Optimal Cord Clamping - How it benefits your baby
After baby is born we might think of the placenta and umbilical cord as now defunct. Of course they were part of the amazing life support system that grew and nourished your baby for all these months, but that is now no longer needed. But hang on a minute, the reality is that the umbilical cord has one last job to do - and it’s a big one.
The umbilical cord and placenta are utterly amazing. The placenta is a whole new organ that grown to support your baby in pregnancy. And the umbilical cord carrys oxygen and nutrient-rich blood from the placenta to your baby, and also carrys carbon dioxide rich blood and waste away from your baby and to the placenta for purification. When your baby is born, around a third of babys volume blood is still in the external part of the circulation system (the placenta and umbilical cord). But it will quickly make it’s way to baby via the umbilical cord. Unless of course the cord is cut before the transfer is complete. And that’s why delaying the clamping and cutting of the umbilical cord is so important.
Benefits of Optimal Cord Clamping
Delaying the clamping and cutting of the umbilical cord, known as ‘delayed cord clamping’ (DCC) or more recently ‘optimal cord clamping’ (OCC) allows more blood to transfer from the placenta to your baby, increasing the baby’s blood volume by up to a third. And it’s important to know that this is babys blood - not cord blood. The term ‘cord blood’ is misleading, the blood collected via the umbilical cord is the baby’s blood. When adults donate blood it is collected via their arm. We don’t refer to that blood as ‘arm blood’ do we? (Thanks to Rachel Reid for that anaology)
These are some of the benefits of optimal cord clamping:
~ Your baby will get 30 percent more of their intended blood volume, from the placenta and umbilical cord (that can go up to 50% in premature babies)
~ The iron in this blood increases the newborn baby’s iron storage, which is vital for healthy brain development and there is less chance of anaemia if you wait to clamp
~ Your baby can gain up to 214 grams in the first five minutes following birth if the cord is left unclamped
~ Your baby will have a higher ratio of red blood cells
~ The extra blood at birth helps the baby to cope better with the transition from life in the womb, where everything is provided for them by the placenta and the mother, to the outside world.
~ Babys lungs get more blood so that the exchange of oxygen into the blood can take place smoothly.
~ Delayed cord clamping also results in an infusion of stem cells, which play an essential role in the development of the immune, respiratory, cardiovascular, and central nervous systems, among many other functions. The concentration of stem cells in fetal blood is higher than at any other time of life. ICC (immediate cord clamping) leaves nearly one-third of these critical cells in the placenta. Stem cells may also help to repair any brain damage the baby might have suffered during a difficult birth.
There is a difference in the terms ‘delayed’ cord clamping and ‘optimal’ cord clamping. In delayed cord clamping , the umbilical cord is left for a minute or more before clamping and the cutting. Whereas in optimal cord clamping you wait for cord to stop pulsing, so not for a set period of time. When the cord stops pulsing you know that the blood has all moved from the placenta to baby.
Is it for all babys? What about premature babies or Caesareans?
We now have the evidence that there is absolutely no need or urgency to cut the umbilical cord immediately after birth. We also know that there are many benefits in waiting one minute at the absolute minimum (preferably longer) or until the cord has turned white and stopped pulsating, before clamping and cutting.
Current NICE guidelines inform professionals that they should delay cord clamping in ALL circumstances, regardless of the TYPE of delivery – and only cut the cord immediately if the baby’s heart rate is lower than 60 beats per minute, and not getting faster.
~ Most babies have no complications at birth and the cord could be left until it has stopped pulsing and baby has transitioned naturally to life outside the uterus.
~ Premature babies can benefit from OCC. For baby's that are premature or are compromised at birth, it is essential that the cord is left for 60 seconds and longer if bedside resuscitaire trolleys are available. It’s actually premature and compromised babies benefit most from optimal cord clamping.
~ Immediate/Early cord clamping is a common intervention and routine global practice which research shows deprives the baby of approximately 30% (in premature babies approximately 50%) of their intended blood volume.
~ Babies born by caesarean can have optimal cord clamping
ANY baby however they are born should experience optimal cord clamping unless their heart rate is lower than 60 beats per minute, and not getting faster, which is extremely rare.
What is ‘wait for white’?
"Wait for White" describes an umbilical cord which has completed its natural physiology, all the blood and is easily facilitated in the majority of births. You can see the white cord on the right of this image. It is ‘white’ as all of babys blood is now in baby, and not in the placenta. Sometimes people use the term ‘wait for white’ in their birth plans and when talking about optimal cord clamping.
So why am I telling you this?
I’m writing this article, as standard practice in the UK had been to cut the cord immediately, even before baby had taken their first breath. This is changing, thankfully. But despite the research showing the huge benefits for optimal cord clamping, it is thought there are still many babies who are not given adequate chance to receive transfer of their own blood from the cord and placenta at birth. Tommy's (2018) report that a survey completed by The Positive Birth Movement demonstrates that 40% of babies continue to have their cord cut immediately after birth.
NICE (National Institute of Clinical Excellence) guidelines in the UK, and international guidelines are now clear that practitioners should wait and delay the clamping of the cord. But unfortunately this does not always happen. So please do put you preference into your birth preference or birth plan - make sure that its’s clear what you would like to happen and that your birth partner reiterates this to your care team too.
What about cord blood banking?
Many parents are becoming aware about the practice of umbilical cord blood banking (UCB) and may wish to choose to bank their infants stem cells for future use for their baby, or to a public bank. This is something that couples sometimes mention to me when we discuss cord clamping on my Hypnobirthing & Birth Preparation Courses.
New research evidence indicates the increasing potential for the use of the blood left in the placenta, which contain stem cells with regenerative potential to treat many age related conditions such as diabetes, heart disease and arthritis (Roura et al., 2015). Although in their infancy, these advances offer potentially life changing benefits for the infant and possibly other family members in the future.
Amanda Burleigh and Hannah Tizzard wrote a blog here on All4Maternity about the tensions between the two practices of optimal cord clamping and and umbilical cord banking.
Unfortunately, parents looking to donate cord blood for the public good are often faced with choosing either to donate or to delay clamping.
Fortunately, in light of the important knowledge and evidence about the benefits of delayed and optimal cord clamping some UCB companies are starting to adapt practice and respect newborn physiology. They have developed new ways of preserving small blood volume collection of stem cells from the placenta after the baby has received OCC. Making it possible, should parents wish, to choose both OCC and UCB stem cell and tissue collection.
More information
To find out more about the science and research on optimal cord clamping and wait for white here’s some resources so you can be fully informed and make the right and informed choice for you and your baby.
BloodtoBaby is now a website and blog educating and sharing free evidence based resources about optimal cord clamping for use by women, families and healthcare professionals. https://www.bloodtobaby.com/
Wait For White is an informative website all about the benefits and reasons behind the push towards the mindset of "WaitforWhite and Optimal Cord Clamping" in new born babies. https://www.waitforwhite.com/
There's some more information here on delayed cord clamping and jaundice, and weiging up the risks/benefits for baby that you mentioned - https://www.tommys.org/pregnancy-information/labour-birth/delayed-cord-clamping-dcc
The World health organisation (WHO) does recommend it, despite the jaundice risk, and it's also discussed more here too - https://www.bellybelly.com.au/birth/delayed-cord-clamping-and-jaundice/
An interesting article by Rachel Reed - https://www.waitforwhite.com/rachel-reed-midwife-thinking
I hope that's this article is helpful to you, in making a choice that’s right for you and your baby. My aim through these articles and through all my work as an antenatal educator through my birth preparation courses and classes is to inform and educate parents to be to find evidence based information all about pregnancy, birth and parenthood and to really have informed choice.
Susan x
PS If you want to know more about what you might do with your placenta - I wrote an article about that too right here - https://www.formodernmothers.com/blog/8-thing-to-do-with-your-placenta