Kuan Lee 
Before you give birth, there’s a list full of options you need to research and many decisions to be made.
Today, we’re talking about an area you may not have considered yet: Decisions around umbilical cord cutting. Many doctors follow routine cutting techniques, even though new research suggests there could be benefits to other cord clamping ways. Because your healthcare provider may not go over these options with you, knowing about them in advance can help you start the conversation and make the best decision for your baby.
In this post, we’re discussing the difference between immediate cord clamping, delayed cord clamping and umbilical cord stripping. You’ll learn the benefits and risks to each.
Definitions
The umbilical cord runs from your baby’s belly button area to your placenta. This is how she receives nutrients and blood. Whether you have a vaginal birth or a c-section, after labor the cord is cut by the healthcare practitioner or your partner (sometimes family members are asked if they’d like to cut it). Two clamps are placed on both ends so that a pair of scissors can easily cut through. The umbilical cord used to be routinely cut seconds after birth. However, now there’s a couple of different options.
Before we dive into the cord cutting options, we’re laying out the acronyms so you can easily refer back to them when you read.
- ICC— Immediate cord clamping
- DCC— Delayed cord clamping
- UCM— Umbilical cord milking or stripping
What is Delayed Cord Clamping?
Immediate cord clamping (ICC) is when the doctor clamps your umbilical cord right after you’ve given birth, usually 10 to 30 seconds after. Although it’s still popular in U.S. hospitals, some experts now recommend against ICC unless the baby can’t breathe and needs to be resuscitated. Recently, some research has shown the benefits of waiting longer, especially for preterm babies.
Delayed cord clamping (DCC) occurs when the cord is clamped at least 30 to 60 seconds after birth, often longer. This allows more blood to flow from the placenta to the baby and can increase the baby’s blood volume by one third.
There’s debate surrounding how long to wait until the cord is clamped; however, the World Health Organization (WHO) says it should not be clamped earlier than necessary. The organization recommends waiting 1 to 3 minutes, but many midwives wait until the cord has stopped pumping. This can be as long as 5 minutes.
Most experts agree that DCC can benefit preterm babies. However, until recently the American Congress of Obstetricians and Gynecologists (ACOG) said there wasn’t enough evidence about its effect on full-term babies. The organization updated its views in 2018, recommending DCC in both vigorous term and preterm babes.
According to research by the ACOG, in term newborns, DCC increases hemoglobin levels and improves iron storage for the first few months of life. This extra blood can benefit development. Unfortunately, among full-term infants, there’s a small increase in jaundice that should be prepared for. DCC has the most benefits for preterm infants. It’s associated with improved red blood cell volume, a decreased need for blood transfusion and reduction in intraventricular hemorrhage.
Having a higher blood volume also lowers a baby’s risk of anemia. This can lead to central nervous system problems and affect cognitive development.
A 2019 study by the National Institutes of Health found that a 5-minute delay in clamping could benefit baby brain development. Compared to others, 4-month old infants who underwent DCC had more myelin. This chemical insulates the brain and improves communication within it. It’s associated with visual, motor and sensory functioning. Since myelin is produced by brain cells that are dependent on iron, having extra blood likely produced this benefit.
Whether you have a vaginal birth or a c-section, DCC is possible and is a decision you should discuss with your healthcare provider. Since many hospitals still practice ICC, you may need to make your doctor or midwife aware of your decision for DCC beforehand.
Delayed Cord Clamping Benefits
- Increases newborn’s iron levels (helps brain development)
- Decreases risk of iron deficiency anemia (and side effects associated with it)
Benefits for Preterm Babies:
- Improved red cell volume
- Reduced need for blood transfusion
- Reduced intraventricular hemorrhage
- Reduced risk of necrotizing enterocolitis (intestinal disease)
- Better blood circulation
Risks of Delayed Cord Clamping
- Not safe for babies who need to be resuscitated
- Can increase jaundice in full-term infants
- Increases risks of needing phototherapy for jaundice
*Contrary to what some believe, the ACOG says that DCC does NOT increase the risk for postpartum hemorrhage or maternal blood loss.
What is Umbilical Cord Milking/Stripping?
Umbilical cord milking (UCM) or stripping is an alternative or can be an addition to DCC. The unclamped umbilical cord is held and blood is pushed to the baby several times before it’s cut. This can be done in about 20 seconds.
Research suggests that this procedure can increase hemoglobin levels and lower the risk for oxygen requirements in preterm babies. It also lowers the risk of intraventricular hemorrhage when compared to ICC.
In the U.S., nearly 39% of obstetrical providers use UCM with 25% using the technique on infants that need resuscitation. Since DCC isn’t safe for babies who need to be resuscitated, UCM may be used instead. Instead of waiting a few minutes for the transfer of blood to occur, the doctor “squeezes” the blood toward the baby in a matter of seconds.
According to a study by the American Journal of Obstetrics and Gynecology (AJOG), UCM is a safe procedure that improves hemoglobin and iron levels for term and near term babies.
Umbilical Cord Stripping Benefits
- UCM can be used on babies who need to be revived (DCC shouldn’t be)
- May lower risk of intraventricular hemorrhages
- Maybe more beneficial than DCC for preterm babies born by c-section
- Can increase hemoglobin levels
- Can increase iron levels
Umbilical Cord Stripping Cons
- DCC is typically preferred
- Adding UCM to DCC may not increase red blood cell volume
- UCM doesn’t further reduce hospital deaths or the need for transfusions
Delayed Cord Clamping vs. Umbilical Cord Stripping
Unlike DCC, there isn’t significant research on the risks and benefits of UCM. Although it may be used in some hospitals and by some midwives in specific cases, there’s not enough evidence to provide general recommendations. Currently, DCC is preferred to UCM when appropriate.
An Australian study found that adding cord stripping to DCC does not increase red blood cell volume.
A 2018 study compared DCC and UCM for preterm infants. Researchers found that, compared to DCC, UCM didn’t reduce in-hospital death rates or the need for blood transfusions. However, UCM may further lower the risk of intraventricular hemorrhages and some health outcomes.
Another comparison study found that UCM may be better at improving blood flow than DCC in premature babies born by c-section.
Cord Clamping Options: Which is Right For You?
Whether ICC, DCC or UCM is right for you depends on your preferences and health.
If you’ve read about DCC and wish to transfer the potential benefits to your baby, talk to your doctor or midwife about it before you give birth. Many hospitals prefer ICC because they can cut the cord right away, transfer the baby into care and move onto the next patient.
Since DCC requires a few minutes more, your provider will need to plan for that. Even if you plan for one technique, that decision may need to be changed depending on how your labor goes. For example, if a baby isn’t in good health when they’re born, a doctor may recommend ICC or UCM instead of DCC.
Summary
DCC is recommended for preterm babies, but can also be beneficial for full-term babies. In both groups, it can increase blood volume, decreasing the risk for anemia and increasing health outcomes. On the other hand, UCM can be beneficial mostly for preterm babies born through c-section. In addition, when DCC can’t be used because a baby needs to be resuscitated, UCM may be used instead. Compared to DCC, it’s more controversial and there’s less research on it.
Have you been researching your umbilical cord cutting options? If so, comment below about the decisions you’re making. If you have any pregnant friends or family members, be sure to share this post to help them, too!
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