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What is Delayed Cord Clamping And Should You Do It?

What is Delayed Cord Clamping (DCC)?

According to the World Health Organization (WHO), delayed cord clamping is when the cord is cut 1-3 minutes after the birth of the baby. This is a practice that they recommend for all births. It can also mean waiting as long as the umbilical cord stops pulsating and/or waiting until the placenta is delivered.

Dr. Heike Rabe, a UK neonatologist specializing in DCC research, states the following: “There is growing evidence from a number of studies that all infants, those born at term and those born early, benefit from receiving extra blood from the placenta at birth.” She continues by saying, “The extra blood at birth helps the baby to cope better with the transition from life in the womb, where everything is provided for them by the placenta and the mother, to the outside world. Their lungs get more blood so that the exchange of oxygen into the blood can take place smoothly.”

This diagram from the British Medical Journal shows the transfer of blood volume from placenta to baby after birth

What Are the Possible Benefits of Delayed Cord Clamping?

1. Neurodevelopmental benefits:

In one study of 263 healthy, full-term Swedish newborns, half of their cords were clamped more than three minutes after birth and the other half clamped at less than 10 seconds after birth. Four years later, the children went back to obtain a series of assessments. These assessments included IQ, motor skills, social skills, problem-solving, communication skills, and behavior. The results showed that those with DCC showed modestly higher scores in both social and fine motor skills. It also showed that only boys showed a statistically significant improvement.

“We don't know exactly why, but speculate that girls receive extra protection through higher estrogen levels whilst being in the womb,” Rabe said. "The results in term infants are consistent with those of follow-up in preterm infants."”

2. Decreased Risk Of Anemia:

When one considers that many pediatricians recommend that breastfeeding mothers supplement their infants with iron drops or ask that formula fed babies be given iron enriched formula, it's obvious that doctors believe that our babies are lacking iron. A quick glance on the shelf at the local supermarket will show a wide range of infant products labeled that they have added iron in them!

Iron deficiency at birth can include cognitive impairment and central nervous system problems. According to the American College of Obstetricians and Gynecologists, “at 3–6 months of age, infants exposed to early umbilical cord clamping were more likely to have iron deficiency compared with the late cord clamping group.” An additional 40 to 50 mg/kg of iron transfers to a newborn baby with DCC, which helps reduce the risk of your baby possibly suffering from the severe side effects that can happen with iron deficiency.

3. Increased levels of stem cells:

Stem cells play an indispensable role in creating many of the body's functions. This includes the development of immune, respiratory, cardiovascular, and central nervous systems. The amount of stem cells in the fetal blood is higher than at any other time in life. Cutting the cord immediately leaves nearly 1/3 of these critical cells in the placenta and cord. Dr. Rabe claims that, “the placental blood is rich with stem cells, which could help to repair any brain damage the baby might have suffered during a difficult birth." She also added, "Milking of the cord would be the easiest way to get the extra blood into the baby quickly in an emergency situation."

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4. Preterm infants can benefit from it.

Most of the research has been focused on preterm infants. They benefit immensely from delayed cord clamping. Dr. Rabe states that, “Preemies who have delayed cord clamping tend to have better blood pressure in the days immediately after birth, need fewer drugs to support blood pressure, need fewer blood transfusions, have less bleeding into the brain and have a lower risk of necrotizing enterocolitis, a life-threatening bowel injury”

Are There Any Risks?

There was one study that found a slight increase (2%) of jaundice among babies who received DCC. However, according to Dr. Racheal Reed, Senior Lecturer in Midwifery at the University of the Sunshine Coast and blogger at the Thinking Midwife, she wonders if this was because women were also given an injection of syntocinon/syntometrine while the placenta was still circulating the blood. These drugs have been linked to giving babies jaundice. She notes that, “All the studies in the Cochrane review were carried out in hospitals where the vast majority of women have an oxytocic injection for management of the third stage. I very rarely come across anything more than mild jaundice following a physiological birth.”

Also, there were no statistical evidence proving that DCC results in an increase in blood loss. There was also no significant difference regarding blood loss greater than 500ml between early and delayed cord clamping.

What About Cord Blood Banking?

A recent study, The Effect of Delayed Clamping on Umbilical Cord Blood Collection Volume and Total Nucleated Cell Count in the Family Banking Setting, was recently presented at the 15th International Cord Blood Symposium, and the abstract was published in the journal Transfusion.

Over a four month period, data collection cards were given to medical professionals who collected cord blood for families that used ViaCord, a popular blood banking company. Over 2,000 data collection cards were completed and used in this study. The health care providers were asked to indicate if delayed clamping was performed, and if so, what was the duration of the clamp delay.

According to Parents Guide to Cord Blood Foundation: “Upon arrival at ViaCord’s processing lab, the cord blood collections were measured for initial cord blood volume and pre-processed TNC counts. The data collected over the four months was then averaged to evaluate the impact delayed clamping had on the cord blood collections.” Below are the findings:

They feel that cord blood collection can be completed, even if a family chooses to do delayed cord clamping. However, they note that they feel every effort should be made to collect as much cord blood as possible.

Dr. Stephen Klasko, who is senior vice president of USF Health and dean of the USF College of Medicine feels that, “There remains no consensus among scientists and clinicians on cord clamping and proper cord blood collection.” He strongly feels that “the most important thing is to avoid losing valuable stems cells during and just after delivery.” It is his mindset that if babies are provided with their stem cells, then they will be given an extra amount of preventative measures for their body's health.

Delayed cord clamping is often not compatible with cord blood banking. Most companies that collect cord blood state that they want the cord to be cut under 60 seconds. Parents would have to speak with the company that they plan on using to find out their guidelines. However, a under one minute delay time will not be long enough for your baby to receive most of the benefits from DCC. Clearly, this is something that new parents will need to discuss with each other, the company they plan on working with, and their health care provider to decide which option is a better fit for the family.

In Conclusion:

Many health care providers and families around the world are starting to learn about the benefits of Delayed Cord Clamping (DCC). It is important to remember that many practicing Doctors and Midwives are used to delivering babies based on their earlier education in obstetrics. They will cut the cord simply out of convince and habit. If a pregnant woman is interested in doing this practice, they will need to take some steps to ensure their wishes will be honored. First, talk about this with whomever is delivering the baby. Ask if it is something that they practice. If not, parents-to-be can offer to show them the research listed in this handout. Below are guidelines regarding this practice for medical professionals to review. Since most mothers will be in an overwhelmed state of just having given birth and loving on their new baby, it would be best for them to not only make a request in writing and state it in their birth plan, but to have their spouse/partner or doula be an advocate and be watchful after the birth. It may be necessary for them to remind the health care provider of these wishes.

How to Benefit from DCC:

The following was taken straight from The American College of Obstetricians and Gynecologists website. It may be helpful for you to show this to your healthcare provider:

Delayed umbilical cord clamping is a straightforward process that allows placental transfusion of warm, oxygenated blood to flow passively into the newborn. The position of the newborn during delayed umbilical cord clamping generally has been at or below the level of the placenta, based on the assumption that gravity facilitates the placental transfusion (20, 21). However, a recent trial of healthy term infants born vaginally found that those newborns placed on the maternal abdomen or chest did not have a lower volume of transfusion compared with infants held at the level of the introitus (22). This suggests that immediate skin-to-skin care is appropriate while awaiting umbilical cord clamping. In the case of cesarean delivery, the newborn can be placed on the maternal abdomen or legs or held by the surgeon or assistant at close to the level of the placenta until the umbilical cord is clamped.

During delayed umbilical cord clamping, early care of the newborn should be initiated, including drying and stimulating for first breath or cry, and maintaining normal temperature with skin-to-skin contact and covering the infant with dry linen. Secretions should be cleared only if they are copious or appear to be obstructing the airway. If meconium is present and the baby is vigorous at birth, plans for delayed umbilical cord clamping can continue. The Apgar timer may be useful to monitor elapsed time and facilitate an interval of at least 30–60 seconds between birth and cord clamp.

Delayed umbilical cord clamping should not interfere with active management of the third stage of labor, including the use of uterotonic agents after delivery of the newborn to minimize maternal bleeding. If the placental circulation is not intact, such as in the case of abnormal placentation, placental abruption, or umbilical cord avulsion, immediate cord clamping is appropriate. Similarly, maternal hemodynamic instability or the need for immediate resuscitation of the newborn on the warmer would be an indication for immediate umbilical cord clamping (Table 1). Communication with the neonatal care provider is essential.

The ability to provide delayed umbilical cord clamping may vary among institutions and settings; decisions in those circumstances are best made by the team caring for the mother–infant dyad. There are several situations in which data are limited and decisions regarding timing of umbilical cord clamping should be individualized (Table 1). For example, in cases of fetal growth restriction with abnormal umbilical artery Doppler studies or other situations in which uteroplacental perfusion or umbilical cord flow may be compromised, a discussion between neonatal and obstetric teams can help weigh the relative risks and benefits of immediate or delayed umbilical cord clamping.

Data are somewhat conflicting regarding the effect of delayed umbilical cord clamping on umbilical cord pH measurements. Two studies suggest a small but statistically significant decrease in umbilical artery pH (decrease of approximately 0.03 with delayed umbilical cord clamping) (23, 24). However, a larger study of 116 infants found no difference in umbilical cord pH levels and found an increase in umbilical artery pO2 levels in infants with delayed umbilical cord clamping (25). These studies included infants who did not require resuscitation at birth. Whether the effect of delayed umbilical cord clamping on cord pH in nonvigorous infants would be similar is an important question requiring further study.

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