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Delayed cord clamping

Delayed cord clamping

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During pregnancy, the umbilical cord connects your baby to the placenta and supports their growth and wellbeing. Blood transfers through the umbilical cord to and from the placenta providing oxygen and nutrients to your baby and removing waste/carbon dioxide.

When your baby is born, this blood continues to flow, with recent studies now showing blood flow can continue through the cord for several minutes after birth.

This additional blood flow can be of great benefit to your baby’s circulatory system by:

  • Increasing newborn blood volume (decreases need for blood transfusions)
  • Improves newborn iron levels (decreases risk of neonatal anaemia)
  • Could improve newborn transition to life outside of the uterus

 

‘Delayed cord clamping’ (DCC) refers to the practice of allowing time for this blood flow to cease before clamping and cutting the umbilical cord after birth. This delay may be anywhere from 1 to 5 minutes, or as stated by some healthcare providers “until the cord has stopped pulsating and is now white”.

Why can’t my baby have DCC?

There are several instances where your baby may not be able to have delayed cord clamping. These can include:

  • Baby requires assistance to breathe and/or resuscitation after birth
  • Very premature delivery
  • Emergency or elective caesareans in some cases

 

Cord clamping and Caesareans

One of the biggest barriers to providing delayed cord clamping in cases of caesarean delivery is temperature considerations. The thermostat in operating theatre is often kept well below 22-23 degrees Celsius in order to help protect the sterile environment, therefore reducing the risk of infection.  For these reasons, DCC >60 seconds may not always be achieved in lieu of transferring the baby under a radiant heater, drying and skin to skin contact to help maintain their critical body temperature. In these cases, allowing the cord to stop pulsating and gently milking the cord towards the baby provides some additional placental blood flow and is still preferable over immediate cord clamping.

Baby Resuscitation

When your baby is born, your healthcare provider must first assess them to ensure they are transitioning to the outside world appropriately. This involves their first cry, healthy muscle tone and circulation. When a baby is born and is in distress, often immediate cord clamping is needed and the baby moved away to assess and/or assist to breathe. While the benefits of delayed cord clamping are well known, resuscitation takes precedence.

Does DCC increase the risk of jaundice?

It has been suggested that the increased blood volume from delayed cord clamping can contribute to a baby’s risk for jaundice by increasing their bilirubin levels (bilirubin is the final product or waste of broken-down red blood cells).  However, at present there are mixed studies supporting and opposing this theory, and insufficient reliable scientific data to prove one way or another. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommends adopting delayed cord clamping when possible and follow conservative guidelines to monitor and treat for jaundice as needed.

Ask your healthcare provider for more information about delayed cord clamping!

Written by Keryn Thompson, RM & IBCLC (L-301766)

References:

Brocato, B., Holliday, N., Whitehurst, R. M., Lewis, D., & Varner, S. (2016). Delayed Cord Clamping in Preterm Neonates. Obstetrical & Gynecological Survey, 71(1), 39–42. https://doi.org/10.1097/ogx.0000000000000263

Hutchon, D., & Uwins, C. (2014). Delayed umbilical cord clamping after childbirth: potential benefits to baby's health. Pediatric Health, Medicine and Therapeutics, 161. https://doi.org/10.2147/phmt.s51867

Katheria, A., Lee, H. C., Knol, R., Irvine, L., & Thomas, S. (2021). A review of different resuscitation platforms during delayed cord clamping. Journal of Perinatology, 41(7), 1540–1548. https://doi.org/10.1038/s41372-021-01052-3

McAdams, R. M. (2014). Time to Implement Delayed Cord Clamping. Obstetrics & Gynecology, 123(3), 549–552. https://doi.org/10.1097/aog.0000000000000122

Nagano, N., Saito, M., Sugiura, T., Miyahara, F., Namba, F., & Ota, E. (2018). Benefits of umbilical cord milking versus delayed cord clamping on neonatal outcomes in preterm infants: A systematic review and meta-analysis. PLOS ONE, 13(8), Article e0201528. https://doi.org/10.1371/journal.pone.0201528

Qian, Y., Ying, X., Wang, P., Lu, Z., & Hua, Y. (2019). Early versus delayed umbilical cord clamping on maternal and neonatal outcomes. Archives of Gynecology and Obstetrics, 300(3), 531–543. https://doi.org/10.1007/s00404-019-05215-8

Scheans, P. (2013). Delayed Cord Clamping: A Collaborative Practice to Improve Outcomes. Neonatal Network, 32(5), 369–373. https://doi.org/10.1891/0730-0832.32.5.369

Sultan, P., Habib, A. S., & Carvalho, B. (2017). Ambient operating room temperature: mother, baby or surgeon? British Journal of Anaesthesia, 119(4), 839. https://doi.org/10.1093/bja/aex307

Uduwana, S. R., & Nemerofsky, S. L. (2021). A Questionnaire Assessing Utilization of Delayed Cord Clamping. American Journal of Perinatology. https://doi.org/10.1055/s-0041-1731047

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