Are you planning your perfect home birth and found yourself wondering about delayed cord clamping? If so, you are not alone. Since the practice isn’t as common knowledge as it should be, there are a lot of questions surrounding it. So, what exactly is delayed cord clamping, and is it even necessary?
Delayed cord clamping is exactly how it sounds, a delay in umbilical cord clamping. It can make a huge difference in your baby’s health. As with anything it has its share of benefits and risks. A direct result of delayed cord clamping is increased Red Blood Cells and neonatal blood volume which result in a plethora of benefits for both preterm and full-term babies alike.
What is Delayed Cord Clamping and why is it important during a home birth?
Delayed Cord Clamping (DCC) is a delay in umbilical cord clamping from the time of birth. During DCC, the cord is normally clamped between 1 and 5 minutes after birth. In fact, most midwives suggest waiting until the cord quits pumping for maximum benefits.
Not only is DCC important for all home births but every birth no matter the setting. It allows placental transfusion to take place which is the transfer of placental blood to the infant. Can you believe that this simple process provides enough iron reserves for the first 6-8 months of life?
You will be amazed at just how beneficial these 5 short minutes are for your baby at the time of cord clamping and in the future! Waiting to clamp the cord instead of doing it immediately after birth allows more blood flow to the baby which increases blood volume by up to one-third. (Source). This is the main benefit that also brings on many other positive short- and long-term effects.
Why isn’t it more common?
I have asked myself this question many times, “why wouldn’t my Doctor tell me I had a choice on something that could potentially improve my child’s health and development?”
The sad truth is, doctors are more concerned with getting the job done. Doctors in a hospital setting are usually extremely busy so any delay is an inconvenience for them. If you don’t mention it to them, chances are it won’t be brought up at all.
It’s easier for them to clamp the cord immediately after birth, send the baby to the nursery and be done with it.
That is one of the awesome benefits to home birth, you get to skip the doctors that always seem to be rushing since you will more than likely have a midwife for your pregnancy and birth who will discuss all of these important things with you.
Benefits of Delayed Cord Clamping
It was previously believed that DCC was only beneficial for pre-term or low-weight babies, but it has since been proven that full-term babies benefit from it as well, although it is absolutely critical for pre-term babies since they are at a higher risk for more complications.
Above we talked about how it increases your baby’s blood volume but just why is this so important for your child? That is what we are going to take a look at now.
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Benefits for full-term babies:
- Increases hemoglobin and hematocrit levels at the time of birth.
- Improves the infants iron stores for the first 6-8 months of life which prevents or delays the child’s risk of ever developing an iron deficiency like anemia.
- Increases brain myelination which is the process of coating the brain of each neuron with a fatty coating called myelin. This coating not only protects the neuron but also helps conduct signals more efficiently. The increase in iron is thought to aid in this process by increasing myelination.
- Improves developmental outcomes in the future. This is a direct benefit of the increased myelination in the brain since it helps the brain conduct signals better.
Special benefits for pre-term infants
Pre-term infants are the first ones found to benefit significantly (or at all) from DCC. Due to insufficient research-based evidence, full-term babies were not recommended for DCC, however, it does indeed have more benefits for pre-term infants than full-term. After all, during DCC, pre-term babies receive up to 30% more blood than they would with immediate cord clamping (ICC). (Source)
Decreases the risk of:
- Intraventricular hemorrhage, or bleeding into the fluid-filled areas or ventricles inside the brain. It is a serious condition and is most common in preterm babies.
- Necrotizing enterocolitis, which is the most common and most devastating intestinal disease among premature babies. In fact, it is one of the leading causes of neonatal mortality in preterm infants.
- Late-onset sepsis, also a major cause of morbidity and mortality, is sepsis that begins at least 3 days after birth.
- Hospital mortality, or deaths that occur in the hospital. Complications of pre-term birth just happen to be one of the leading causes of hospital mortality in infants. According to one study, DCC greatly reduces this risk, making it crucial to delay cord clamping.
Decreases the need for:
- Blood transfusion due to anemia or low blood pressure.
- Mechanical ventilation or artificial ventilation where mechanical means are used.
Increases:
Other important benefits for pre-term babies:
- May support neurodevelopmental outcomes in male infants.
- Increases hemoglobin up to 10 weeks.
- Helps develop better motor skills due to increased myelin production.
Risks of Delayed Cord Clamping
Although DCC is extremely beneficial, there are risks to DCC like most everything. That means you must decide for yourselves if the benefits outweigh the risks and I’m going to try to make that a little bit easier for you. Some of the risks include:
1.) Increased jaundice- One of the risks that come along with DCC is jaundice which is when a breakdown of red blood cells occurs resulting in a yellow tint to the skin and eyes caused by a build-up of bilirubin.
This is because of the increased iron levels and it often results in the newborn needing phototherapy to treat.
It is important to note that other reports have found no significant difference in bilirubin levels in DCC babies compared to babies whose umbilical cords were cut immediately.
In these studies, there was only a 2% increase in infants needing phototherapy to treat the infant’s jaundice. (Source)
2.) Polycythemia- This is another theorized risk of delayed cord clamping although studies have found no significant difference between the DCC group and the ICC group. (Source)
Polycythemia is an abnormally high amount of red blood cells, or more specifically a hematocrit level of 65% or higher.
It most commonly occurs with post-term babies, infants of diabetic mothers, and those with chromosomal abnormalities.
Is Delayed Cord Clamping Right for Me and My Baby?
As you can see above, the risks associated with DCC are minimal since there is no significant difference in the occurrence of Jaundice and Polycythemia in the two trial groups (DCC and ICC).
It is good for and recommended for all babies (even with c-sections and among mothers with HIV) according to the World Health Organization (WHO) since other studies have found that it benefits both preterm and full-term babies.
If this 5-minute delay helps your baby that much (immediately and in the future), it is more than worth it. I just wish more mothers were aware of how beneficial these five minutes are to their child!
Who is right for DCC?
Although it is recommended for all babies, there are some groups that need it more than others.
Delayed cord clamping is especially vital for infants living in low-resource settings with less access to iron-rich foods. This limited access leads to a higher chance of anemia and since DCC builds up iron supplies, it is a must-have for them.
DCC is also a must-have for pre-term babies since the infant isn’t inside the womb long enough to fully develop. It aids them along in this process.
Remember, these are the cases that need it the most. All infants should receive delayed cord clamping seeing as it benefits every group in varying ways.
Who should avoid DCC?
There is always an exception to the “everybody” rule.
Avoid DCC if:
Your baby needs positive-pressure ventilation. In this case, the cord should be clamped and cut immediately to allow for effective ventilation to be performed.
Before cutting the cord, however, it is recommended that the baby is stimulated by rubbing his back 2-3 times.
It is also recommended that if someone is experienced in providing effective positive-pressure ventilation without cutting the umbilical cord, ventilation can be started before clamping the cord. (source)
Final Thoughts
As you see, delayed cord clamping is extremely beneficial to the baby, if not only for the increase in neonatal blood volume since enough iron is necessary for proper brain development.
If you still aren’t sure if delayed cord clamping is right for you, talk with your midwife and get her opinion.
If she doesn’t cover everything you want to know, just ask her. I’m sure she will be more than happy to answer any of your questions!
Just keep in mind, the benefits of Delayed Cord Clamping outweigh the theoretical and unproven risks of it!
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