Delayed Cord Clamping, How long should I wait?

In recent years there has been a lot of talk about delayed cord clamping, with even some women opting to deliver the placenta while it is still attached to their new born. But the question still remains, how much time is enough time? And is there such a thing as too much time?

Delayed Cord Clamping is a birth practice where the umbilical cord is not cut immediately after birth. Instead, the attending physician will wait for the pulsations to end or for the placenta to be delivered before cutting the cord. This is often done while the newborn is positioned safely below the level of the placenta.

After delivery the placenta still continues to perform its gas exchange function which can prove to be beneficial to pre-term and sickly babies. In addition, according to the American College of Obstetricians and Gynecologists delayed cord clamping increases the volume of blood in new borns by 80ml, 1 minute after birth and 100ml 3 minutes after birth which leads to an increase in the level of iron in new borns by 40 – 50 mg/kg of body weight. This increase in body iron could help prevent iron deficiencies anemia during the first year of life. It is also believed to decrease the incidences of intracranial hemorrhage in preterm infants.

However, the question still remains, how much time is sufficient enough time to hold off on cord clamping? The World Health Organization advocates for a delay in cord clamping of no less than 1 minute unless a term or pre-term new born requires positive pressure ventilation. On the other hand, The American College of Obstetricians and Gynecologists advocate for 30 – 60 seconds of delayed cord clamping. With the varying suggestions on sufficient time required before cord clamping, the fact still remains that there is still not enough research to effectively dictate the most efficient time required to lapse before cord clamping.

One might be tempted to assume that the longer you wait the better; which raises the question: Is there a risk to delayed cord clamping? The answer is yes. According to the American College of Obstetricians and Gynecologists delayed cord clamping could delay timely resuscitation which might be necessary in some pre-term new borns. It could also cause neonatal polycythemia, which is when there is an abnormally high level of red blood cells in a new born. This is especially likely for mothers who are diabetic, have severe intrauterine growth or live in a high altitude area. In addition, delayed cord clamping could also interfere with the gathering of cord blood for families looking to store this; however the importance of this and its practice in Kenya is a discussion for another day.

That being said, having all this information on delayed cord clamping from various organizations sounds really good in theory but is it really practical? I therefore, spoke to Dr. John N Mutsumi a consultant gynecologist in Malindi who was able to give a more realistic view to the issue of delayed cord clamping. He mentions that once a baby is born the first priority of the attending physician is to ensure that the baby is healthy. Therefore, their first instinct will be to cut the cord and immediately begin making the necessary checks to ensure that the baby is not in distress, the baby is breathing fine and is warm among other things. Should the baby require any medical intervention like a glucose solution then this is best administered through the umbilical cord which will be difficult should this cord still be attached to the placenta.

This therefore raises the question on the practicality of sitting down and counting the minutes at the risk of missing out on an important health issue. Not to mention that the position required for delayed cord clamping might not always be feasible.

Therefore, one might be tempted to ask, should delayed cord clamping become a common practice in hospitals? Overall there seems to be insufficient evidence to refute or support the practice. My suggestion would be to discuss this with your gynecologist or obstetrician to find out what will work best for you and your new born child.

However, do let us know what your views are on delayed cord clamping or if you have practiced delayed cord clamping by leaving a comment below.