Delayed Cord Clamping
by Salli Gonzalez, LM

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Baby Sari, left attached to her placenta to allow physiologic closure of the cord. Photo courtesy Cheri Williams

If you’ve ever been around midwives, you will notice that we are pretty confident about the process of birth.  After all, birth has been around for, well, since the beginning of the human race.  Allowing the birth processes to happen without unnecessary intervention, we believe, keeps both mother and baby safe.   

Birth with a midwife tends to be very hands off even through 3rd stage which is the birth of the placenta.   In a natural birth, placentas remain attached to the baby for as long as the baby needs them.  In fact, it’s the norm for placentas to be born while the baby is still attached, which means many minutes have passed since birth.  It is not unusual for a placenta to be born up to an hour or more after birth.

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Notice how the intact, non-clamped cord is thick and full. Photo courtesy Doula.Seana

Which answers the often asked question.   “Do you practice delayed cord clamping?”

What would be the benefit of waiting, you may ask?  What do the facts say about letting the baby have all the blood needed after birth?  

Medically managed third stage along with immediate cord clamping have only been in practice for around 100 years.  Relatively speaking, this is a small increment of time in the history of the human race.  So, not only is waiting as a practice historical, and logical, it is also very important. Delayed cord clamping or as we say in midwifery land, physiologic cord clamping is a normal process of birth.    

Physiologically speaking, the cord itself shunts off the blood to the baby after birth.  It is our job to wait for the cord to accomplish this. There is no rush to facilitate this process.  In fact, the mother is so engrossed with her baby, that she may forget that there is still a placenta attached to her and baby. The cord continues to pulse unhindered as mother and baby are meeting each other for the first time, nursing for the first time, counting fingers and toes, etc. The baby will often cry a few cries, and mother states that she feels cramping and is ready to deliver her placenta. The placenta is soon expelled and it is then that the parents are ready to release the baby from the cord. Sometimes many minutes have passed in this time period, sometimes an hour or more.  

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After physiologic closure of the cord, it appears flaccid, almost like a flat shoelace. Photo courtesy: http://www.facebook.com/Doula.Seana/

Why is all this beneficial?  

It is believed that the baby will dictate the amount of blood he needs as the blood is pumped into his body after birth.  As the baby takes his first breaths physiological shunting is under way.  As the baby physiologically orchestrates this process, he is only receiving the amount of blood he needs, not too little, not too much.  It is believed that the practice of immediate cord clamping deprives the baby of up to 1/2 of his blood.  (Sarah J. Buckley, Gentle Birth, Gentle Mothering) When delayed cord clamping is done, this blood virtually transfuses to the baby after birth and is essential in supplying the newly functioning lungs, kidneys, and liver.  The initial moments after birth is a huge transition for these organs functionally and baby’s transition relies on this initial transfusion of blood.  As well, in the case of a baby needing resuscitation, the pulsing cord provides life giving oxygen to the baby until breaths can be given, and the baby eventually begins breathing on his own.

To deny the baby of his own blood by immediate cord clamping also denies the baby of essential blood stores as well, often leading to anemia after birth.  Sarah J Buckley, MD, in her book, Gentle Birth, Gentle Mothering, states that immediate cord clamping can “reduce iron stores by 15% at 2-3 months.”

Many may counter that allowing the cord to pulse until finished, may lead to polycythemia or excess red blood cells.  Again, Sarah J. Buckley addresses this stating, based on studies, the increased blood cells may actually benefit the baby by carrying oxygen to the newborn’s organs and tissues as he transitions to using his lungs for the first time.  The other argument often stated for immediate cord clamping is that delayed clamping may lead to jaundice.  Physiological jaundice is “almost certain” according to Sarah J. Buckley, since jaundice is caused by a breakdown in the extra red blood cells in the days following birth.  Physiologic jaundice is rarely harmful and in fact quite beneficial.  Bilirubin, the byproduct of this breakdown, is actually necessary, according to some recent studies.  It is known as a “powerful antioxidant” protecting the baby from oxidative stress associated with the baby’s transition to life outside the womb.  Is it possible that nature is wise, and instead there being an excess of red blood cells, but rather, just enough, for the transition to life here on earth.