Cord clamping is a surgical birth intervention where a baby’s umbilical cord is clamped and cut. This procedure clamps off the baby’s arteries and vein contained within the cord, which can immediately halt circulation depending on when the clamps are applied.
Cord clamping might be done prior, during, immediately after or hours after birth – however it is not yet routine to record the timing of cord clamping in formal birth records.
When cord severance is performed before physiological closure, a plastic clamp or ligature is also applied to the remaining cord to prevent blood loss from the baby.
Delayed cord clamping is the practice of waiting to clamp the umbilical cord compared to immediately clamping at birth. Optimal cord clamping does not occur before the baby has transitioned to full independence from the placenta and the circulation in the umbilical cord has ceased. Timing can vary from 3-5 mins or not until the placenta has delivered.
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 terminates normal physiology, anatomy and 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.
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.
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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).”
All parents should be informed about cord clamping and discuss their preferences with their clinical care provider/s.
When choosing a health care provider/ organisation, be aware there may be a degree of “implied consent” to their standard practice of care (check your country/state consumer medical rights). Parents need to be aware what their standard practice is – and the ‘management’ of the third stage and umbilical cord at birth should be discussed in detail. (There are many ‘standard’ practices that can result in immediate clamping, such as ‘active management’, surgical intervention, responses to a baby’s condition at birth, and collecting ‘cord blood’ for testing or banking.)
Parents can then make informed decisions and give verbal and written instruction if they choose informed refusal of immediate or early cord clamping, (including immediate clamping to relocate the infant for observation/ suction/ warming). For a discussion on cord clamping and the compromised infant, click here.
Parents wishing to delay cord clamping may need to state verbally and in writing their refusal to consent to early cord clamping.
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 and the fetal to neonatal transition takes place. For the mother, a successful third stage involves a physiological blood loss (without hemorrhage).
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).