Preparing for birth involves knowing about the third stage of labour (birthing your placenta). At the time of birth, the placenta continues to function pumping blood to the baby (Enning 2007) but eventually the umbilical cord stops pulsing and the placenta will need to be birthed.
In many Australian hospitals it is quite common for delivery of the placenta to be ‘managed’. This involves an injection of synthetic oxytocin. A natural third stage (without drugs being used) is called a ‘physiological third stage’. It is also quite common to clamp the cord soon after birth, however, there is no sound scientific evidence that supports the immediate clamping in vaginal or cesarean births (Emerson 2012).
The World Health Organization states that even if you want/need the synthetic oxytocin injection, you can still leave the baby attached to receive the benefits of delayed cord clamping (Cernadas 2006).
What does it mean to delay cutting the cord?
According to Abalos (2009) an exact definition of ‘delayed’ cord clamping is unclear, however, it is generally understood to mean a delay of cutting the cord until 2-3 minutes after birth or when the cord has stopped pulsing.
What are the benefits of delayed cord clamping?
- At the time of birth, up to one-third of the baby’s blood volume is still in the placenta (Buckley 2009). By allowing the cord to finish pulsing, the baby will receive most or all of its blood. This extra blood contains iron, oxygen and stem cells and is beneficial for the baby to receive it! Stem cells may even help with recovery from the birth (Reed 2015).
- Gentle transition to earth: It’s a big transition to make from womb to world. The baby needs to initiate breathing and this can take a little time. By leaving the cord unclamped, the baby can continue to receive oxygen from the placenta via the pulsing umbilical cord (Buckley 2009). This gives the baby time to expand it’s lungs and get used to breathing on it’s own (before this oxygen supply is removed).
- Keeping mother and baby close to each other helps with bonding and helps the mother to release her own natural oxytocin which helps prevent post-partum hemorrhage and helps her to safely birth the placenta (Buckley 2009).
A 2013 Cochrane review (McDonald et al) found “There are some potentially important advantages of delayed cord clamping in healthy term infants, such as higher birthweight, early haemoglobin concentration, and increased iron reserves up to six months after birth. These need to be balanced against a small additional risk of jaundice in newborns that requires phototherapy.”
When is a good time to cut the cord?
Dr Sarah Buckley (2009) recommends delaying the cord clamping for as long as possible and ideally after the mother has birthed the placenta. If this is not possible, then consider waiting until:
- After the baby takes its first breath
- After 30 seconds from birth
- After 3 minutes or so after birth
- After the cord stops pulsing
World Health Organisation (2013/2014) recommends:
Waiting to cut the cord until at least one to three minutes after birth or after the cord stops pulsating. This leads to improved infant and maternal health.
When does the cord stop pulsing?
Did you know you can actually feel the cord pulsing? It feels like a pulse through a thick udon noodle. According to Dr Rachel Reed (2015), textbooks will tell you it stops pulsing between 3-7 minutes, but she has felt cords pulse for longer than that.
Hold the baby below the placenta
Once the baby is born, where it is placed (ie; on mothers chest) will impact how quickly the placenta can transfer the extra blood. If the infant is held below the level of the placenta, then this accelerates the transfusion of blood from placenta to baby (Buckley 2009). For a baby who is being held skin-to-skin on the mothers chest, a five minute delay will allow enough time for the baby to receive all its blood from the placenta (Mercer and Erikson-Owens 2012).
According to Dr Buckley (2009), several studies have shown that respiratory distress can be eliminated (babies can establish breathing easier) when they have been allowed to receive their full placental transfusion (their full blood supply from the placenta).
In a cesarean birth, it’s possible to request that the doctor wait until your baby takes its first breath before cutting the cord. The baby can also be positioned lower than the placenta and the blood can be ‘milked’ from the cord to the baby to help it establish breathing and receive it’s normal blood volume (Emerson 2011).
So, when writing your birth preferences, be sure to include your ideas surrounding delayed cord clamping and make sure your care provider knows your wishes!
Abalos E. (2009 March 2). Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. The WHO Reproductive Health Library. Retrieved 9 July, 2015 from http://apps.who.int
Buckley, S. (2009). Gentle birth, gentle mothering: A doctor’s guide to natural childbirth and gentle early parenting choices. Berkeley, California: Ten Speed Press.
Cernadas, C. (2006, March 7). Early versus Delayed Umbilical Cord Clamping in Preterm Infants. The WHO Reproductive Health Library. Retrieved 9 July from http://apps.who.int
Emerson, K. (2011, September 8). Cesarean section and delayed cord clamping. Retrieved July 9, 2015 from cord-clamping.com
Emerson, K. (2012, July 13). Birth Plan for delayed cord clamping. Retrieved July 9, 2015 from cord-clamping.com
Enning, C., & Smith, C. (2007). Placenta: The gift of life : The role of the placenta in different cultures and how to prepare and use it as medicine. Eugene, Oregon: Motherbaby Press.
McDonald, S., Middleton, P., Dowswell, T., & Morris, P. (2013, July 11). Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Retrieved July 9, 2015 from onlinelibrary.wiley.com
Mercer, JS., & Erickson-Owens, DA (2012). Rethinking placental transfusion and cord clamping issues.Retrieved July 9, 2015 from ncbi.nlm.nih.gov
Reed, R. (2015, May 1). The Placenta: Essential resuscitation equipment. Retrieved July 9, 2015 from midwifethinking.com
World Health Organisation (2013). Delayed clamping of the umbilical cord clamping to reduce infant anaemia.Retrieved July 9th, 2015 from www.who.int
World Health Organisation (2014). Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes. Retrieved July 9th, 2015 from www.who.int