From the Guidelines
Delayed cord clamping for at least 1 minute at a term delivery and at least 30 seconds at a preterm delivery is recommended. To implement this:
- After the baby is born, place them on the mother's abdomen or chest.
- Wait at least 60 seconds for term deliveries and at least 30 seconds for preterm deliveries before clamping the cord, as recommended by the American Journal of Obstetrics and Gynecology 1.
- During this time, ensure the baby is breathing well and doesn't require immediate resuscitation.
- After the delay, clamp the cord in two places about 2-3 inches apart, and cut between the clamps. This practice allows for continued blood flow from the placenta to the newborn, which provides several benefits:
- Increased blood volume for the baby
- Higher iron stores, reducing the risk of iron deficiency anemia in the first 6 months of life
- Improved transitional circulation
- Better establishment of red blood cell volume For preterm infants, the benefits may be even greater, including reduced need for blood transfusions and lower risk of intraventricular hemorrhage, as supported by the guidelines for intraoperative care in cesarean delivery: enhanced recovery after surgery society recommendations (part 2) 1. In cases where immediate resuscitation is needed, prioritize the baby's immediate health needs over delayed cord clamping. Key considerations include maintaining the baby's body temperature between 36.5°C and 37.5°C after birth, and avoiding routine suctioning of the airway or gastric aspiration unless necessary for symptoms of an obstructive airway 1.
From the Research
Benefits of Delayed Cord Clamping (DCC)
- Delayed cord clamping (DCC) increases the blood volume and hemoglobin levels in newborns and reduces the risk of iron deficiency anemia in both term and preterm infants 2.
- DCC is associated with significant neonatal benefits, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage in preterm infants 3, 4, 5.
- In term infants, DCC increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes 3, 4, 5.
Recommended Duration for DCC
- The American College of Obstetricians and Gynecologists recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30-60 seconds after birth 3, 4, 5.
- A study found that delayed cord clamping at 120 seconds compared to 30 seconds resulted in significantly higher stroke volume and cardiac output in full-term infants, which continued for the first 24 hours of life 6.
Considerations for DCC
- There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing DCC, and mechanisms should be in place to monitor and treat neonatal jaundice 3, 4, 5.
- DCC was not associated with an increased risk of postpartum hemorrhage or increased blood loss at delivery, nor was it associated with a difference in postpartum hemoglobin levels or the need for blood transfusion 3, 4, 5.