Delayed Cord Clamping

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Lil Momma 1991's picture
Joined: 10/05/09
Posts: 444
Delayed Cord Clamping

Anyone with any experience with this? I am starting to do a but of research on it and like the idea but wanted to get some opinions on it first. I have an appt with my OB on Friday at 2 and plan to ask him about it and how he feels about it.

Also, I have read that it increases the risk of Jaundice. Do any of you have experience with this? Is it work the higher risk?

smsturner's picture
Joined: 05/11/09
Posts: 1303

I had never heard of it. But now I'm kinda interested.

Stormy Weather's picture
Joined: 10/03/09
Posts: 326

Yes, we did a lot of research on it before DS was born and I felt very confident after reading the studies that it was a positive thing to do. I asked my consultant about it (this was in 2010) and she said they generally only do it for pre-term babies, because it's very beneficial to them, but she was happy to do this for me even though DS was full term, as long as the surgery was going well and there were no breathing problems.

During surgery he was born and lifted onto my thighs, with the cord not clamped. They did their initial apgar tests and counted his toes etc, and his cord had stopped pulsating after about 90 seconds, at which point they asked permission to clamp and DH cut the cord.

DS suffered from very mild jaundice. Nothing was needed for it and it went away after a week or so. I don't know if this was because of the cord clamping or if it would have happened anyway, but I felt that the benefits outweighed the mild jaundice massively anyway. We'll definitely be doing it again, barring emergency situations.

Interestingly, since 2010 I believe more hospitals are now delaying cord clamping as standard practice, but don't quote me on that. It's certainly more 'normal' than it was 3 years ago. I've read a few papers on it that were published since 2010.

Lil Momma 1991's picture
Joined: 10/05/09
Posts: 444

"Stormy Weather" wrote:

Interestingly, since 2010 I believe more hospitals are now delaying cord clamping as standard practice, but don't quote me on that. It's certainly more 'normal' than it was 3 years ago. I've read a few papers on it that were published since 2010.

Oddly, when doing my research is shows that most hospitals in America cut the cord within a minute of birth 0.o (I could be TOTALLY wrong)

smsturner's picture
Joined: 05/11/09
Posts: 1303

I think that in Europe they do it much more often than here in America. We are stubborn for some of this natural stuff. (like stopping male circumcision, etc)

Stormy Weather's picture
Joined: 10/03/09
Posts: 326

When I say they're delaying it more often I just mean they aren't cutting it the actual second the baby is out! I think the immediate cutting of it is still the most common scenario here too. I've just read in a few places that they are moving away from that (probably very, very slowly).

Joined: 12/01/10
Posts: 997

We delayed cord clamping with DS, it was part of our birth plan. He also had mild jaundice at birth that had to be monitored for about a week (he needed blood draws to check his bilirubin levels before and after discharge). Not sure if the jaundice was related to him being a late preterm baby at 36 weeks or something else. Cord clamping seems more common in the US birth center/home birth setting versus US hospital setting which is what we were aiming for before my care was transferred. I plan to discuss it with my current OB as I would like to do the same with this baby, however will review the research again so the benefits are fresher in my mind during the discussion.

ETA: to clarify above

stbernardlover's picture
Joined: 03/02/12
Posts: 277

I'm really not interested in trying it. Jaundice happens because of the increased number of red blood cells that need to be metabolized in the lover, which is immature even in a term infant. So, allowing the cord to continue to pulsate after the infant has taken the first breath, allows even more red blood cells to enter into the infant's vascular system. There's just no way around the fact that it increases jaundice risk. There's not been enough large studies to evaluate any real benefit to the infant to convince me that its worth the risk.
If the research changes then I'll look at it again.

Joined: 12/01/10
Posts: 997

I wanted to add that delayed cord clamping does not only mean waiting until the cord stops pulsing or the placenta is delivered. It can even mean just waiting longer than the norm, say clamping after 45-60 sec versus within 10 seconds of delivery. You might be able to find a middle ground with your provider. Even with slight delay, you can still have immediate skin to skin time either at breast or on your stomach depending on length of the cord.

Joined: 12/01/10
Posts: 997

"stbernardlover" wrote:

I'm really not interested in trying it. Jaundice happens because of the increased number of red blood cells that need to be metabolized in the lover, which is immature even in a term infant. So, allowing the cord to continue to pulsate after the infant has taken the first breath, allows even more red blood cells to enter into the infant's vascular system. There's just no way around the fact that it increases jaundice risk. There's not been enough large studies to evaluate any real benefit to the infant to convince me that its worth the risk.
If the research changes then I'll look at it again.

Not trying to start a debate here but just wanted to say the blood flow thing confused me even when I was researching for DS's delivery and asking different HCP's their thoughts on the matter. I had some providers tell me that they thought the baby would get too much blood from the unclamped cord and others who told me that the baby would lose too much blood because it was draining out through the cord (can it work both ways or was one side misinformed??). I also remember reading something that use of synthetic oxytocin (e.g., pitocin) could be increasing the blood flow in an unclamped cord more so than would naturally occur (in this case they were stating it could result in an overabundance of red blood cells in baby). I definitely want to do more research before I discuss with my OB.

Stormy Weather's picture
Joined: 10/03/09
Posts: 326

"xtinagreen" wrote:

I wanted to add that delayed cord clamping does not only mean waiting until the cord stops pulsing or the placenta is delivered. It can even mean just waiting longer than the norm, say clamping after 45-60 sec versus within 10 seconds of delivery. You might be able to find a middle ground with your provider. Even with slight delay, you can still have immediate skin to skin time either at breast or on your stomach depending on length of the cord.

This is pretty much what we did, in a surgery situation. And it's what I'd do again. I think it's the first minute when a lot is happening anyway. I've asked for 1 min to 90 seconds.

knhoward's picture
Joined: 04/22/08
Posts: 999

*Lurker*
I believe delayed cord clamping is standard practice in the midwifery group that is currently caring for me. Clamping was delayed with my son until the cord stopped pulsing (which was only a minute or two) There is decent evidence for this. You can read this article here:
JAMA Network | JAMA | Late vs Early Clamping of the Umbilical Cord in Full-term Neonates: ?Systematic Review and Meta-analysis of Controlled Trials from the journal of the American Medical Association

The long and short of it is allowing the child to have all the blood flow into them from the cord increases their iron stores and it outweighs the risk of jaundiced (of course you can read this and draw your own conclusions...)

From the article...
"Late clamping of the umbilical cord is a physiological and inexpensive means of enhancing hematologic status, preventing anemia over the first 3 months of life and enriching iron stores and ferritin levels for as long as 6 months. Although this is of particular importance for developing countries in which anemia during infancy and childhood is highly prevalent, it is likely to have an important impact on all newborns, regardless of birth setting....."

Stormy Weather's picture
Joined: 10/03/09
Posts: 326

I asked today at my appointment and apparently they wait 3 minutes before clamping now for all births at our hospital and birth centre, so it does seem to be moving towards normal practice here.

Lil Momma 1991's picture
Joined: 10/05/09
Posts: 444

"Stormy Weather" wrote:

I asked today at my appointment and apparently they wait 3 minutes before clamping now for all births at our hospital and birth centre, so it does seem to be moving towards normal practice here.

I am really quite curious about this now. My OB is pushing Cord Blood Banking at almost every single appointment. And realistically, it's not something DH and I can afford. If we could we would likely go that route. So, if that's the 'norm' in America (Which it seems to be) Then I am sure that delayed clamping is not a normal procedure at our hospitals. I have an appt. with my OB Tomorrow at 2, I plan to ask about this : )

knhoward's picture
Joined: 04/22/08
Posts: 999

"Lil Momma 1991" wrote:

I am really quite curious about this now. My OB is pushing Cord Blood Banking at almost every single appointment. And realistically, it's not something DH and I can afford. If we could we would likely go that route. So, if that's the 'norm' in America (Which it seems to be) Then I am sure that delayed clamping is not a normal procedure at our hospitals. I have an appt. with my OB Tomorrow at 2, I plan to ask about this : )

i wonder if your OB has a financial stake in cord blood banking? Like he gets a cut for each person he gets to bank. Lately I have read in a few places it's better for baby to get the blood at birth then banking (and paying a lot of money). For a pretty small chance you will use it. Annual storage fees are very high for cord blood banking. I'm not sure what research is out there, but it might be a good idea to look into it.

stbernardlover's picture
Joined: 03/02/12
Posts: 277

"xtinagreen" wrote:

had some providers tell me that they thought the baby would get too much blood from the unclamped cord and others who told me that the baby would lose too much blood because it was draining out through the cord (can it work both ways or was one side misinformed??). I also remember reading something that use of synthetic oxytocin (e.g., pitocin) could be increasing the blood flow in an unclamped cord more so than would naturally occur (in this case they were stating it could result in an overabundance of red blood cells in baby). I definitely want to do more research before I discuss with my OB.

You are correct, the blood can move either way. It all depends on th pressure gradient. Pitocin increases the strength and/or frequency of the contractions of th uterus, so that can increase the pressure gradient toward the baby. It just depends on the situation.

I dont think it would be detrimental to wait a minute or a few, i thought the original topic was more about those that were choosing to wait long periods of time to cut the cord. For example, sometimes it stakes 30 minutes or more for all pulsating to stop. That is what i thought the original topic was relating to.

Joined: 12/01/10
Posts: 997

"stbernardlover" wrote:

You are correct, the blood can move either way. It all depends on th pressure gradient. Pitocin increases the strength and/or frequency of the contractions of th uterus, so that can increase the pressure gradient toward the baby. It just depends on the situation.

I dont think it would be detrimental to wait a minute or a few, i thought the original topic was more about those that were choosing to wait long periods of time to cut the cord. For example, sometimes it stakes 30 minutes or more for all pulsating to stop. That is what i thought the original topic was relating to.

I wish I could remember how long we had waited with DS (I was kind of out of it at the time). DH seems to think it wasn't longer than a minute. I know it was long before placenta delivered since mine took almost 30 minutes and the OB was concerned for bleeding, but I cannot recall if she waited to clamp until the cord stopped pulsating. We were kind of thrown into the hospital situation quickly and had to write our official birth plan quickly upon admit with the nurse's assistance as I only had jotted down notes beforehand. The hospitalist OB on call reviewed our birth plan when meeting us for first time so there wasn't much time to discuss the details. In my mind, I was thinking a couple minutes tops this time around if my OB is okay with it.

Lil Momma 1991's picture
Joined: 10/05/09
Posts: 444

I don't to delay clamping for 10 minutes or anything but, I guess I would love to for a minute to a minute and a half? Just to get that extra blood. We will see what my OB says today:) Thanks everyone for all the reply's!

Joined: 07/21/02
Posts: 1006

I've never done it but I had thought about talking to my OB about it. With my last, it was not an option. My OB actually had to cut the cord after his head was delivered because it was wrapped so tightly several times around his neck and he was very blue that she had to cut it to loosen him enough to be fully delivered. And he had to be delivered very quickly after that. He was born with one arm and his head coming out first--which the OB actually said was a good thing because his arm up kept the cord from becoming too compressed and cutting off his oxygen before he was born.

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