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Pregnancy

The Deal with Delayed Cord Clamping

Written By
Jessalyn Ballerano
Certified Childbirth Educator & Doula

Planning for your newborn’s arrival you may have encountered “DCC." Learn about this beneficial practice to incorporate into your birth planning preferences or discuss further with your prenatal health care provider.

Thinking about delayed cord clamping for your baby’s birth? Read on to learn about what this practice is, why it could be beneficial to your baby, and other considerations for your birth planning.

  • What is delayed cord clamping?
  • What are the benefits of delayed cord clamping?
  • Are there any reasons not to delay cord clamping?
  • How can I get delayed cord clamping at my baby’s birth?

What is delayed cord clamping?

Also referred to as “DCC,” delayed cord clamping is a recommended practice internationally, with clear benefits for newborn babies. However, DCC is often confused with other practices or misunderstood, so read on for a clear understanding of what it is and is not.

Uninterrupted biology

More so than a procedure, it may be helpful to think of delayed cord clamping as a delayed procedure, because it is actually a practice that protects the normal physiology of the immediate postpartum process between a newborn and the person who gave birth to them.

During pregnancy, a baby receives all its nutrients and oxygenated blood through the umbilical cord at its naval, which delivers healthy blood that has been filtered from the parent’s system through the placenta. Deoxygenated blood and waste products are also sent back from the baby to the placenta and then processed safely in the parent’s system. 

The umbilical cord has a rubbery protective outer layer and blood vessels running its length that support this transfer of blood to and from the fetus and the pregnant parent - in this way the cord and placenta serve as the baby’s “equipment” for circulation, nourishment and elimination before they are born.

When a typical healthy human - or really any mammal - gives birth, after the baby is born, the placenta and cord are also delivered, as they are no longer needed to sustain the pregnancy. Some of the baby’s blood supply will be in the placenta at the time of delivery - the umbilical cord, however, will continue to pulse and bring that healthy blood back to the baby’s body within minutes. It is estimated that up to as much as 80-100mL of blood is transfused to the baby in this window.

Once the placenta has transferred most of that blood supply back to the baby’s system, the umbilical cord eventually stops pulsing and turns from a full, engorged purple-colored cord of vessels to a nearly-white, thin limp and inactive cord. This usually takes anywhere from a few minutes to a half hour or so.

DCC in practice

Through most of human history, an umbilical cord would be left alone unless there was a medical problem that required action. In more recent medical history, it became common practice to clamp the umbilical cord immediately after birth at the baby’s navel, and then cut the cord between the clamp and the placenta. This was partially due to an inaccurate belief that the maternal parent was losing blood as the cord continued to pulse - we now know that DCC does not pose any risk to a healthy postpartum mother.

In the United States, the main organization of physicians in maternal health - the American College of Obstetricians and Gynecologists - considers cord clamping “delayed” when it occurs 30-60 seconds after birth. The World Health Organization considers DCC to be after 1-3 minutes, and worldwide, many midwifery practitioners wait for 3-15 minutes or longer. 

Culturally, some people practice something called a “Lotus birth”, which refers to leaving the cord and placenta intact and attached to the baby until the cord comes off of the baby’s navel on it’s own. The placenta is kept on ice until this occurs, which is usually in the first week or so postpartum. This is a distinct and separate practice from delayed cord clamping for which benefits and safety has not been extensively studied.

Pro tip: Ask your provider what DCC means to them and their practice. Also note that the umbilical cord is a sensitive tissue with a specific function that can be interrupted with handling. You may specify a request that your umbilical cord is allowed to pulse “until it turns limp and stops pulsing on it’s own without manipulation.” 

What are the benefits of delayed cord clamping?

The benefits of delayed cord clamping cannot be understated. DCC can support both full-term and preterm infant health and is recommended as a major step improving infant health outcomes. Below are some benefits of DCC for babies of all ages.

Since the umbilical cord carries healthy nutrients and essential oxygenated blood to the fetus during pregnancy, it’s ability to deliver the remainder of that blood supply to the newborn is essential for health factors related to blood health. DCC facilitates this transfer and is considered an evidence-based practice for these important benefits:

Benefits for full-term babies

  • Decreasing the risk of infant anemia. For the first several months of life, babies benefit from the increased blood volume and iron stores of the full red blood cell volume that comes with DCC. Infants don’t even make their own iron at first, and it is one of the nutrients that is harder to transfer through breast milk, so this early blood supply and iron level is essential.
  • Boosting stem cell supply. Humans are born with a finite number of stem cells - valuable cells that can be specialized to become any kind of cell the body could possibly need. Some of these stem cells are in the umbilical cord and transferred to their rightful “owner” - the baby! - through the cord blood they receive with DCC.

Benefits for preterm babies and resuscitation

  • Same benefits as above, but even more so for preterm babies who rely on their blood health and stem cells even more than newborns do to continue developing and recovering robustly enough to stabilize and go home.
  • Increasing oxygenation and survival rates. A preterm newborn may need resuscitation, but not always immediately, and the additional time attached to the placenta with DCC may either help a baby receive enough oxygen while they begin to breathe on their own or while resuscitation efforts begin.
  • A reduction of 29% in the rate of preterm infant sepsis (infaction).
  • New research on the benefits of DCC continues, including the reduction of brain bleeding in very premature infants, and improved brain development.

Are there any reasons not to delay cord clamping?

Occasionally, if immediate care is needed for a newborn or their parent, delayed cord clamping may not be available. Otherwise, practitioners should be prepared to offer DCC as a healthy preventative measure for newborn health. Misinformation and cultural perceptions may suggest that delayed cord clamping is dangerous, but most of this is based in a misunderstanding of the science. Here we break down some of the reasons people used to decline DCC and potential reasons it may not be a good fit for your planning.

Myth: Gravity and blood flow

It used to be thought that a newborn had to be held “at placenta level” to receive the blood transfusion benefits of delayed cord clamping. This is not true, however, and we now understand that a baby can be placed at their parents chest or abdomen, skin-to-skin for bonding and recovery, and still receive the benefits of delayed cord clamping by the mechanism of the placenta and the arteries and veins that run through the umbilical cord.

Maybe: DCC & cord blood banking

Some families are interested in “banking” their baby’s cord blood, either for scientific research, to donate the stem cells, or to save the stem cells in the rare chance that their baby would need stem cell treatment for a specific condition or disease.

Generally, the benefits of DCC are thought to outweigh the possibility of needing stem cells for a rare disease in the future, but it may be possible to use both DCC and bank some cord blood. There may be limitations on how much cord blood can be kept if DCC is used, and whether both procedures can be done effectively may depend on the lab facility. Some will have the technology to make use of any blood leftover in the cord and placenta, while other labs do not have that capacity. Ask about your option ahead of time to avoid disappointment and make an informed decision about which practice is more important if you have to choose one.

Misconception: DCC & Jaundice

Jaundice is part of a normal physiologic process that occurs in many newborns, but can require treatment if it is severe or related to other health issues. It is the buildup of a yellow substance called bilirubin, a natural product that results from the breakdown of old red blood cells in the body. It results in yellowing of the skin and eyes. 

Usually, our liver filters bilirubin out of the blood and it is eliminated in the bowels, but if a newborn baby is very young, or had some bruising during birth (and therefore extra red blood cells), or has a hard time breastfeeding or eliminating, they may have an increased risk of jaundice.

Since delayed cord clamping does increase the amount of red blood cells in a baby’s body by transferring a greater blood supply to them after birth, some babies who receive DCC will also have signs of jaundice at higher rates. However, all babies are monitored for normal and problematic jaundice and it is usually minor and easily treatable, and so despite this possible outcome, the benefits of DCC are still considered great enough to outweigh the moderate risk of jaundice.

How can I get delayed cord clamping at my baby’s birth?

Would you like to incorporate delayed cord clamping into your birth planning? Here are a few tips on how to get DCC for your baby.

  • Discuss delayed cord clamping ahead of time with the health care providers you expect to deliver your baby with. Ask them for specifics on their timing and instances in which they would not be able to do DCC.
  • Write it in your birth plan! Ask for “Delayed cord clamping of at least 1-3 minutes” or be specific about your preference to “let the umbilical cord pulse until it stops spontaneously without handling or manipulation,” by medical staff.
  • If you are anticipating or planning a delivery by Cesarean section, you may still be able to request DCC. although provider technique and experience may be a factor.
  • Let your preferences be known so that your support people can help you advocate during labor and delivery. Helping your partner or primary support person to understand your birth plan and working with a doula are great ways to support your vision and needs.

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Selected Sources

Jessalyn Ballerano
Certified Childbirth Educator & Doula
Jessalyn (she/her) is a Childbirth Educator and Doula serving families in the San Francisco Bay Area, nationwide, and in her new home of Eugene, Oregon. She started studying birth in 2010 as an anthropologist, and often brings a systemic approach to helping birthing people to understand their options, experiences and possibilities. She integrates evidence-based training and research with a holistic mindset and an activist’s passion for reproductive empowerment. Jessalyn serves on the board for the Oakland Better Birth Foundation, where birthworkers, birthing people, and care providers work together to end preventable maternal and infant mortality and address racial disparities in health care. Jessalyn is a CAPPA-Certified Childbirth Educator, SMC Full-Circle Doula.
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