When You Should Cut Your Baby's Umbilical Cord

mom and baby with doctor cutting cord

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It used to be that the question was who should cut the cord after the birth of your baby. Though today, when it comes to the umbilical cord, there are more things to consider after the birth of your baby. Here is what you need to know to make the most informed decisions.

What’s an Umbilical Cord?

The umbilical cord is typically a collection of two arteries and a vein covered in a substance called Wharton’s Jelly. The jelly prevents the arteries and vein from being compressed during the pregnancy as well as during birth. (Some babies have a single umbilical artery known as a two vessel cord.)

Your baby receives oxygen and nutrients through this delivery system. Your baby will also excrete waste via the same system. The umbilical cord is attached to the placenta. This is where the blood vessels of the mother and the baby, while not in direct communication, exchange the things that the baby needs for the things that baby needs to dispose of from their blood.

Once your baby is born, the umbilical cord will begin to cease this delivery. The placenta is a disposable organ, meaning that with each new pregnancy, a mother will create a new placenta for that pregnancy alone.

The Third Stage of Labor

Once the baby has been pushed out of the uterus and is born or is delivered via cesarean, the third stage of labor begins. This is typically thought of only as the delivery of the placenta. In a vaginal birth, there is about a five to 30-minute window where the placenta naturally begins to separate and then is finally expelled via the vagina. After a cesarean section, the placenta is simply manually removed from the uterus.

So What Happens to the Cord?

This is where the options for the umbilical cord come in. In the past, the umbilical cord has been clamped and cut immediately, separating the baby from the mother even before the delivery of the placenta happens. New research in the past decade has shown that there are benefits for both premature and full-term infants to have delayed cord clamping.

Delayed Cord Clamping or Waiting Until the Cord Quits Pulsing

Delayed cord clamping can be a confusing term. The most common definition for delayed cord clamping is a simple delay of cutting and clamping the cord for a period of a minute or two. This allows the baby to receive more of the blood that is stored in the placenta, allowing it to flow to the baby as the cord continues to pulse.

Another option is to wait until the cord stops pulsing to cut it. This is said to allow all of the blood that would go to the baby to actually be received by the baby.

What Are the Benefits of Waiting?

For full-term infants, the benefits of delaying the clamping and cutting are that there is a decreased risk of iron deficiency anemia for the first six months of life. It is also important to note that while the baby is receiving blood from the umbilical cord, it acts as the body’s natural resuscitation system. 

If your baby is premature, it becomes even more critical for their health. In fact, some neonatal intensive care units (NICU) have made delayed cord clamping their standard of care. With these babies, it can decrease both the need for transfusions and the incidence of intraventricular hemorrhage (IVH), in addition to decreasing anemia.

What Are the Risks of Delayed Cord Clamping?

There have been many proposed concerns about the risks of delayed cord clamping. The good news is that delayed cord clamping is not associated with increased blood loss in the mother. While some studies show that full-term infants may be at a slightly increased risk for jaundice, it is not a reason to skip the delayed cord clamping—assuming treatment is available where you are giving birth.

There is some data that shows there may be a slight increase in polycythemia in full-term babies, the opposite of anemia (extra red blood cells in the baby’s blood). This, however, neither required treatment nor did it appear to be a direct result of the delayed cord clamping.

How to Get Delayed Cord Clamping?

The first step is to always to talk to your doctor or midwife to see what their normal practice is at birth. If delayed cord clamping is not their standard of care, you could explain your desire to your practitioner and together decide on a care plan.

When Is Delayed Cord Clamping Not Possible?

Occasionally something happens at the birth necessitating that the cord is cut sooner. One example might be if the cord is tied tightly around the baby’s neck at birth and the practitioner is not able to bring it over the baby’s head before birth. This is not typical. But, it’s important to realize that while the benefits of delayed cord clamping are good for your baby, if you are unable to do it safely, it’s generally not something that can’t be overcome with other measures.

Some other things to consider when delayed cord clamping is not an option:

1. The baby requires immediate neonatal attention or resuscitation, as can be the case in emergent deliveries or in some cases of prematurity 

2. Premature separation of the placenta from the uterine wall can occur resulting in excessive blood loss for both the baby and mom, as in cases of placental abruption or with placenta previa where rapid blood loss may be an issue. 

3. The desire to collect cord blood for banking where smaller volumes of placental blood collection can result in inadequate samples for storage. 

Who Can Cut the Cord?

With delayed cord clamping families are often able to have more choices as to who can cut the cord. It allows time for your partner or you to participate in this if you are interested. Be sure to check with your practitioner about this option for your birth plan.

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  • Mcdonald, Susan J., Philippa Middleton, Therese Dowswell, and Peter S. Morris. "Effect of Timing of Umbilical Cord Clamping of Term Infants on Maternal and Neonatal Outcomes." Evid.-Based Child Health Evidence-Based Child Health: A Cochrane Review Journal 9.2 (2014): 303-97.
  • Mercer, J. S. "Delayed Cord Clamping in Very Preterm Infants Reduces the Incidence of Intraventricular Hemorrhage and Late-Onset Sepsis: A Randomized, Controlled Trial." Pediatrics 117.4 (2006): 1235-242.
  • Nevill, Elizabeth, and Michael P. Meyer. "Effect of Delayed Cord Clamping (DCC) on Breathing and Transition at Birth in Very Preterm Infants." Early Human Development 91.7 (2015): 407-11.
  • Rabe, Heike, Jose Luis Diaz-Rossello, Lelia Duley, and Therese Dowswell. "Effect of Timing of Umbilical Cord Clamping and Other Strategies to Influence Placental Transfusion at Preterm Birth on Maternal and Infant Outcomes." Cochrane Database of Systematic Reviews Reviews (2012): n. pag. 

By Robin Elise Weiss, PhD, MPH
Robin Elise Weiss, PhD, MPH is a professor, author, childbirth and postpartum educator, certified doula, and lactation counselor.