Clamping and Cutting the Cord
What are my choices?
When thinking about what to do with your baby’s cord, you have three choices – have it clamped and cut straight away, delayed cord clamping and not clamping and cutting at all. Clamping and cutting the cord immediately after your baby is born is part of ACTIVE third stage management. Delayed cord clamping may be undertaken with ‘MODIFIED ACTIVE’ management, but may also be part of a physiological third stage. Not clamping and cutting the cord at all is called a lotus birth.
Why active management?
There are two reasons why your baby’s cord may be clamped and cut straight away. First, a woman may choose to have it managed this way. The other reason is the medical need to cut the cord. If your baby needs help with their breathing when they are first born, the cord will need to be cut so they can get this help. If you are bleeding excessively, you will need to birth the placenta so that we can manage your bleeding.
Why delayed cord clamping?
Delayed cord clamping is where your care provider leaves the umbilical cord to stop pulsating rather than immediately clamping and cutting at birth. Delayed clamping allows the transfer of your baby’s blood from their placenta into their body. This transfer happens while your baby is skin to skin with you on your chest, and can take from 60 seconds to 10 minutes, and beyond.
What are the risks and benefits?
Studies continue to show the benefits of waiting to cut the umbilical cord until it stops pulsating. Delaying cord clamping will enable your baby to transfer blood from the placenta to their bodies. Childhood iron deficiency and anaemia are reduced in these babies (12-14). This cord management can be especially helpful for preterm babies, reducing the necessity of blood transfusions, and can reduce the time needed on oxygen and ventilators (12,15). While some studies have found a slightly higher rate of jaundice requiring treatment when delayed cord clamping occurs, no significant risks of delayed cord clamping to mother or baby have been identified (14).
Can my baby still have delayed cord clamping if I have a c-section?
While the operating room is a different environment to a birthing suite (different temperature, sterile fields, bright lights), many care providers are happy to give your baby’s cord time to stop pulsating, or for some transfer of blood from the placenta to your baby. It is a topic worth discussing with your care provider prior to your birth so that they are aware of your wishes.
Are there any exclusions?
Your baby may need to have immediate medical assistance at birth. This need is not always predictable. While we try to support breathing support for baby at your bedside, it is not always medically possible. If your baby needs help to breathe at birth, the cord may need to be clamped and cut while it is still pulsating.
How do I get it?
Delayed cord clamping is becoming a policy in different care settings. However, for some practitioners and services, delayed cord clamping is a relatively new concept. This change may lead to care providers being unsure and hesitant in helping to provide you with this. However, for some practitioners and services, this management is a relatively new concept. Having a discussion with your care provider before your birth, or putting your wishes in writing, is an important step, is an important step that enables you to voice your preferences and the evidence behind them.
What is a lotus birth?
Lotus birth is when the umbilical cord is left uncut after birth. The baby is left attached to the placenta until the cord dries up and falls off at the babies belly button, usually a few days after the birth. You can manage your placenta a few ways. A colander is an ideal first vessel as it lets the placenta drain. Some women have a unique bag to carry it around in or wrap it in cloth nappies or wraps. Others treat it with daily salt or oils. If this interests you, please click here for more information.
Hayley Moyes (MMid) /Dr Janelle McAlpine (PhD) Clinical Midwives
Photo by N1_5.6 used under license from Shutterstock.com