Delayed (optimal) cord clamping

What is delayed (or optimal) cord clamping (DCC)?

The umbilical cord links your placenta to the baby. After your baby has been born, the umbilical cord continues to pulsate. It is still transferring blood, oxygen, and stem cells to your baby while they adjust to being outside the womb. 

It used to be common practice to cut the cord straight after the birth. Now guidelines say that delayed (or optimal) cord clamping is better for your baby. This means waiting until the cord has stopped pulsating and has become white before cutting the cord. The midwife should be able to feel when this happens by just touching the cord. 

The cord should not be clamped earlier than 1 minute after birth.

It’s recommended that the cord is clamped before 5 minutes (so the placenta can come out after it has separated from the uterus), but you can ask for it to be clamped and cut later than this.   

Your doctor or midwife may need to clamp the cord earlier if there is a problem. For example, if there are concerns about your baby’s heartbeat and they need breathing support. 

You do not have to have delayed cord clamping if you don’t want it. 

You can have delayed cord clamping if you have active or physiological management to deliver the placenta after giving birth. Find out more about delivering the placenta.

Can I or my birth partner still cut the cord if we have delayed (or optimal) cord clamping?

You or your birth partner can still cut the cord if you have delayed cord clamping, if this is what you want. 

Can I still have delayed (or optimal) cord clamping  if I am HIV positive?

You may still be able to have delayed cord clamping if you are HIV positive. Evidence shows that the benefits of delayed cord clamping outweigh the risk of HIV transmission if the mother has been taking antiretroviral medications.  

If you are HIV positive, make sure your healthcare team is aware as early as possible in your pregnancy. They can help get the treatment you need to reduce the risk of passing the infection to your baby. 

Why is delayed (or optimal) cord clamping recommended?

The benefits of delayed cord clamping include: 

• increased iron levels in the baby even up until they are 6 months old, which helps with growth and both physical and emotional development 
• increased amount of stem cells, which helps with your baby’s growth and helps with their immune system.

There is also some research that suggests that delayed cord clamping can improve the health of premature babies. 

When is delayed (or optimal) cord clamping not recommended?  

In most situations, delayed cord clamping is beneficial and will be recommended. But there are some circumstances where it may not be suitable, such as:

• if the person giving birth is bleeding heavily and need immediate medical treatment 
• if there is an issue with the placenta, such as placental abruption, a low-lying placenta or placenta praevia, vasa praevia 
• if the cord is bleeding so the blood is not getting to the baby
• if they baby needs help to breathe (resuscitation).

Twins who share the same placenta (monochorionic twins) should not have delayed cord clamping. This is because there is a small risk that blood could move from one twin into the other during the birth.  

Find out more about multiple pregnancies. 

What if my baby needs help breathing at birth?

Sometimes babies need additional support when they are born. Midwives and doctors are trained to make decisions to help babies adapt to the outside world. It may be possible to help your baby without cutting the cord. 

If they can, your healthcare team will provide any immediate care that your baby needs and keep baby close to you while the cord is intact. Some hospitals have equipment that gives breathing support without having to cut the cord.

But if your baby needs more help, your healthcare team may need to cut the cord straightaway.

Can I have delayed (or optimal) cord clamping with a caesarean section?

You can still have delayed cord clamping if you have a caesarean section, whether it is planned or an emergency. 

Usually, the placenta will be taken out at the same time as your baby. Your healthcare professional will then wait to cut the cord (or for your birth partner to cut the cord, if that’s what you want) before cleaning and checking your baby’s health, and passing them to you for a cuddle.

You can talk to the health professionals caring for you about this.

Should I have delayed (or optimal) cord clamping on my birth plan?

Yes. It may be helpful to talk to your midwife or doctor about delayed cord clamping during your pregnancy. You can then add your preferences to your birth plan.

If you have a birth partner, talk to them about what you’d like to happen so they are also aware. 

But try to remember that labour does not always go to plan. You may need to be flexible and prepared to do things differently.

What is the difference between delayed (or optimal) cord clamping and milking the cord?

Delayed cord clamping is a natural process where the cord blood is transferred to the baby with no help from health professionals.

But milking the cord is when the midwife or doctor push the blood through the cord, so it is transferred more quickly. It is a safe technique, but it usually only happens if the process needs to happen more quickly. This is usually because the baby needs help with their breathing.

Milking the cord may also be a better option for babies born before 28 weeks of pregnancy. 

Can delayed (or optimal) cord clamping cause increased levels of jaundice in the first week of birth?

There is a small increased risk of jaundice in babies who have received deferred cord clamping, but this is usually mild. 

Jaundice is very common in newborn babies and it may happen no matter how soon the cord is clamped after birth. 
Your baby will be examined for signs of jaundice within 72 hours of being born as part of their newborn physical examination. 

Can I still preserve blood from the cord for medical research?

Umbilical cord blood can be used to treat and cure many life-threatening diseases. 

Some parents want their cord blood to be collected at the time of birth and stored, so that it is available for medical research.

Banks can still collect high-quality units of cord blood following delayed cord clamping. But it is important that the cord blood is drained as soon as possible following delayed clamping to maximise the potential volume. 

Your midwife or hospital maternity unit may have more information about cord blood banking. You can also find out more from the Human Tissue Authority.