Recommendations for Delayed Cord Clamping

Umbilical chord.
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In 2016 the American Academy of Pediatrics released new guidelines for doctors and other medical professionals about the importance of delayed cord clamping for newborns. In a new recommendation that is also endorsed by the American College of Obstetricians and Gynecologists, the AAP issued a statement that is a little different than their previous recommendations for cord clamping.

Older guidelines recommended that all premature infants should practice delayed cord clamping, but said that the jury was still out if routine delayed cord clamping could benefit all babies.

Now, the jury has spoken and has recommended delayed cord clamping for all babies, both premature and term.

Delayed Cord Clamping

If you're wondering what on earth delayed cord clamping is, don't worry—it's actually a very simple practice. Traditionally, when a baby has been born, a doctor or midwife would immediately clamp the baby's umbilical cord somewhere along the cord, while the placenta is still inside the mother. This stops the blood flow from the placenta to the baby.

The doctor would then place another clamp a little higher than the first clamp and the doctor or partner would do the ceremonial "cutting of the cord" that officially releases a baby from its mother. The whole process generally takes less than 30 seconds.

With delayed cord clamping, however, the cord is not immediately clamped off. Instead, the doctor allows the blood to continue flowing through the cord into the baby's circulation from the placenta.

He or she may watch until the cord stops pulsating, signifying that the placenta's blood flow has stopped on its own, or wait a certain amount of time, such as sixty seconds, before clamping the cord.

The Benefits of Cord Clamping

The AAP and ACOG have found conclusive evidence that delayed cord clamping has benefits for all babies.

For babies who are born full-term (after 37 weeks), they found the following benefits:

  • Increased hemoglobin (red blood cells) levels at birth
  • Improved iron store in the baby's system throughout the first several months of life, which is linked to positive developmental milestones such as behavioral, motor, and cognitive ability. 
  • Improved transfer of immune cells from mother to baby

For infants who are born prematurely (below 37 weeks), the benefits of delayed cord clamping are even more significant. The benefits include:

  • Lower rates of brain hemorrhage
  • Better circulation 
  • Better blood volume levels 
  • Lower rates of necrotizing enterocolitis, a dangerous disorder in the intestines and stomach 
  • Lower rates of blood transfusion 

New Recommendations

To reap the benefits of delayed cord clamping, the AAP is recommending that all doctors and those who deliver babies wait for at least 30 to 60 seconds after a baby is born before clamping the cord. The exact time recommendation is left up to the discretion of the doctor and may vary from hospital to hospital. The British College of Obstetricians, for example, recommends routinely delayed cord clamping for at least two minutes.

What You Can Do

Talk to your doctor about his or her practices for delayed cord clamping and whether or not he/she plans to follow the new recommendations.

If your doctor is unaware of the practice, share the latest research with him or her and be sure that you and your doctor are on the same page with what is best for your baby.

You should also know that there has been some association with increased rates of jaundice for term infants who have delayed cord clamping, because it increased their red blood cell volume. When red blood cells break down after birth, they release bilirubin, which causes jaundice. In many cases, the jaundice is not harmful, but you should be aware of the signs and symptoms of jaundice, which include yellowing of the skin or eyes and a change in your baby's behavior, such as increased sleepiness or a reluctance to eat.

Sources:

American College of Obstetricians and Gynecologists. (2017, Jan.) Committee opinion: Delayed cord clamping. Retrieved from http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Delayed-Umbilical-Cord-Clamping-After-Birth

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