Delayed Cord Clamping

A foetus inside the womb

Umbilical Cord is the link that connects the mother’s placenta and the baby in the womb. The cord continues to pulsate and transfer blood, oxygen and stem cells to the baby. A better transition from life in the womb, to the outside world, is possible from the extra blood for the baby; hence delayed cord clamping is the best option for newly born babies.


What is Delayed Cord Clamping?

A new born baby sleeping next to its mother

Delayed cord clamping is the elongation of the time between the delivery of the newborn and the clamping of the umbilical cord. It has been customary for 50 to 60 years to cut the cord immediately after the birth. However, some suggest that it is not good for the baby as it misses out a large amount of blood and other benefits. The World Health Organization suggests that DCC is safe for the full term as well as premature babies, as long as they do not require breathing assistance; the cord being attached to the baby and the mother can significantly hamper resuscitation efforts.


Is Delayed Umbilical Cord Clamping Common?

In the past few years, the potential benefits of the delayed cord clamping have gained more attention. Despite no risk for infants and mothers, it should be practised on healthy infants and mothers without complications.

How long Should you Delay Cord Clamping?

The circumstances of mother and baby influence the timing of the clamping of the umbilical cord. An infant receives 30% more foetal-placental blood volume in delaying cord separation than immediate cord clamping. The WHO states that “optimal time to clamp the umbilical cord for all infants regardless of gestational age or foetal weight is when the circulation in the cord has ceased, and the cord is flat and pulseless (approximately 3 min or more after birth)”.

Benefits of Delayed Cord Clamping

Before birth, the circulating blood supply is shared by the baby and the placenta. The baby is provided with oxygen and nutrients by the placenta and the umbilical cord. The functions of lungs, liver, gut, and kidneys of the baby are performed by the placenta. So, the baby organs require a small flow of blood. Hence at any time, placenta carries the significant portion of the baby’s blood volume. The blood in the placenta belongs to the baby. After birth, the placenta provides essential oxygen and nutrients and delivers the blood back to the baby. This imperative part of the birth process is called placental transfusion. Placental transfusion provides the baby with red blood cells, stem cells, immune cells and blood volume.

There are multiple benefits of DCC. Here are few:

1. Neurodevelopmental benefits

Extra minutes attached to the umbilical cord at birth may translate into a small boost in the neurodevelopment of the child several years later. Children with DCC have slightly higher social skills and fine motor skill than ICC children.

2. Decreased risk of Anaemia

Breastfed children need to be supplemented with iron since breast milk is low in iron to prevent anaemia. Infants require iron for rapid brain growth and development. A Study found that DCC increases the iron endowment at birth and haemoglobin concentration at 2 months of age. Delay in cord clamping of 2 minutes could help prevent iron deficiency from developing before six months of age.

3. Increased blood volume or Smoother cardiopulmonary transition

Approximately one-third of the blood volume resides in the placenta for both premature and full-term babies. This volume of blood is required to suffuse the foetal lungs, kidneys, and liver at birth. Babies whose cords are clamped with 2-3 min delay have adequate iron stores and smoother cardiopulmonary transition. Another potential benefit of this increased blood volume is increased blood platelets required for normal blood clotting.

4. Increased levels of stem cells

Stem cells play an imperative role in the development of immune, respiratory, cardiovascular and central nervous system amid many other functions. It also repairs the brain damage suffered by the baby during difficult birth. Delayed cord cutting results in an infusion of stem cells.

5. Better outcomes for preterm infants

Premature babies who have DCC tend to have better blood pressure immediately after birth and need fewer drugs to maintain blood pressure. They also need few blood transfusions and less bleeding into the brain. It reduces the risk of critical bowel injury – necrotizing enterocolitis.

Risks of Immediate Cord Clamping

ICC causes complications for both mother and baby. Here is the list of risks:

  • ICC disrupts normal physiology, anatomy and the birth process – it splits the baby from the still functioning placenta and stops the blood circulation.
  • It results in the lower iron stores in the baby which has an adverse effect on their neurodevelopment.
  • Early clamping increases the risk of haemorrhage and retained placenta by engorging the placenta with the baby’s blood. This makes uterus contraction harder causing difficulty in expelling the placenta.

Delayed Cord Clamping Risks

Risks related to DCC:

  • Polycythemia: Circulation of an excess of blood flow to the newborn may develop blood hyperviscosity causing polycythemia.
  • Hyperbilirubinemia: Due to increased iron stores DCC babies will have a greater incidence of hyperbilirubinemia is because of the high level of bilirubin in the blood. In the womb, the placenta takes care of the excess bilirubin, but birth baby’s liver must process the bilirubin. This leads to jaundice and often requires phototherapy.
  • Respiratory distress: Respiratory distress occurs when there is not enough of a liquid coating the lungs after birth to keep the airways and tiny alveoli of the lungs open. This can cause cell damage near the lungs and a build-up of carbon dioxide in the blood. Due to this babies need to be placed on a ventilator.

From the delayed cord clamping pros and cons, it is clear that the benefits of DCC do outweigh the hypothesized risks. DCC is beneficial to both premature and full-term infants with higher levels of iron in the blood, better oxygenation of brain tissues and protection from lead poisoning.