been studied sufficiently to either recommend or deny. Additionally, births of multiples (twins or more) have not been sufficiently researched to either recommend for or against delayed clamping. However, multiples are frequently born prematurely and could benefit from delayed cord clamping.

Lamaze International has advocated for delayed cord clamping for quite some time. Immediate cord clamping interferes with two of the Lamaze Six Healthy Birth Practices: Avoid Interventions that are Not Medically Necessary and Keep Mother and Baby Together - It's Best for Mother, Baby and Breastfeeding. So, how can you increase the chance that your newborn will receive the significantly important remaining blood that she deserves? First and foremost, discuss this recent revised recommendation with your doctor or midwife. At your next prenatal visit, say: "I've learned about delayed cord clamping and recently read the new recommendation to wait at least 30-60 seconds for all newborns. Is that a practice you follow?" It's possible that delayed cord clamping is already a routine practice for your provider. If not, find out why. If any of the reasons offered don't align with ACOG's research, offer to provide information supporting the practice. Tell your provider it's important to you. If you continue to receive push back, it could be a red flag that your provider does not practice according to current best evidence and that other preferences you desire may not be supported. Consider opening a broader discussion to find out more. It may be that you decide your provider isn't the best fit. It's almost never too late to switch!

During your labor and birth, your birth support team (your partner/friend/spouse/family member, nurse, and doula) can help ensure that delayed cord clamping is part of your birth by talking about the preference when you check in to your place of birth and mentioning it again near the end of labor. Of course, delayed cord clamping is also important to include on your birth plan.

Have you heard about delayed cord clamping? Is your provider already doing this?

Photo information: Credit: f1uffster (Jeanie) Newborn! via photopin (license). This photo does not depict delayed cord clamping. For a detailed series of photos that do show what delayed cord clamping looks like, check out this post from Apple Blossom Families.