In recent years, there has been ongoing debate regarding the optimal time to clamp the umbilical cord at birth. The current practice at many centers in the United States is to immediately clamp the umbilical cord at time of delivery. However, numerous studies have demonstrated safety and advantages to delayed cord clamping (DCC), a practice endorsed by the American College of Obstetricians and Gynecologists Committee Opinion statement published in 2012, which recommended DCC in preterm neonates, when feasible. In term infants, DCC is typically considered clamping 60 seconds after birth, typically at 1 to 3 minutes after delivery. In preterm infants, DCC is considered clamping between 30 to 60 seconds after birth. When DCC is performed, a newborn receives a placental blood transfusion that may increase their blood volume by up to 40%. Over time, this transfused volume of red blood cells naturally gets broken down, leaving iron for the body to use by developing cells. In the brain, iron is essential for normal development and is important in helping form the insulating sheaths around nerve fibers, a process called myelination, which increases the speed at which nerve impulses travel.
Based on multiple randomized controlled trials, there are many potential advantages to performing DCC compared to immediate cord clamping in preterm babies, including decreased overall mortality, blood transfusion incidence and the risk of intraventricular hemorrhage. DCC reduces the incidence of intraventricular hemorrhage by nearly 50%, thereby preventing one case of intraventricular hemorrhage for every 15 neonates treated. While more studies are needed to better understand the long-term impact of DCC on neurodevelopment, emerging studies continue to demonstrate safety of this natural and cost-effective practice.
As part of the birth plan, I encourage all parents to discuss with our obstetricians and midwives how to optimize their birth experience, which should include a conversation discussing the possibility of performing DCC to promote the benefits of placental transfusion for their baby.
1. Committee on Obstetric Practice American College of Obstetricians and Gynecologists. Committee opinion no. 543: timing of umbilical cord clamping after birth. Obstet Gynecol. 2012; 120(6): 1522–1526.
2. Backes CH, Rivera BK, Haque U, et al. Placental transfusion strategies in very preterm neonates: a systematic review and meta-analysis. Obstet Gynecol. 2014;124(1):47-56.