Delayed Cord Clamping (DCC): is it right for me and my baby?

When planning for your birth, it can seem as though there are an infinite amount of decisions to make and even more information to consider. Here, we demystify “delayed cord clamping” or DCC. We provide data and identify the benefits and risks to help you make an informed decision about delayed cord clamping in your birth plan. At the time of this writing, the American College of Obstetricians and Gynecologists now recommends a delay in “umbilical cord clamping in vigorous term and preterm infants for at least 30–60 seconds after birth, given the benefits to most newborns.” Read on to learn more.

 

What is the umbilical cord?
In conversations about labor and delivery, you may hear a lot about clamping or cutting the umbilical cord and maybe even delaying the clamping of the cord. But why is there so much fuss about cords and the blood that flows within them? Well, the umbilical cord serves as a passageway for three incredibly important vessels: two arteries that carry waste from the fetus back to the placenta and one vein that carries food and oxygen from the placenta to the infant. The blood which flows through the umbilical cord or “cord blood” is rich in blood-forming STEM cells, which can be used for transplants that cure diseases such as blood disorders, immune deficiencies, metabolic diseases, and some kinds of cancer. Cord blood is vital to the health of the infant in utero and also has lasting benefits for the infant following delivery.

 

What is delayed cord clamping?

Delayed cord clamping refers to the time just after birth, before the delivery of the placenta. According to The American College of Obstetrics and Gynecology, delayed cord clamping is defined as “cord clamping at least 30–60 seconds after birth”. According to The American College of Nurse-Midwives, delaying the clamping of the cord for 5 minutes if the newborn is placed skin-to-skin ensures the greatest benefit. With that said, blood is still flowing from the placenta into your infant until the cord stops pulsating or is white in color. For years, medical professionals in hospital settings would immediately clamp the umbilical cord and remove the child from the birthing parent, immediately passing the infant off to the medical staff to take newborn assessments. As more research is done, it is clear that keeping the infant in skin-to-skin contact with the birthing parent is optimal and that delaying the clamping of the umbilical cord is now recommended, as well as the fact that the term ‘delayed’ is open to interpretation.

Here is a helpful short video by Penny Simkin PT illustrating the concept of delayed cord clamping.

 

What are the benefits of delayed cord clamping?

While in utero, your fetus is constantly producing fetal hemoglobin – an iron-rich protein found in red blood cells. This fetal hemoglobin sucks the oxygen from the placenta and delivers it to the baby. After birth, the production of fetal hemoglobin stops, and production of regular hemoglobin begins, meaning that your baby will then make their own new red blood cells.

By delaying cord clamping after birth, you are allowing for those beneficial blood cells to travel into your baby, creating a sort of iron-rich blood reserve. Even though it may seem insignificant, these extra iron-rich cells help your baby transition to make this new form of hemoglobin outside of your body. This can result in:

• better blood circulation for your baby
• decreased risk of low iron (iron deficiency anemia)
• better establishment of red blood cell count (60% increase)
• increase in blood volume (30% increase)
• an increased coating that protects neural pathways in the brain and spinal cord (myelin)
• decreased need for blood transfusions in preterm infants
• lower incidence of inflammation and death of intestinal tissue in preterm infants (necrotizing enterocolitis)
• decreased risk of bleeding in the brain in preterm infants (intraventricular hemorrhage)
• allows time for your baby to ease into the post-uterus world
• allows for initial bonding with the birthing parent rather than immediate intervention/separation

 

Are there any risks to delaying cord clamping?

With so much information available on the internet and so many voices sharing their perspective, you are sure to find some sources claiming that delayed cord clamping has pertinent health risks to the birthing parent and/or their baby. Let’s utilize evidence-based research to address these concerns one at a time.

1. Is there an increased risk of jaundice in infants? Some studies claim that there is a slightly increased risk of jaundice (hyperbilirubinemia) in infants as a result of delaying cord clamping. In contrast, others claim that jaundice in babies is fairly normal and is not affected by the timing of umbilical cord clamping. When the baby’s reserve of fetal hemoglobin breaks down, they form bilirubin, which in excess can be harmful to the baby’s brain. While ACOG does say there is a slight increase, they also note that it is recommended to delay cord clamping and that monitoring for jaundice and having treatment available is appropriate. Sufficient lactation is one of the factors that can reduce the likelihood of jaundice. Whether it is caused by delayed cord clamping or not, this can be quickly identified and solved by increasing breastmilk intake and or exposing the baby to phototherapy lights that will improve this condition.
2. Is there an increased risk of excess red blood cells (polycythemia) in baby? Polycythemia is a disorder in which the body has too many red blood cells and can lead to trouble breathing, jaundice, abnormal blood circulation, and other circulatory issues. However, as of July 2022, there is very little evidence that supports the claim that delayed cord clamping causes polycythemia.
3. Is there an increased risk of trouble breathing (respiratory distress) in baby? Though there is a risk of respiratory distress in preterm infants, there has been no correlation or causation found between delayed cord clamping and breathing difficulties.
4. Is there an increased risk of heavy bleeding after birth (postpartum hemorrhage) for the birthing parent? Unless there is a preexisting condition that would put the birthing parent at risk of postpartum hemorrhage, delaying cord clamping does not increase this risk of postpartum hemorrhage, as per the American College of Obstetrics and Gynecology. However, if the birthing parent shows signs of distress or immediate medical concerns (like placental abruption or excessive bleeding), the cord should be clamped immediately to address the concern.

 

When is delayed cord clamping not appropriate?

Delayed cord clamping has many benefits that seem to outweigh the alleged risks. However, this practice is not recommended for all births. Delayed cord clamping should not be implemented if the infant:

• is born limp and/or floppy
• has heart rate abnormalities
• has an infection
• is exhibiting health concerns in which the NICU team and/or neonatologist are recommending immediate cord clamping
• has other concerns that need to be addressed immediately (cold temperature, low oxygen, etc.)
• needs to be resuscitated (however, this is up for debate as some evidence shows that babies resuscitated while still tethered to the placenta started to breathe and establish regular breathing earlier than in the early cord clamping group)

 

Should I include delayed cord clamping on my birth plan?

Each birth is completely different, and each parent deserves to have their wishes respected during their labor, delivery, and beyond. After weighing the benefits and risks of delayed cord clamping outlined above, we recommend that you do research of your own to ensure that you feel confident about your approach to cord clamping. With that said, The American College of Obstetrics and Gynecology (ACOG) does recommend delayed cord clamping in vigorous term infants (healthy and “on-time” infants) and preterm infants (infants who came early) for at least 30-60 seconds after birth, whether it is a vaginal or cesarean delivery. Speak with your midwife or doctor to discuss and decide. 

Regardless of your personal views on cord clamping or any other custom or procedure done during the birthing process, above all else, we recommend that you have someone who can advocate for you by your side. While a partner can be wonderful to have as an advocate, we highly recommend having a doula present to ensure that you and your birthing plan will be respected. A doula will not only advocate on your behalf but also will be able to help you understand potential medical surprises that may arise and communicate on your behalf to the physician assisting during your labor and delivery.

 

Disclaimer: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment.
Photo Credit: @eletfababapraxis on IG