Optimal cord clamping: what’s the evidence?

What’s the evidence on optimal cord clamping?

We’ve known for many years that there are many advantages to leaving the umbilical cord intact for a few minutes after birth. Clamping and cutting the cord too early (including with shoelaces – please don’t ever do this) can deplete a baby’s iron stores and be detrimental to their health. In premature babies, early clamping and cutting of the cord leads to a lower chance of survival.

This is important information for parents, caregivers, birth workers and others. And expert researchers in this field have recently published a freely available paper which brings together the evidence in this area. I’m sharing that paper today as it’s such a useful addition to our knowledge and resources.


The Research

In Cord Management of the Term Newborn, Ola Andersson and Judith Mercer summarise the key points from the available evidence.

  • “Keeping the umbilical cord intact by delaying cord clamping for at least 3 minutes improves iron stores during infancy and supports health and development for the growing child. In preterm infants, delayed cord clamping reduces mortality by approximately 30%.
  • Many midwives prefer to delay cord clamping until pulsations cease or until the placenta is ready to deliver and experience good results.
  • To warn for risk of jaundice and need for phototherapy after delayed cord clamping is not evidence based.
  • A multidisciplinary approach is critical to implement guidelines, training, and education with scheduled audits to increase compliance with delayed cord clamping.
  • Intact cord resuscitation has been practiced for centuries at midwifery births, and has shown physiologic improvements in animal and human trials.” (Andersson & Mercer 2021).

The paper covers everything from the physiology of transfusion to the most recent evidence about the optimal timing of cord clamping. Andersson & Mercer (2021) discuss giving uterotonics (RCT evidence showed no negative effects when given 3 minutes after birth). They describe optimal cord clamping at caesarean section and cord milking. The remainder of their paper is a comprehensive summary of the evidence in every area related to optimal cord clamping.


Why we need to celebrate this paper

This summary is so important. It’s not the first article on this topic, but it’s a great one, and it summarises the current evidence. It’s one that I’ll be sharing in Gathering in the Knowledge and with clients and colleagues.

One of the reasons we need this so badly can be seen in the authors’ description of how modern medical practitioners ignored centuries old wisdom, thinking they knew better.

“Leaving the umbilical cord intact after birth has ensured our survival for millennia … In the mid twentieth century, with the advance of modern medicine, delayed [cord clamping] CC was replaced with the efficiency and expediency of immediate CC without testing for its safety. Practice was guided by expert opinion and delayed CC at birth was discarded from mainstream practice.” (Andersson & Mercer 2021).

So-called “expert opinion” is responsible for causing harm to women, babies and families in many other areas of maternity care. I’ve written about several other examples of this in my books. So it’s vital that we celebrate, share and cite papers like this one, which are based on scientific evidence and not the opinion, convenience or bias held by those who seek to control women and birth.


How to find out more

If you’d like to know more about this and related areas, I have a whole information hub offering blog posts and articles related to the birth of the placenta, which includes optimal cord clamping. I’ve also written a book which helps women and families to better understand the evidence, so you can make the decisions that are right for you.

You can see the research study that I’m talking about here: Cord Management of the Term Newborn

If you’d like to delve deeper into birth-related research and thinking, you’re always welcome to come and join me in an online course.

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Andersson O & Mercer JS (2021). Cord Management of the Term Newborn. Clinics in Perinatology 48(3): 447-70. https://doi.org/10.1016/j.clp.2021.05.002.