Waiting an extra few minutes to cut the umbilical cord after birth—delayed cord clamping—is now proven to have positive effects on your baby. So why don't we do it?
Visit any online message board for pregnant women, and you'll find one of the most hotly debated topics is when to clamp and cut the umbilical cord. The idea behind "delayed cord clamping" (DCC) is that allowing blood to flow from the placenta to the baby for a few minutes after birth has health benefits for the tiny newborn. A new study by researchers in Sweden published this week in JAMA (Journal of the American Medical Association) Pediatrics backs up this theory, proving the advantages extend into childhood.
Proven benefits of delayed cord clamping
The study found that although their overall development was the same, four-year-olds whose cords were clamped three minutes after birth had better fine motor skills, like drawing and fastening buttons, than those whose cords were cut within ten seconds. "The main benefit is improved fine motor function," Dr. Ola Andersson, the study's lead author and a pediatrician and researcher at Uppsala University in Sweden, told FitPregnancy.com of the findings.
The results support the researchers' 2011 study, which showed that DCC babies were less likely to be iron deficient at four months old, because the extra blood they received at birth increased their iron stores. Iron is important for brain development, and the new study reveals the lasting effects of the iron boost from DCC. "The brain develops motor skills in infancy that you can notice later," Dr. Andersson says. "See it as the roads are built but not really used until later in life."
When the researchers broke down the results by sex, they found that boys benefited from DCC even more than girls. "We discovered that boys have lower iron stores at birth and are more prone to have iron deficiency at four months," Dr. Andersson says. "That could mean that delayed cord clamping will be of greater advantage."
Dr. Ryan McAdams, a neonatalogist at Seattle Children's Hospital and a professor of pediatrics at the University of Washington, believes that the increase in iron from DCC is critical for babies. "Starting life with an adequate amount of iron may promote better growth and neurodevelopment," he told FitPregnancy.com. "This study is certainly encouraging, especially considering the intervention for improving long-term fine motor development took three minutes, was free, and was safe." Previous studies haven't shown any significant risks of DCC, besides a possible increase in jaundice.
Although the study didn't examine if there are further benefits to waiting even longer than three minutes to cut the umbilical cord, Andersson says, "My belief is that it depends on the completion of the placental transfusion [of blood to the baby], which is usually completed after three minutes but can take longer." He says that an OB or midwife should be able to tell when the umbilical cord turns from thick and blue to thin and white, which means the transfer of blood is done.
Discussing delayed cord clamping with your doctor
Andersson says that DCC is now standard practice in Sweden, but the majority of U.S. hospitals are still cutting the umbilical cord early. Although the World Health Organization supports it, the American College of Obstetrics and Gynecology hasn't yet endorsed DCC, citing a lack of evidence of its benefit. In light of this new study they might change their tune, but pregnant women who want to delay cord clamping should still talk to their OB well before delivery to review hospital policy and come up with a plan. "Discuss early in pregnancy, and provide the doctor with studies such as ours," Andersson advises.
Also, write it down as part of your birth plan, and give a copy to the labor nurse when you get to the hospital. As with any birthing preference, you may have to advocate for your choice during labor, or have your partner or doula do it for you. But McAdams says that's why it's best to get on the same page with your doctor beforehand. "I think all physicians or midwives caring for pregnant women should spend time discussing DCC," he says. "The birth experience will be improved for the parents and the healthcare providers if they have a conversation clarifying the mother's birth plan, discussing the various delivery options available, and listening to each others concerns."
McAdams says that the potential benefits of DCC greatly outweigh the risks, and hopes that studies like this one will prompt more doctors to agree. "When dealing with the precious lives of newborns, we should not waste this opportunity by quickly clamping the cord when a few minutes of patience may lead to improved long-term fine motor skills," he says. "You only get one chance to clamp the umbilical cord. In this case, there is wisdom in waiting."