What is delayed cord clamping (DCC)?
After your baby has been born the umbilical cord, which links your placenta to the baby, continues to pulsate and transfer blood and oxygen and stem cells to your baby until baby has transitioned to life outside the uterus and becomes stable.
Cutting the cord immediately after the birth has been routine practice for 50-60 years but more recently research is showing that it is not good for the baby as it means the baby misses out on a large amount of blood (214g). This has led to more recent changes in guidelines and practice towards delaying clamping. Waiting until the cord has stopped pulsating and becomes white is becoming increasingly normal practice in births where there is no medical reason to speed things up.
Normally the midwife should be able to feel when this happens by just touching the cord. If there is a reason why time cannot be allowed for this, then the midwife or doctor should wait at least 1-3 minutes following the birth of the baby before clamping and cutting the cord.
NICE guidance recommends that cord clamping is delayed in all maternity units for at least 1-5 minutes in all babies unless the fetal heart is less than 60 bpm and not getting faster, at this point, for practical reasons, the baby may need to be taken away to get breathing support.
Why is delayed cord clamping recommended?
Delayed cord clamping allows the blood from the placenta to continue being transferred to the baby even after they are born. This means that the baby could receive up to 214g of cord blood, which is about 30% more blood than they would have without it.
The benefits of this include:
- increased iron levels in the baby even up until they are six 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.
Babies who have immediate cord clamping (particularly boys) have also been shown to be more likely to:
- be anaemic at four months of age
- have decreased fine motor skills (coordinating small muscles, such as hands and fingers) at the age of four years
- have decreased social skills at the age of four years.
When would DCC not be practised?
In most situations DCC is extremely beneficial. However there are a few circumstances in which it may not be suitable, such as:
- if the mother is bleeding heavily
- there is an issue with the placenta, such as placental abruption, placenta praevia, vasa praevia or the cord is bleeding so the blood is not getting to the baby.
If the baby needs help with breathing (resuscitation) the cord may need to be clamped early if there are no facilities in the hospital to do this beside the mother, however it should be possible to delay cord clamping while the baby is assessed and the breathing support starts.
What is the difference between DCC and milking the cord?
DCC is a natural and physiological process where the cord blood is transferred to the baby with no assistance from health professionals. ‘Milking’ the cord occurs 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 there is a need to speed this process up, most commonly if the baby needs help with their breathing.
Should I have DCC on my birth plan?
Yes, you can add DCC to your birth plan, particularly if you know you are at risk of having a premature baby or if you are having a planned caesarean section. Although most units should be practising it, it is taking longer for it to become ingrained in usual practise and the more women who open up the conversation about it, the more usual it becomes.
Cord clamping and having a premature baby
DCC has been shown to have lots of benefits for premature babies or babies of a low birth weight. These include:
- higher blood pressure
- higher amount of red blood cells
- fewer days on oxygen and ventilation (help with breathing)
- fewer blood transfusions needed
- lower risk of haemorrhage (bleeding)
- lower risk of infection
- lower risk of intraventricular haemorrhage (bleeding in the brain)
- lower risk of necrotising enterocolitis (damage to the intestines)
- lower risk of anaemia
If you know you are at risk of having a premature baby, you can put Delayed Cord Clamping on your birth plan and discuss it with your health care team.
Can I have DCC with a caesarean section?
DCC can still be practised if you have a caesarean section, whether it is planned or an emergency and is becoming very common practice at hospitals which recognise the benefits of delayed cord clamping. Do talk to the health professionals caring for you about this. Including it in your birth plan will give you an opportunity to talk about it.
If I have the injection to deliver my placenta, can DCC still happen?
Yes, even with the injection it usually takes at least 5-10 minutes before the placenta is delivered and during this time the cord can remain intact allowing for the transfer of the blood.
What if my baby needs help breathing at birth?
It is possible to help your baby with the cord remaining intact. In fact, it has been shown that babies have better outcomes if their cord is left than if it is clamped and cut quickly after the birth. Some hospitals have equipment to allow breathing support to happen without having to cut the cord.
I have read that DCC can mean my baby is more like to have increased levels of jaundice in the first week of being born?
Some small studies have shown that DCC can slightly increase the chance of baby have a higher level of jaundice but strong evidence shows that the benefits of DCC outweigh this.
Jaundice is very common in newborn babies and usually does not need treatment however a small amount of babies may need phototherapy to help them get rid of the jaundice (no matter when the cord was clamped).
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- WHO (2014) Guideline: Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes. Geneva, World Health Organization; 2014 (http://www.who.int/nutrition/publications/guidelines/cord_clamping/en/). http://apps.who.int/iris/bitstream/10665/148793/1/9789241508209_eng.pdf?...
- WHO (2012) Optimal timing of cord clamping for the prevention of iron deficiency anaemia in infants, extracted from the WHO Guideline: Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes, World Health Organisation, Geneva http://www.who.int/elena/titles/full_recommendations/cord_clamping/en/
- McDonald SJ, Middleton P, Dowswell T et al (2014) Effect of timing of umbilical cord clamping of term infants onmaternal and neonatal outcomes (Review). Evid.-Based Child Health 9:2: 303–397 (2014) http://onlinelibrary.wiley.com/doi/10.1002/ebch.1971/epdf
- NICE (2014) Intrapartum care for healthy women and babies Clinical guideline [CG190], National Institute for Health and Care Excellence, London, England https://www.nice.org.uk/guidance/cg190/chapter/Recommendations#third-sta...
- Raju TNK, Singal N (2013) Optimal timing for clamping the umbilical cord after birth. Clin Perinatol. 2012 Dec; 39(4): 10.1016/j.clp.2012.09.006. doi: 10.1016/j.clp.2012.09.006 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835342/
- Mercer JS, Vohr BR, McGrath MM et al (2006) Delayed Cord Clamping in Very Preterm Infants Reduces the Incidence of Intraventricular Hemorrhage and Late-Onset Sepsis: A Randomized, Controlled Trial. Pediatrics. 2006 Apr; 117(4): 1235–1242. doi: 10.1542/peds.2005-1706 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1564438/
- Rabe H, Reynolds G, Diaz-Rosello J (2004) Early versus delayed umbilical cord clamping in preterm infants. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD003248. https://www.ncbi.nlm.nih.gov/pubmed/15495045
ℹLast reviewed on September 1st, 2017. Next review date September 1st, 2020.
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