The umbilical cord provides a growing fetus with nutrients and oxygen crucial to development and growth. It runs from an opening in your baby’s stomach to the placenta in the womb. The average cord is about 50cm (20 inches) long. At birth, the cord is clamped and cut to separate the maternal-infant blood supply.
| The World Health Organization recommends delaying cord clamping for at least 1 minute. |
How the Cord is Clamped ?
Soon after the birth, the midwife clamps the umbilical cord about 3-4cm (1½-2 inches) from your baby’s belly button with a plastic clip, place another clamp at the other end of the cord, near the placenta. The cord is then be cut between the two clamps, leaving a stump about 2-3cm (1-1½ inches) long on your baby’s belly button. Your midwife will cut the cord or, with their agreement, you or your birth partner could do it.
There are no nerves in the cord, so cutting it isn’t painful for you or the baby. Between 5 and 15 days after your baby is born, the umbilical stump will dry out, turn black and drop off. After the stump comes off, it usually takes about 7-10 days for the belly button to heal completely.
Until the stump drops off and the belly button is completely healed, it’s important to keep the area clean and dry, to prevent infection..
When to Clamp the Umblical Cord ?
In most cases, umbilical cord clamping is performed within 15–20 seconds after birth, with the infant maintained at or below the level of the placenta. Although many randomized controlled trials of term and preterm infants have evaluated the benefits of immediate umbilical cord clamping versus delayed umbilical cord clamping (generally defined as umbilical cord clamping performed 30–60 seconds after birth), the ideal timing for umbilical cord clamping has yet to be established and continues to be a subject of controversy and debate.
Benefits of Delayed Cord Clamping
There are both immediate and long-term infant benefits for delayed cord clamping, including
- Increased blood volume
- Decreased necessity for blood transfusions
- Decreased need for surfactant use and mechanical ventilation in premature and low birthweight babies
- Decreased incidence of intracranial hemorrhage, necrotizing enterocolitis and late-onset sepsis
- Increased hematocrit and hemoglobin
- Increased blood pressure, cerebral oxygenation and red blood cell flow in premature and low birthweight babies
- Decreased incidence iron deficiency anemia in term babies.
- A mother is holding her newborn baby.
Research suggests that delayed cord clamping could benefit both mother and child.
Iron store improvement can also be experienced, especially when the cord is clamped after around 2-3 minutes. In December 2014, Medical News Today reported on a study published in the journal Pediatrics that found delaying cord clamping by 2 minutes results in better development for the newborn during the first days of life. During this time, “placental transfusion” (transfer of placental blood) occurs, providing the infant with 6-8 months of iron reserve. This extra iron is especially important in cases of “infants living in low-resource settings with less access to iron-rich foods and thus greater risk of anemia.” Iron deficiency early in life can lead to permanent delayed psychomotor development, impaired language and motor skills, as well as coordination impairments.
The single most important clinical benefit for preterm infants is the possibility for a nearly 50% reduction in intraventricular hemorrhage. It is important to note that the timing of umbilical cord clamping should not be altered for the purpose of collecting umbilical cord blood for banking.
To sum up, further studies are needed to evaluate the optimal timing of umbilical cord clamping, the management of the third stage of labor in relation to umbilical cord clamping, and the timing of umbilical cord clamping in relation to the initiation of voluntary or assisted ventilation in the neonate. The ideal time for clamping the umbilical cord after cesarean delivery versus vaginal birth is an especially important area for future research.