What is Cord Clamping?

Cord clamping is a where a baby’s umbilical cord is clamped and cut. Cord clamping might be done prior, during, immediately after or hours after birth, although usually takes place in the third stage of labour (for a vaginal delivery).

When cord severance is performed before physiological closure, a plastic clamp or ligature is applied to the remaining cord to prevent blood loss from the baby. The blood collected is often stored for future emergency use in a cord blood bank.

What is the Third Stage of Labour?

The ‘third stage of labour’ is described as the time from birth of the baby to the expulsion of the placenta and membranes. For the baby, this is the period when blood is distributed back to the baby.

Active management of the third stage of labour is designed to speed up the delivery of the placenta and minimise maternal blood loss (but studies vary, with some identifying less bleeding while others found increased risk of hemorrhage linked to active management in low risk women). Active management can involve cord clamping, administration of uterotonic drugs, cord traction and uterine massage.

Immediate clamping used to be recommended as part of routine active management – however international and some national guidelines on active management now advise to defer cord clamping  for approximately 3 minutes (or until cord pulsations cease/ cord collapses).

What is Immediate Cord Clamping?

Immediate cord clamping occurs within the first 30 seconds after birth. The cord might be clamped with the birth of the shoulders or immediately afterwards. Immediate or early cord clamping disrupts normal physiology, anatomy and the birth process.

Researchers claim the practice of immediate and early cord clamping developed without adequate evidence or regard for the baby and the profound physiological changes that occur at birth.

What is Delayed Cord Clamping?

Delayed cord clamping is the practice of waiting to clamp the umbilical cord at birth, usually until the cord has stopped pulsating.

What are the Benefits of Delayed Clamping?

The benefits of physiological cord closure or delayed clamping for the baby include a normal, healthy blood volume for the transition to life outside the womb; and a full count of red blood cells, stem cells and immune cells.

For the mother, an avoidance or delay in cord clamping keeps the mother-baby unit intact and can prevent complications with delivering the placenta.

Studies show delayed cord clamping produces increased vasodilation and perfusion: higher blood pressure, higher hematocrit levels, more optimal oxygen transport and higher red blood cell flow to vital organs, reduced infant anaemia and increased duration of breastfeeding. For preterm infants, the benefits also included fewer days on oxygen and ventilation, fewer transfusions, and lower rates of intraventricular hemorrhage and late-onset sepsis.

How to Delay Cord Clamping

In normal birth, delayed clamping is achieved by leaving the umbilical cord intact during the placental transfusion and not clamping until the cord has stopped pulsating.

Once the baby has begun to breathe and achieved a normal circulating blood volume, the cord ceases to pulse and closes naturally (physiological cord closure, cord appears thinner, white and flaccid). It can take around 3 to 7 minutes for a baby to transition and to establish a physiological blood volume, but this process can take longer for some babies.

In surgical deliveries (caesarean section), a ‘delay’ in clamping can be achieved (except in cases where there is incision or damage to the placenta). The baby can be held below the level of the placenta to assist with the transfer of blood from the placenta to the baby. Some practitioners may choose to “milk” the blood in the cord towards the baby and/or wait 40 seconds or more before clamping. With a ‘lotus’ caesarean section the placenta may remain attached to the baby, without clamping the cord.

The World Health Organisation states the “optimal time to clamp the umbilical cord for all infants regardless of gestational age or fetal weight is when the circulation in the cord has ceased, and the cord is flat and pulseless (approximately 3 minutes or more after birth).”

For more on the blood distribution and the benefits of delayed cord clamping watch this video

Delayed Cord Clamping explained by Penny Simkin

This article is summarised from resources found on CordClamping.com. For additional resources on delayed cord clamping please visit http://cord-clamping.com/