Why Doctors Are Waiting To Cut The Umbilical Cord

“Cutting the cord” is a big moment in a newborn’s birth story, but exactly when to cut the umbilical cord has at times been a matter of debate. Now, major medical organizations are recommending that doctors wait longer to cut the umbilical cord after birth than they have in the past. Experts argue that delaying cord clamping and cutting by 30 seconds to a minute can have a significant impact on infant health and development, the effects of which can reverberate for years to into a child’s life.

In January, the American College of Obstetricians and Gynecologists (ACOG) released an official recommendation that doctors wait 30 to 60 seconds after birth before clamping and cutting an infant’s umbilical cord. ACOG’s report echoes earlier recommendations for delayed clamping made the American Academy of Pediatrics, the American College of Nurse–Midwives, and the World Health Organization.

According to ACOG’s committee opinion on the matter, it has been common since the mid-1950s to cut the umbilical cord almost immediately after birth — within 15 to 20 seconds. Prior to that, a longer delay before clamping was more common, but the time started getting shorter and shorter, due to the belief — since disproven — that faster umbilical cord clamping would reduce the mother’s risk of hemorrhaging. Now, experts are urging physicians to return to a longer delay, of 30 seconds to one minute.

The difference between 15 to 20 seconds and 30 to 60 seconds may seem small, but it turns out that big things happen in those extra few moments. ACOG reports that, if you don’t immediately cut the umbilical cord, 80 – 100 mL of blood will flow from the mother’s placenta to the infant in the first three minutes of a baby’s life, and most of that happens in the first minute. A baby’s first few breaths even encourage that blood flow from the placenta.

As you probably already know, blood contains iron, and research has shown that the extra iron provided by this last-minute blood infusion from the placenta helps to reduce instances of iron deficiency in infants. According to ACOG, childhood and infantile iron deficiency have “been linked to impaired cognitive, motor, and behavioral development that may be irreversible.” Iron deficiency is a major problem among children in developing countries, and even in the United States, it affects between 8 and 14 percent of babies and toddlers.

Delayed cord clamping may help to solve that problem. The New York Times reports that a 2011 study out of Sweden found that 5.7 percent of full-term babies who had their umbilical cords cut immediately upon birth had iron deficiency four months later. In contrast, only 0.6 percent of full-term babies with a cord clamping delay of 3 minutes had the same problem at 4 months. The study further showed that the effects of delayed cord clamping could echo for years: By the time they were 4 years old, kids who’d had delayed cord clamping showed “modestly higher scores in fine motor and social skills” that those who hadn’t.

Although ACOG’s recommendation for delayed cord clamping applies to all infants, the delay seems to be especially beneficial to babies born early. Studies have shown that preterm babies who receive delayed clamping are less likely to require blood transfusions for anemia (a red blood cell deficiency), and have a lower incidence of intraventricular hemorrhage (a type of bleeding in the brain) and necrotizing enterocolitis (a dangerous intestinal disease).

Delayed cord clamping and cutting seems like a fairly simple way to safeguard infant health. Previous concerns that delayed clamping could cause hemorrhaging in the mother have proven unfounded, and the primary risk of delayed clamping for infants is an increased incidence of jaundice requiring phototherapy (aka exposure to a special type of fluorescent light). ACOG’s report points out that, though delayed clamping is the organization's general recommendation, physicians will need to suit action to individual circumstances; there are cases in which the health of the infant or the mother may necessitate immediate clamping.