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Guest Post: What is Delayed Cord Clamping and Why do we do it?

The first few minutes after your baby is born is a whirlwind of emotions. While you are focused on your beautiful newborn, your healthcare team is busy taking steps to optimize your child’s health for months to come. 

After your baby is born, they are still connected to the placenta by the umbilical cord. The umbilical cord is a flexible tube filled with the blood vessels that supplied your baby with nutrients to help them grow throughout the pregnancy. At some point the umbilical cord must be clamped off and cut. But when is the right time to clamp and cut the cord?

Delayed Versus Early Umbilical Cord Clamping

Delayed cord-clamping (DCC) is defined as clamping of the umbilical cord at least 30-60 seconds after the birth of baby. DCC allows for more blood to flow from the placenta to the baby as they take their first breaths and can increase their blood volume by up to 30%. 

Early cord clamping occurs at less than 30 seconds of life. Sometimes this is necessary when baby is in trouble and needs immediate medical attention or if there is maternal hemorrhage or blood pressure instability. 

Benefits of Delayed Cord Clamping

There has been debate about the pros and cons of delayed cord clamping depending on the gestational age of the baby and how stable the mother is at delivery.  However, there is unanimous consensus from the Society of Obstetricians and Gynecologists of Canada, the American College of Obstetricians and Gynecologists, the Canadian Paediatric Society, and the American Academy of Pediatrics.  All agree that the benefits of delayed cord clamping outweigh the drawbacks when your baby is vigorous (i.e. crying and a good pink color) and they do not need any immediate attention from the NICU team.

In pre-term babies born at less than 37 weeks gestation, DCC has been shown to reduce the risk of:

  • necrotizing enterocolitis – inflamed intestines that can die
  • intraventricular hemorrhage – a bleed in the brain
  • late-onset sepsis – a life threatening infection
  • reduces the need for blood transfusions

In infants born at term between 37 and 40 weeks gestation, DCC improves red blood cell counts in the newborn and iron stores at 6 months of age, which is when babies usually start eating iron-containing solid foods. Infants with proper iron stores at 6 months of age have improved development outcomes.  DCC has even been shown to reduce the rates of iron deficiency anemia in term infants in the first year.  

Risks Of Delayed Cord Clamping

There are potential risks to delayed cord clamping though, which is why the practice has been controversial in the past. In full-term babies who have DCC, there is a slight increase in the risk of neonatal jaundice and the need for phototherapy. However, if you are at a facility that has the ability to monitor and treat the jaundice, this risk does not outweigh the benefits.

What About Mom? 

The effect of DCC on mom’s health has also been examined, and the practice does not increase the risk of postpartum hemorrhage, blood loss during delivery, or the need for transfusions after delivery.

Standard Of Practice 

Delayed cord clamping after delivery has become a standard of practice across many health zones because of the numerous benefits to baby no matter their gestational age.  The norm in Alberta is 60 seconds.  You can discuss with your prenatal care health care provider the timing of your cord clamping – this a joint decision between you and your health care provider. 

This post was co-authored by Dora Gyenes, a fourth year medical student at the University of Alberta and Dr. Yuliya Koledenko, a family physician with special interest in obstetrical care.

The post was reviewed and edited by Erin Manchuk, BScPharm, BCGP and Stephanie Liu, MD, MSc, CCFP, BHSc.

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