New Delayed Umbilical Cord Clamping Guidelines Released

The American College of Obstetricians and Gynecologists recently released new guidelines regarding when a baby’s umbilical cord should be cut in singleton pregnancies- a significant development, as they now officially support waiting at least 30-60 seconds before cutting the cord in vigorous term and preterm infants.

Why Is Delayed Cord Clamping Beneficial?

For a short while after birth, the placenta is still pumping some oxygen-rich blood to the baby. Waiting to clamp the umbilical cord can allow additional blood from the placenta to perfuse into the baby’s systems. In turn, this can increase blood volume and iron levels, which are important for normal development. Iron deficiency during infancy and childhood is linked to potentially irreversible cognitive/motor/behavioral developmental deficits.

When Is Delayed Cord Clamping Beneficial?

According to ACOG Committee Opinion #543,

  • “In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes.”
  • “Delayed umbilical cord clamping is associated with significant neonatal benefits in preterm infants, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage.”

Specifically, in term infants, immediate cord clamping was associated with lower hemoglobin concentrations at birth and a greater risk if iron deficiency. In preterm infants, delayed cord clamping was associated with a decreased need for transfusions to alleviate anemia, lower rates of intraventricular hemorrhage (IVH), and lower rates of necrotizing enterocolitis (NEC).

It’s important to note that there is a slightly higher risk that babies who’ve had delayed cord clamping will develop jaundice that requires phototherapy to treat. This therapy involves the baby being placed under special purple lights (informally called ‘bili lights’) to help their bodies get rid of excess bilirubin that otherwise might cause brain damage. Generally, when properly monitored and treated, jaundice does not cause any lasting negative effects.

When Is Immediate Cord Clamping More Appropriate?

Of course, the delayed cord clamping recommendation doesn’t apply to all pregnancies. In some situations, immediate cord clamping may be needed to ensure that the health of the mother and baby are maintained:

  • If a baby needs resuscitation (which is more likely in preterm babies).
  • If placental circulation is compromised (such as in the presence of abnormal placentation, placental abruption, or umbilical cord avulsion)
  • If the mother has hemodynamic instability

Are There Situations Where the Benefits and Risks Between Delayed or Immediate Clamping Aren’t Clear?

Yes. In some situations, research hasn’t been done into the relative risks and benefits of immediate vs. delayed clamping, and the decision or immediately clamp the cord or wait is left up to the neonatal care provider to individualize. This can happen when:

  • A baby is born with fetal growth restriction (IUGR) with abnormal umbilical artery Doppler studies
  • Care providers suspect that uteroplacental perfusion or umbilical cord blood flow is compromised

Does Delayed Cord Clamping Have a Health Impact on the Mother?

Traditionally, one of the fears that practitioners had was that delayed cord clamping would increase the risk that mothers would have postpartum hemorrhage, which could potentially be damaging to the mother’s health. However, research has found that (in most pregnancies) delayed cord clamping was not associated with increased hemorrhage risk, increased blood loss at delivery and that it had no impact on postpartum hemoglobin levels or the need for blood transfusion.

In situations where underlying conditions already predispose a mother towards hemorrhage (such as placenta previa or placental abruption), however, delayed cord clamping’s benefits must be balanced with the need to make sure the mother’s blood levels are stable.

What About Twins, Triplets, and Multiples?

Many clinical trials don’t take into account pregnancies with multiple gestations, so it is harder to establish whether delayed cording clamping will be as beneficial to multiples as to single babies. Theoretically, because multiples increase the risk of preterm birth, delayed cord clamping could be beneficial, but there are some theoretical risks for problematic hemodynamic changes in multiples, especially if they share the same amniotic sac.

Disclaimer: The research upon which Committee Opinions are based continue to evolve and is subject to change. These documents are meant as educational materials and should not be interpreted as dictating specific courses of treatment or specific procedures.

Disclaimer: This page is intended solely as an educational tool for parents. It is not intended as – and should not be mistaken for – medical advice. If you have any medical concerns about your the timing of cord clamping, please speak to a medical professional.

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