Delayed Cord Clamping – A Comprehensive Guide by Dr Lathiesh Kumar Kambham

Delayed cord clamping was not in practice for all these years due to the belief that delaying even a few seconds will lead to hemorrhage in the mother. Since the blood flows from the mother’s body to the baby’s body via the clamp, it was believed that if the clamp was not cut right away, the mother’s body will continue to lose blood.

What Does The Umbilical Cord Do?

To understand more about cord clamping, you need to first familiarize yourself with how a fetus gets blood and nutrition. When the baby is inside the mother, then the baby and the placenta together have a blood circulation system that is separate from that of the mother. At any given point in time, about one-third of the baby’s blood will be inside the placenta and only two-thirds of it inside the baby.

So how does the baby’s body connect with the placenta? Through the cord of course. The umbilical cord, which connects the baby and the placenta to the mother’s body, has one vein and two arteries. The vein takes oxygen and nutrients from the placenta to the fetus and the arteries take waste from the baby’s body to the placenta. So, the placenta can be considered your baby’s “external blood circulation system”.

When your baby is born, remember that one-third of the blood is still inside the placenta. Right after birth, the cord starts pulsating and this is a sign for the placenta to send back all the blood to the baby. This process is called placental transfusion.

It is this transfusion of blood that ensures that the baby has enough blood volume and all the necessary blood cells like WBC and RBC in the right amount. The whole argument for delayed cord clamping is based on the fact that if the cord is clamped early, the placental transfusion is interrupted, and the baby is left with a lower volume of blood.

[Read : Importance of Umbilical Cord and Placenta During Pregnancy]

Why Are Cords Clamped Early?

Clamps have been traditionally clamped early because it was earlier believed that delay in cord clamping increased the risk of hemorrhaging in mothers, a belief that was later refuted by research. The practice of clamping the cord early, however, continued mainly because no one wanted to change it.

Some experts also vouched that more blood or more RBCs in the baby could put the baby at risk of neonatal jaundice. But as a practice, because delaying cord clamping would need more time, no doctor really takes the pain owing to their busy practices.

What is Umbilical Cord Milking?

Umbilical cord milking is a technique that helps in pushing more blood into the infant’s abdomen, from the umbilical cord. In this technique, the doctor will form a small circle with the umbilical cord by wrapping it around the thumb and forefinger. Then, they will gently push the blood from the cord into the abdomen of the baby.

When a baby is born preterm or via C-section, the blood in the circulatory system can be low at birth. By using the umbilical cord milking method, the blood flow and the blood pressure in the infant improves before clamping the cord. Once the cord is clamped, the blood flow from the placenta to the baby will stop.

Is Delayed Cord Clamping Safe?

Overall, delayed cord clamping has proven to be very safe and beneficial for babies that were born via C-section or preterm. In very few cases, delayed cord clamping can lead to the following complications.

1. Jaundice

When the extra red blood cells delivered via delayed cord clamping breaks down, it increases the bilirubin levels, which leads to jaundice in the newborn.

2. Polycythemia

In this condition, the baby will have too many red blood cells. Delayed cord clamping increases the red blood cell count in the baby and if the increase is too much, it can cause breathing and circulatory problems in the baby.

3. Breathing Problem

It is a known fact that babies need to push out the fluid and start breathing once they are out of the amniotic fluid. According to some beliefs, an increase in the blood due to delayed cord clamping might reduce the space a baby has to absorb the fluid, thus leading to breathing issues. However, there is no scientific proof to back up this claim.

How is Delayed Cord Clamping Done – Process And Techniques

Delayed cord clamping is nothing but waiting for a few seconds before clamping the cord like usual. The waiting time can vary between 30 seconds to five minutes. In some cases, the doctor will wait until the cord stops pulsating, to clamp it.

When they wait to clamp the cord, they will hold the baby below the placenta’s level to let gravity do its work. This way, whatever blood and stem cells remain in the cord will reach the baby.

In the case of cesarean delivery, the baby may be placed on the mother’s legs or abdomen, right next to the placenta until the cord is clamped.

Since the mother is under anesthesia and there is no risk of her moving her legs or abdomen, the baby can stay safe in this position until the cord is clamped.

How Long is Cord Clamping Delayed?

In the case of cesarean births, waiting 40 – 60 seconds before clamping the cord has proven to benefit the baby in multiple ways. However, in the case of vaginal births, this delay in clamping does not seem to make any difference.

In many cultures around the world, the cord is clamped only after it stops pulsating, but this has not proven to increase the benefits in any way.

When to Consider Delayed Cord Clamping?

If you are not planning on having a lotus birth, the cord will be clamped soon after the baby’s delivery. With not enough data to support either the benefits or the risks of delayed cord clamping, it can be a tough decision for parents to take. Here are a few instances when you should consider this technique:

1. Preterm Birth

Babies born preterm will have lower immunity and are prone to more infections. Delayed cord clamping can increase the healthy blood supply in them, thus lowering the risk of infections and making them stronger.

[Read : Common Health Issues of Premature Babies]

2. Cesarean Birth

In most cases, cesarean deliveries happen before it is time for the baby’s birth. So, the baby gets lesser blood from the placenta. A delayed cord clamping will increase the blood supply in babies.

3. Anemia

If the mother was anemic during pregnancy and the doctor suspects the baby to have low hemoglobin levels as well, delayed cord clamping can increase the blood flow and red blood cell concentration in the baby.

[Read : Fetal Anemia During Pregnancy]

Top 5 Benefits Of Delaying Cutting The Cord

The placental transfusion is expected to continue for the first five or six minutes after delivery. In delayed cord clamping, the obstetrician waits for 5-6 minutes before clamping the cord, thereby letting the placenta transfer full blood volume back to the baby, making him/her better prepared for the transition from inside the womb to outside. Some doctors say that even one minute of delay can help the child much better than early clamping. Not convinced?

Here are the top five benefits of delayed cord clamping:

1. Better Blood Volume

The primary advantage is that the 1/3rd volume of blood present in the placenta will be transferred to the baby if cord clamping is delayed. Increased blood volume will result in increased blood platelets which in turn helps in better clotting of blood.

2. More Stem Cells

Stem cells are absolutely important for all bodily functions. Fetal blood has a higher concentration of stem cells than normal adult blood. This is why this blood is used in stem cell banking. Delayed cord clamping would ensure that the baby’s body is infused with all the stem cells present in the placenta.

3. Decreases Risk of Anemia

Placental transfusion ensures that the baby’s body has enough amount of iron at birth. This is because breast milk is naturally low in iron. However, placental transfusion will be interrupted if the cord is clamped within 10 seconds of birth as is the practice. This leads to a risk of anemia, due to which many pediatricians prescribe iron drop supplements to babies. However, in delayed cord clamping the risk of anemia is reduced substantially

4. Better Blood Pressure For Preemies

Research has shown that pre-term babies whose cord was clamped late generally had better health. It is found that they needed fewer drugs or blood transfusions than the ones who had early cord clamping.

5. Overall Long-Term Health

Research shows that delayed cord clamping impacts the child’s health in a positive way in long term. The research further showed better neuro-development, better fine motor skills, and even higher social skills in kids who had delayed cord clamping.

Delayed cord clamping offers many health benefits to newborn babies. In babies who are born prematurely, delaying the clamping would mean a life support system, albeit for a few minutes. It is recommended that you ask your doctor about this, and include the same in your birth plan.

Risk Factors Involved in Delayed Cord Clamping

Since the cord is clamped only after the baby is delivered, there aren’t many risks associated with delayed cord clamping. Some of the possible risks are jaundice in the baby and an increase in red blood cells in the baby leading to breathing or circulation issues. Both of these can be corrected immediately, thus making the risks very minor.

Delayed Cord Clamping in Preterm Births and Multiple Gestations

While delayed cord clamping is generally recommended and very safe for preterm birth, it should be avoided in multiple births. In the case of multiple births, each baby has its own blood supply from the placenta.

During delayed cord clamping, when the blood is forced into the baby’s body, there is a high risk of the blood moving from one baby to another. If the blood transfers this way, it can be very risky or even fatal for the baby.

It is a well-known fact that blood transfusions happen only with blood that matches. In the case of multiple births, though the babies are all growing in the same womb, they can have different blood types if the parents have different blood types. So, mixing different blood types via delayed cord clamping can be very risky.

If both parents have the same blood type, the babies will also mostly have the same blood type. However, since there is not enough data on this, doctors will not take a chance.

Is Delayed Cord Clamping Popular in India?

Iron deficiency in women and babies is a common problem in India. With medical research and knowledge sharing doctors and midwives in India are more aware of the benefits of delayed umbilical cord clamping. As a result, this practice is picking up in India. However, if you do not discuss this with your doctor or midwife before your delivery, they are bound to clamp the cord soon after birth.

When to See a Doctor?

During pregnancy, you will meet your OB-GYN regularly. It is advisable to do your research and clarify all doubts regarding delayed cord clamping before you go in for your delivery. It is even better to discuss all this in the initial days itself. In case you are very keen on delayed cord clamping or a lotus birth, you need to ensure your doctor is okay with this technique too. Else, you may want to consider switching doctors.

Delayed cord clamping is a technique gaining attention and acceptance in the recent times. With increased exposure to and knowledge about this technique, more doctors are learning and agreeing to follow this technique. It can be beneficial for some and not so for others. It is important to discuss this with your doctor and take an informed decision.

FAQ’s

1. Does Delayed Cord Clamping Cause Post-Partum Hemorrhage in The Mother?

Since the delayed cord clamping is done only after the delivery and when the baby is out of the mother, it will not increase the risk of hemorrhage.

2. Can Delayed Cord Clamping Cause Jaundice in the Newborn?

Yes, in a few cases, an increase in the red blood cells can result in blood cells breaking down and increasing the bilirubin levels in the baby. this can result in jaundice.

3. Can Delayed Cord Clamping Cause Breathing Problems in The Newborn?

Sometimes delayed cord clamping can lead to polycythemia which can result in breathing issues. But this can be managed with phototherapy and is nothing very alarming.