Delayed Cord Clamping And The Umbilical Cord
Today more parents are choosing delayed cord clamping to ensure their newborn baby has all the benefits of this slow introduction to life outside the womb.
Pausing before clamping and cutting the cord honours the connection and life-support the umbilical cord has provided your baby for the last nine months.
What is delayed cord clamping and is it possible in all situations?
What is the umbilical cord?
Within the first 3 weeks of conception, the connection between you and your baby begins to form. By week 7, the umbilical cord is fully formed.
Often referred to as your baby’s lifeline, the umbilical cord is that and more. It provides oxygen and nutrients to your baby, nourishing them throughout the next nine months.
On the outside, the umbilical cord looks like a tube. Inside the cord is one vein and two arteries. Wharton’s jelly surrounds these, a gelatinous substance that insulates and protects the umbilical vessels.
- The vein carries oxygen and nutrients from the placenta
- The arteries transports waste material from your baby to the kidneys via the placenta.
In the third trimester, antibodies pass through the placenta to your baby, priming the immune system for life outside the womb. By the time your baby is born, the umbilical cord is about 60cm long, but can be up to 100cm!
Umbilical cord conditions
Most of the time, the umbilical cord is in the right place and does its job perfectly. Occasionally, there are problems with the cord but these don’t cause you or your baby any issues. Very rarely there are more complex problems with the cord that can be serious.
If you choose to have an ultrasound at 18-20 weeks, the sonographer will check if there is three vessels in the umbilical cord. They will also check the cord is well connected to the placenta.
Complications with umbilical cords can include:
- Single umbilical artery: when one artery in the umbilical cord is missing. This is rare, happening in 1% of pregnancies, and related to heart, kidney or digestion conditions.
- Vasa previa: one or more blood vessels from the umbilical cord or placenta cross the cervix. The vessels can potentially tear, causing serious bleeding in babies.
- Nuchal cord: when the umbilical cord is wrapped around a baby’s neck. Usually this causes no problems but it can affect the heart rate during labour, leading to a cascade of interventions.
- Knotted cord: these often form early in pregnancy when the baby moves around. Knots frequently happen when the umbilical cord is very long and in pregnancies with identical twins who share the same amniotic sac.
- Umbilical cord cysts: sacs of fluid in the umbilical cord. Less than 1% of pregnancies has an umbilical cord cyst.
If any of these cord complications is found or suspected, your care provider might suggest future ultrasounds or other prenatal tests.
What happens to the umbilical cord during labour?
The umbilical cord continues to play an important role in your baby’s well being during labour and birth.
As your uterus contracts, it temporarily compresses the blood vessels that take oxygen to your placenta. In response, your baby’s heart rate slows, to conserve energy and oxygen.As the contraction ends, your baby’s heart rate picks up again.
If there’s a problem with the umbilical cord, this can affect your baby’s heart rate picking up. It can be seen as a sign of distress and your care providers will want to check your baby is coping with labour.
What happens to the umbilical cord after birth?
As your baby is completely born, an incredible transformation takes place. The central nervous system registers the change in environment and temperature and your baby takes their first breath.
The transition your baby’s body makes from being dependent on the placenta (and you) for oxygen to breathing air can take some time. As this amazing transition happens, the umbilical cord pulsates, delivering oxygen rich blood to your baby.
The blood vessels in the umbilical cord will begin to close naturally when this transition is complete. The cord goes from being blue-purple and quite thick, to white and thin looking. This can take from a few minutes to as long as an hour!
When should the umbilical cord be clamped and cut?
In the past, clamping and cutting the umbilical cord happened before the placenta was expelled. Doctors believed a fast and large volume placental blood increased complications such as jaundice, respiratory distress and even a type of blood cancer called polycythemia.
Research over the past decade has shown there are benefits for babies in leaving the cord intact until it naturally finishes transferring blood from the placenta to the baby, including:
- Increases haemoglobin in baby. This is a protein in the red blood cells that carries oxygen to organs and tissues and transports carbon dioxide back to the lungs.
- Increases iron stores in baby, particularly important for the first six months of life.
- Increases blood volume by up to 30% in babies.
- Premature babies are less likely to need a blood transfusion.
- Babies, especially premature newborns, have a lower risk of intra-ventricular haemorrhage and necrotizing enterocolitis.
Delayed cord clamping versus optimal cord clamping
Sometimes different terms are used, such as delayed cord clamping, or optimal cord clamping.
Delayed cord clamping is waiting between 1-5 minutes before clamping and cutting the umbilical cord. Most hospitals have a policy to wait three minutes delayed cord clamping. Then the cord is clamped and cut, even if the cord is still pulsating.
Optimal cord clamping is the practice of waiting until the cord is white and the blood vessels in the umbilical cord begin to close naturally, clamping themselves shut. This usually takes much longer than five minutes. In this time, the circulating oxygen and iron/stem cell rich blood is transferring from the placenta to your baby.
While this is happening, your baby is making a gentle transition to breathing at birth. It also allows your baby to remain with you, enabling the benefits of skin to skin contact and early breastfeeding.
Can I have delayed cord clamping during a c-section?
It’s possible to have delayed cord clamping with a c-section birth. This depends on your care provider being aware of the benefits and supporting a gentle transition for your baby.
It also depends on the reason for your c-section. If your baby is in severe fetal distress, there is placental abruption, or placenta previa, delayed cord clamping might not be possible.
Ideally, discuss delayed or optimal cord clamping with your care provider during pregnancy. You can negotiate the different scenarios to ensure your wishes are respected.