Many of our patients request that we delay clamping of the umbilical cord for a period of time after their baby is born. The theory is that the baby will benefit from receiving more blood flow from the cord until the cord stops pulsating several minutes after delivery. This theory has been particularly promoted in natural childbirth and midwifery circles, as the routine in traditional obstetric practice has always been to clamp the cord immediately after birth.
Recently a large study was done looking at all the prior smaller studies on this subject to see if there is truly any benefit from delaying cord clamping. What is clear is that delaying cord clamping for a period of time increases the newborn’s iron stores and blood volume. While on face value this sounds like a good thing, there is no evidence that this is beneficial in any way to an otherwise healthy full term baby.
In fact it has been shown to increase the incidence of jaundice. Other than the increase in jaundice, there was no other significant difference found in neonatal outcome for full term babies regardless of when the cord is cut. So the real answer is that is does not seem to matter much when the cord is cut, sooner or later, but that if cord clamping is delayed there needs to be treatment available for jaundice should that occur (such as bilirubin lights).
There was some possible benefit shown for delaying cord clamping in neonates born prematurely (less than 37 weeks). The problem is that many premature infants need immediate assistance at birth and cannot wait to be evaluated for 2-5 minutes for the cord to stop pulsating. So in reality this is rarely an option for premees who have bigger problems than low iron stores (such as not breathing well). Iron is easy to replace.
Obviously in C-sections the cord is cut immediately so that the baby can be handed off to allow your surgeons to continue operating. In general for vaginal deliveries we will cut the cord pretty soon after birth, because for many reasons it is more practical. We generally put the baby right on mom’s abdomen and it is hard to cuddle a baby still attached to the cord. Certainly there is no urgency to cut it, and this can all happen in a calm and unrushed manner. If a patient strongly wants to delay cord clamping we will honor that request but will ask you to review the data above and be aware that it can increase the risk of jaundice which may require treatment and can delay discharge home.