Delayed Cord Clamping - Why Wait?

It seems my parents were ahead of their time when, in 1976, they asked that their doctor, who was attending my birth, sign an agreement which, amongst other things, stated that my umbilical cord was not to be clamped until it had stopped pulsating. Thankfully he agreed, and was amazed to witness my cord pulsating for 15 minutes before it was clamped and cut (indeed, it was the first time he had ever left a cord intact for more than a brief moment following birth). My wonderful parents had read that leaving the cord intact allows the baby to experience a much more gentle start to breathing. It was argued that when the cord is cut immediately following birth, the baby has to suddenly suck in air, causing pain in their delicate and sensitive virginal airway. By leaving the cord to continue pulsating after the birth, the baby is supplied with oxygen while it gradually learns how to breathe... a much more gentle start to terrestrial life.

Just to clarify, for those of you who may not be aware, for many years now Western medicine has preferred an 'actively managed' approach to the third stage of labour, part of which involves the immediate clamping of the umbilical cord at birth. Delayed cord clamping is the term given to the approach whereby the cord is left intact until it ceases to pulsate (in other words, until the baby has received its full quota of blood). 

What my parents didn't know was that they were actually benefitting me in other very important ways as well. When a baby's umbilical cord is clamped straight away, it is estimated that up to half of the newborn baby's total blood volume is left in the cord!  (See photos below comparing Jonah's cord full of blood straight after his birth with the limp, bloodless cord that remained when his placenta was born). This blood not only contains helpful oxygen, but other important nutrients and minerals as well. Red blood cells, stem cells and immune cells are all in there too. Iron-deficiency anaemia in infancy is linked to early cord clamping, and for babies whose breathing is compromised at birth, the additional source of oxygen with delayed cord clamping can be life-saving. Doesn't it seem illogical that the babies most in need of resuscitation almost invariably have their umbilical cord severed immediately?! Surely it makes more sense to leave the cord intact, allowing the baby to passively receive oxygen whilst any further resuscitation that is required is done with the baby in the mother's arms (or between her legs or at her side)?

There are many easily accessed articles that delve into the physiology behind the benefits of delayed cord clamping if you wish to research it further, but I think for the purposes of this blog post that that's enough technical jargon to swallow for now. (Here is an 18 minute TED talk youtube clip that is well worth a listen).

When my second child, Luca, was born he was slower than most to begin breathing on his own. He'd had a very lovely water birth and when I initially held him in my arms he was incredibly peaceful. His colour was good but he wasn't attempting to breathe spontaneously and his heart rate was dropping. I tried giving him a few mouth-to-mouth breaths, but felt a bit clumsy so the back-up midwife gave him some oxygen via the bag and mask. About a minute later my midwife vigorously turned him onto his front and that startled him into breathing on his own. I think he was just so relaxed following his gentle birth and he was receiving oxygen via his cord that there was simply no urgency on his part to start breathing. Although his dad and others in the room felt anxious during his first few minutes of life, I can honestly say that I didn't feel in the least bit worried that he might be compromised (of course, it may have been all those delicious endorphins that were skewing my view of the situation!). To me, he was just taking his sweet time to become fully present in the world. Undoubtedly I would not have felt nearly so trusting and confident had his cord been immediately severed following his birth.

The transitional time of babies gradually switching between intrauterine and extrauterine life (the time following birth until the cord stops pulsating) is also natures way of encouraging and protecting the important initial bonding that takes place between the mother and her baby. While the cord is intact the baby and mother are unable to be separated.  The baby remains intimately close to its only source of comfort - its mother; breathing in her smells, feeling the warmth of her skin and hearing her familiar sweet voice. And the mother instinctively cuddles her baby; keeping him warm and safe, marvelling at his beauty and quickly falling in love with him. The early initiation of breastfeeding is also encouraged with this close, undisturbed baby-mother contact, the benefits of which are many.

With all three of my children's water births, I left cutting the umbilical cord until after the placentas had been birthed. This whole process took place in the birth pool, allowing plenty of time and opportunity for me to cuddle, admire and bond with my new babies (the baby in the photos below are of my third-born, Jonah). Having experienced this precious and most important phase of the birth process, I find it incredibly distressing when I hear about, or see footage of, babies being separated from their mums immediately following their birth, taken to a resuscitation table and vigorously rubbed, suctioned, injected... all manner of unnecessary undertakings, when where they should be and where they need to be, is in their mother's arms. Baby checks, weighing, injections, bathing and dressing can all wait. What's most important in those first minutes following birth is that the mother and baby are given undisturbed time to bond. Fullstop.

Not all midwives and obstetricians have altered their recommendations and practices to be congruent with current research findings regarding the benefits of delayed cord clamping. If you are having a baby it is important that you discuss cord clamping with your caregivers prior to birth and make it clear that you do not want the cord clamped before it's ceased pulsating. Some maternity care providers might argue that if the baby is compromised at birth, or if it is born by caesarean section, that immediate clamping will be necessary in order to carry out resuscitation measures. If you speak up and present the evidence then maternity care providers should be hard pressed to deny you the right to maximise safety and wellbeing for your baby at birth! Here is an example of an emergency caesarean birth where the woman's birth plan request for delayed cord clamping was respected. And here's a midwives' explanation for how resuscitation of a newborn can take place in the mother's arms.

Full cord immediately after birth.

Full cord immediately after birth.

Limp lifeless cord. Placenta birthed.

Limp lifeless cord. Placenta birthed.