It’s something of a ritual: the cutting of the umbilical cord. Often the father or other family member or someone attending the birth is allowed to cut the cord attaching mother and baby, completing the baby’s birth.
Turns out, it matters when and how the cord is cut. In the womb, the baby’s blood supply is found both in her own body and in the umbilical cord and placenta. After delivery, blood continues to flow from the placenta and cord to the baby for a brief period of time. Traditionally, the cord has been clamped immediately after delivery. However, if it is left unclamped for a brief period of time, the baby receives more blood from the placenta. This increases the amount of iron the baby has and helps prevent anemia. Some delay cord clamping until the cord stops pulsating; others delay it for a set time period. Other techniques have included holding the baby lower than the mother to allow gravity to increase blood flow to the baby.
Premature babies are at much higher risk of anemia, since babies store up a lot of iron in the last few weeks of a term pregnancy. The first research studies showed that premature babies benefited from delayed cord clamping and
Some concern about side effects, primarily jaundice. Also polycythemia, which is too many red blood cells which can cause the blood to be too thick. Systematic review of published studies 2013 some increased phototherapy though guidelines were inconsistent, no increase in polycythemia.
OB GYN congress recommendation, AAP?
ACOG 2012, reaffirmed 2014, insufficient evidence except preterm babies, AAP endorsed the ACOG recommendation. In 2017, changed recommendation to all babies, new evidence of benefits for term babies, and small risk of jaundice in the baby and hemorrhage in the mother.
Delayed umbilical cord clamping after birth. Committee Opinion No. 684. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;129:e5–10. Reaffirmed in 2018.
https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Delayed-Umbilical-Cord-Clamping-After-Birth
References
Andersson O et al. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: A randomised controlled trial. BMJ 2011 Nov 15; 343:d7157. (http://dx.doi.org/10.1136/bmj.d7157)
McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD004074. DOI: 10.1002/14651858.CD004074.pub3 http://www.cochrane.org/CD004074/PREG_effect-timing-umbilical-cord-clamping-term-infants-mother-and-baby-outcomes
Palethorpe RJ, Farrar D, Duley L. Alternative positions for the baby at birth before clamping the umbilical cord. Cochrane Database of Systematic Reviews 2010, Issue 10. Art. No.: CD007555. DOI: 10.1002/14651858.CD007555.pub2 http://www.cochrane.org/CD007555/PREG_alternative-positions-for-the-baby-immediately-at-birth-before-clamping-the-umbilical-cord
Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD003248. DOI: 10.1002/14651858.CD003248.pub3 http://www.cochrane.org/CD003248/PREG_early-cord-clamping-versus-delayed-cord-clamping-or-cord-milking-for-preterm-babies
Andersson O, Lindquist B, Lindgren M, Stjernqvist K, Domellöf M, Hellström-Westas L. Effect of Delayed Cord Clamping on Neurodevelopment at 4 Years of Age: A Randomized Clinical Trial. JAMA Pediatr. 2015;169(7):631-638. doi:10.1001/jamapediatrics.2015.0358.
Vain NE et al. Effect of gravity on volume of placental transfusion: A multicentre, randomised, non-inferiority trial. Lancet 2014;384(9939):235-240. http://dx.doi.org/10.1016/S0140-6736(14)60197-5
Timing of umbilical cord clamping after birth. Committee Opinion No. 543. American College of Obstetricians and Gynecologists. Obstet Gynecol 2012;120:1522–6. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Timing-of-Umbilical-Cord-Clamping-After-Birth
