Not only is delayed cord clamping one of the most common items on most birth plans generated by the Internet (obviously, the most reliable source for birth plans), but it is also one of the most common questions I get from my patients. Along with epidurals, episiotomies, and VBACs, I usually get a request daily to delay cord clamping as much as possible.
What does delayed cord clamping actually mean? Immediate clamping is clamping of the cord within 15 seconds of delivery of the baby. Delayed clamping is clamping of the cord between 25 seconds to 3-5 minutes. The purpose of this delay is to potentially increase baby's blood volume. The cord usually stops pulsating between 3-5 minutes. The risks and benefits of delayed cord clamping have been studied extensively and they are different for preterm and term infants.
Preterm Infants (baby that is born before 37 weeks gestation): Delayed clamping usually involves waiting between 25 seconds to 3 minutes in preterm infants. Studies have shown that delayed cord clamping in preterm infants has resulted in fewer blood transfusions, 50% reduction in intraventricular hemorrhage (brain bleeds which are common in preterm neonates) and necrotizing enterocolitis (NEC is a disease of the intestines of premature infants; the wall of the intestine is invaded by bacteria, which causes local infection and inflammation that can ultimately destroy the part of the intestine). Most NICU's have developed a protocol based on gestational age to determine how long to delay clamping and milking of the cord.
Term Infants (baby that is born at or after 37 weeks gestation): Studies in term infants have shown that an additional 80 mL transfer of blood occurs by one minute after birth. This can supply extra iron and result in a higher hemoglobin in term neonates that have undergone delayed cord clamping at birth and up to 3-6 months after birth. However, there appears to be some risks associated with delayed cord clamping in term infants. Several studies noted that there was an increased need for phototherapy for jaundice after birth among infants who underwent delayed cord clamping. Just what you wanted--your baby in a tanning booth :) In addition there is concern that infants that are born at high altitude (we are almost at 5000ft in Idaho Falls) have an increased risk of fetal polycythemia (excessive thickening of blood that can affect oxygen transport and transfer of nutrients) when delayed umbilical cord clamping is performed.
What does all this mean??? There are some clear benefits to delayed cord clamping for preterm neonates, and NICU protocols should be followed for preterm infants. However, for term infants while delayed cord clamping for 60 seconds may increase iron stores and hemoglobin levels, delayed clamping beyond 60 seconds (as many internet sites recommend until after the cord stops pulsating) may increase the risk of jaundice requiring phototherapy and polycythemia at high altitudes, which ultimately results in a longer hospital stay for your otherwise healthy baby.
When to avoid delayed cord clamping: If you plan on cord blood banking, you should avoid delayed clamping because it will reduce the volume of blood obtained, and if your baby requires immediate resuscitative efforts (extra help breathing/crying), then delayed cord clamping should be deferred.
Pam
What does delayed cord clamping actually mean? Immediate clamping is clamping of the cord within 15 seconds of delivery of the baby. Delayed clamping is clamping of the cord between 25 seconds to 3-5 minutes. The purpose of this delay is to potentially increase baby's blood volume. The cord usually stops pulsating between 3-5 minutes. The risks and benefits of delayed cord clamping have been studied extensively and they are different for preterm and term infants.
Preterm Infants (baby that is born before 37 weeks gestation): Delayed clamping usually involves waiting between 25 seconds to 3 minutes in preterm infants. Studies have shown that delayed cord clamping in preterm infants has resulted in fewer blood transfusions, 50% reduction in intraventricular hemorrhage (brain bleeds which are common in preterm neonates) and necrotizing enterocolitis (NEC is a disease of the intestines of premature infants; the wall of the intestine is invaded by bacteria, which causes local infection and inflammation that can ultimately destroy the part of the intestine). Most NICU's have developed a protocol based on gestational age to determine how long to delay clamping and milking of the cord.
Term Infants (baby that is born at or after 37 weeks gestation): Studies in term infants have shown that an additional 80 mL transfer of blood occurs by one minute after birth. This can supply extra iron and result in a higher hemoglobin in term neonates that have undergone delayed cord clamping at birth and up to 3-6 months after birth. However, there appears to be some risks associated with delayed cord clamping in term infants. Several studies noted that there was an increased need for phototherapy for jaundice after birth among infants who underwent delayed cord clamping. Just what you wanted--your baby in a tanning booth :) In addition there is concern that infants that are born at high altitude (we are almost at 5000ft in Idaho Falls) have an increased risk of fetal polycythemia (excessive thickening of blood that can affect oxygen transport and transfer of nutrients) when delayed umbilical cord clamping is performed.
What does all this mean??? There are some clear benefits to delayed cord clamping for preterm neonates, and NICU protocols should be followed for preterm infants. However, for term infants while delayed cord clamping for 60 seconds may increase iron stores and hemoglobin levels, delayed clamping beyond 60 seconds (as many internet sites recommend until after the cord stops pulsating) may increase the risk of jaundice requiring phototherapy and polycythemia at high altitudes, which ultimately results in a longer hospital stay for your otherwise healthy baby.
When to avoid delayed cord clamping: If you plan on cord blood banking, you should avoid delayed clamping because it will reduce the volume of blood obtained, and if your baby requires immediate resuscitative efforts (extra help breathing/crying), then delayed cord clamping should be deferred.
Pam
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