Her labour was a whirlwind—only eight hours from start to finish—and most of it was a blur. But time stood still when Elaine Kapogines first held her daughter, Anastasia. “I delivered her and she was put on my chest,” says the first-time mom. “We had these nice few minutes together before the cord cutting.”
With guidance from her midwife during prenatal visits, Kapogines and her husband had decided ahead of time that they would go for delayed cord clamping and cut their baby’s umbilical cord when it stopped pulsing, which can take up to 10 minutes. Anastasia got three minutes of uninterrupted cuddles with her mom after birth and a big transfer of blood from the placenta, which some studies suggest may protect babies against iron deficiency, also called anemia.
“You’re basically transfusing 70 percent of the blood in the placenta to the baby in that first minute after birth,” explains Amanda Selk, an OB/GYN at Women’s College Hospital in Toronto.
Cord clamping is considered delayed when it’s done more than 30 seconds after birth. But there are no official Canada-wide guidelines for when to cut a full-term baby’s umbilical cord, and the issue is controversial among healthcare providers. “Nobody knows the ideal time to clamp a full-term baby’s cord,” Selk says.
The standard for Canadian midwives, however, is to leave it attached for several minutes or until it stops pulsing, both for the transfer of blood and to promote bonding between the baby and mother, says Katrina Kilroy, vice-president of the Canadian Association of Midwives. “The baby is born, you put it on the mother’s belly, and they’re interacting; there’s this incredible thing happening,” she says.
But without concrete standards, how do you know the best time to clamp your baby’s umbilical cord? It’s up to you and your healthcare provider, and there’s lots to consider. Anemia protection can last up to six months after birth, but beyond that, there isn’t a lot of scientific evidence to support any long-term advantages. A much-publicized study in JAMA Pediatrics in July suggests that waiting to cut the cord until several minutes after birth may be linked to better motor and social skills in childhood. However, the results of this research aren’t strong enough to impact standards, says Selk.
Expectant parents should also consider the potential risks of delayed clamping. A review of 15 trials suggests that delayed clamping may increase the risk of jaundice, because the procedure can lead to increased levels of bilirubin. And know that in an emergency situation, your doctor may forgo delayed cord clamping, even if it’s something you’ve asked for.
“You have to balance it with the other needs of the delivery,” says Geoffrey Cundiff, head of the department of obstetrics and gynaecology at the University of British Columbia. “For example, if there’s meconium in the amniotic fluid, it’s more important to clear the baby’s throat so none of the fluid gets into the lungs.”
Another variable to consider: If you’re planning to bank umbilical cord blood, delayed clamping usually isn’t an option—the longer you wait to cut the cord, the less blood there will be to save.
Selk says that in an uncomplicated birth, many doctors will wait two minutes or longer to cut the cord in both vaginal births and C-sections, but not all do. If it’s important to you, be sure to bring it up with your doctor ahead of time.
For Kapogines, delayed cord clamping is the plan again for baby number two. “After the chaos of labour, to have a few quiet moments with the baby is really beautiful.”
Preemies & cord clamping
While there aren’t standardized Canadian guidelines for when to clamp a full-term baby’s cord, the Society of Obstetricians and Gynaecologists of Canada does have recommendations for delayed cord clamping in preterm babies. For infants born before 37 weeks, the society says that, whenever possible, cord clamping should be delayed by at least a minute after birth to reduce the need for transfusion and the potential for bleeding in the brain.
A version of this article appeared in our November 2015 issue with the headline, “When to Cut the Cord,” p.45.