When is the right time to cut the newborn umbilical cord?
When I was growing up, as a young keenly-interested-in-everything girl in Tasmania, I remember listening in to my mother and grandmother as they chatted about and debriefed the births they had attended in their roles as support women to birthing mums. One of the topics that I remember them discussing was “umbilical cord clamping”. The umbilical cord is the flexible rope-like structure containing blood vessels that connects the placenta to the baby. When I was born forty four years ago, delivered at home in a candle-lit setting by my dad and grandma, my cord was not clamped until it had stopped pulsating, it was not in line with the medical practice of the day which was immediate cord clamping but my parents had read extensively and were following age old practice in the hope that I’d get the very last of the goodies stored up in my placenta. My young mum wanted my dad to be present at my birth but was told by the hospital he couldn’t be there, another sad custom of the day, so they decided on a home birth. My dad found old text books on birth and read them cover to cover in the apple orchard on his lunch break while he picked fruit in the Huon Valley. It was there that he read about waiting for the cord to stop pulsating and he and my grandma trusted this ancient knowledge.
The debate about when to cut the umbilical cord has been wrangled for more than 2000 years. More recently, in the 1960s, there were concerns relating to mother and baby outcomes which saw the practice of immediate or early cord clamping. This became standard care. Immediate cord clamping meant it was normal for the umbilical cord to be clamped and cut within ten seconds of birthing because it was thought that delay could cause jaundice among other things. Immediate cord clamping is no longer recommended unless the newborn is having trouble adjusting to it’s new world and needs a little help in breathing. In this case, it is best to cut the cord and get the little one some resuscitation help.
The placenta and umbilical cord are part of the amazing life support system that grows and nourishes the baby for its entire time in the womb. The placenta is incredible, it grows as a whole new organ to nourish the baby during pregnancy by delivering blood rich in oxygen and nutrients via the umbilical cord to the growing fetus and removes waste products from the baby’s blood. After the baby has been birthed, some might assume that the placenta and umbilical cord are now obsolete. But this isn’t true, they have one final role that is very important.
When the baby is born, around two thirds of the volume of blood is in the baby’s body and the remaining third is held in the placenta, outside of its body but connected by the umbilical cord. The cord pumps and pulses and pushes the last 30% of blood into the baby. The baby gets white blood cells to fight infection and antibodies and stem cells to help repair tissues. This extra blood at birth helps the baby to cope better with the transition from life in the womb, where everything is provided by the placenta, to the outside world. The babies lungs get more blood so that the exchange of oxygen into the blood can take place smoothly. Increased iron storage reduces the risk of the baby suffering from the severe side effects associated with iron deficiency. Iron is also essential for healthy brain development. This nutrient rich blood will quickly make its way to the baby via the umbilical cord but only if it is left to do so. Half of the extra blood is transfused into the baby after one minute and by three minutes more than 90% of the transfusion is complete. It definitely makes sense to delay the clamp to allow this transfer to occur to give baby the best possible start.
In a normal vaginal birth, once the baby has been delivered, the mother begins the third stage of labour which happens either physiologically (waiting for the placenta to come out naturally with no help) or, an active third stage (when the midwife gives some help by an injection to help birth the placenta). Whichever option you plan for, or end up having, delayed cord clamping is still an option.
Delayed or deferred cord clamping (DCC) is the name typically given to the practice of waiting before clamping. It is usually completed one to five minutes after giving birth. It is recommended for all babies and particularly premature infants, by many well regarded international bodies including The World Health Organisation, American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynecologists and National Institute for Health and Care Excellence.
I’ve only recently heard of the term Optimal cord clamping (OCC) but it sounds a lot like the practice my dad read about and my mum and grandma were talking about. The difference in the terms ‘delayed’ cord clamping and ‘optimal’ cord clamping can sound confusing but let’s put it this way. In “delayed cord clamping” the umbilical cord is left for a minute up to about five minutes before clamping and cutting. In “optimal cord clamping” the cord is left until it stops pulsing and there is no set time for this, some cords are faster than others. The process is complete when the cord stops pulsing and is “white” in colour which can take up to an hour, after which the umbilical cord vessels will have closed naturally. Optimal cord clamping has considerable advantages for the newborn. It allows all of the baby's circulating iron, oxygen carrying haemoglobin and stem cell rich blood to move from the placenta to the baby. Professionals agree that delayed cord clamping is still a valid option after a Caesarean Section in theatre and most hospitals have guidelines in place to permit it.
It’s a lovely thing that while all this nutrient goodness is transferring over to the baby, the mother is able to keep her baby attached, skin against skin, while the baby learns to takes its first breaths using their newly inflated lungs. While the midwife does all they need to do, the newborn stays close and bonds and begins outside life gently without the startle of a sudden clamp and a gasp for breath. What a beautiful, precious, life-altering moment in time!
In the image on the left is a cord that is still transferring blood, it looks like a large vein. On the right is a “white” cord which has finished pulsating and has transferred all the blood. Sometimes people ask for ‘wait for white’ when writing their birth plans which means they would like optimal cord clamping. International guidelines state that medical providers should delay the clamping of the cord, but sadly this does not always happen. Do be clear in your birth plan that you would like this to happen, let your birth partner and your doula know too.
Many parents are becoming aware of the practice of umbilical cord blood banking which is a recent discovery. In Australia there are two options for cord blood banking; either donate to a public cord blood bank where the collected blood stem cells will be made available to any patient in Australia needing them or private storage of your baby’s cord stem cells for future possible use by your baby or a family member. It is not possible to do both delayed cord clamping and umbilical cord blood collection as the cord must be clamped early to capture the most stem cells.
Natures intention was that the placenta nourishes the baby and gives it the best start at life possible, why not let the placenta give the baby the very last of this goodness via optimal cord clamping?
Benefits of Optimal Cord Clamping
Baby continues to receive oxygenated blood until breathing is established and this has been shown to reduce the chances of any breathing difficulties (particularly in preterm infants).
The baby receives an extra 30% of blood from the placenta which can lower the risk of anaemia or compromised heart function.
The risk of late onset sepsis is reduced
The need for a blood transfusion in preterm babies is reduced
There is a reduced chance of Mum having a retained placenta (where the cervix closes before the placenta has been born).
The iron in the placental blood increases the newborn baby’s iron storage, which is vital for healthy brain development and there is less chance of anaemia if you wait to clamp
Your baby can gain up to 214 grams in the first five minutes following birth if the cord is left unclamped
Your baby will have a higher ratio of red blood cells
Delayed cord clamping also results in an infusion of stem cells, which play an essential role in the development of the immune, respiratory, cardiovascular, and central nervous systems, among many other functions.
The concentration of stem cells in fetal blood is higher than at any other time of life. ICC (immediate cord clamping) leaves nearly one-third of these critical cells in the placenta. Stem cells may also help to repair any brain damage the baby might have suffered during a difficult birth.
My name is Bonnie Walker and I live in the Byford Hills in Perth, Western Australia. I am a Birth Doula and Coach.
If you would like to talk more about your birthing options, please contact me
For further reading, see these links:
https://www.placentapractice.co.uk/blog/what-is-delayed-cord-clamping/
https://www.all4maternity.com/natures-first-stem-cell-transfer-occurs-at-birth/
https://www.tommys.org/pregnancy-information/labour-birth/delayed-cord-clamping-dcc
https://www.bellybelly.com.au/birth/delayed-cord-clamping-and-jaundice/
https://www.themothersprogram.ca/during-pregnancy/delayed-cord-clamping-dcc