1. Killion, Molly M. MS, RN, CNS

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Delayed umbilical cord clamping has often been considered a request initiated by women seeking less interventions during labor and birth. However, a growing body of evidence suggests it should be established as best practice and that it offers benefits to newborn babies (American College of Obstetricians and Gynecologists [ACOG], 2017). Immediate cord clamping was likely adopted as a matter of provider convenience without adequate study or evidence about immediate or long-term effects (Katheria, Lakshminrusimha, Rabe, McAdams, & Mercer, 2017). Immediate cord clamping disrupts physiologic processes that occur at birth. At midterm gestation, blood is relatively equally distributed between the fetus and the placenta, however at term, about two thirds of this shared blood is within the fetus at any given moment in time (Katheria et al.). Similarly, the fetal lungs only receive about 10% of the fetal cardiac output, whereas the neonatal lungs require about 50% to support respiration, thus blood from the placenta, which was responsible for in utero gas exchange, at birth needs to get to the newborn lungs (Katheria et al.).


For term babies, delayed cord clamping has been shown to improve hemoglobin levels at birth and improve iron stores in the first months of life (ACOG, 2017). Iron deficiency in early life has been associated with likely irreversible impaired cognitive, motor, and behavioral development so delayed cord clamping could positively affect developmental outcomes or offer a potential for neuroprotection (ACOG). For preterm babies, benefits are more widely recognized, and include decreasing rates of transfusion, and lower incidence of intraventricular hemorrhage and necrotizing enterocolitis (ACOG). Increasing the amount of feto-placental blood that remains with the baby rather than in the placenta also increases the amount of immunoglobulins and stem cells being passed to the baby (ACOG). A major concern about delayed cord clamping at term has been risk of jaundice. Although there is a slight increase in incidence of phototherapy for jaundice (ACOG), studies have not found a significant difference in risk for jaundice by 48 hours of life (Katheria et al., 2017). Delayed umbilical cord clamping is now being recommended when safe and feasible for all births by ACOG, the Neonatal Resuscitation Program (NRP) guidelines, and the World Health Organization (WHO) (ACOG).


Timing of delayed cord clamping is often debated; ACOG and NRP recommend 30 to 60 seconds between birth and clamping of the umbilical cord, whereas the WHO recommends no less than a minute (unless the baby requires positive pressure ventilation) and the American College of Nurse-Midwives advises a 2- to 5-minute delay (ACOG, 2017). Physiologically, immediate cord clamping leaves approximately 30% of feto-placental blood volume in the placenta; 60 seconds of delayed cord clamping decreases this to 20%; and, if the delay in clamping the umbilical cord lasts 3 to 5 minutes, only approximately 13% of that shared feto-placental blood is left behind (Katheria et al., 2017). Babies born vaginally can be placed skin-to-skin on the mother's abdomen or chest during delayed cord clamping; babies born by cesarean should be held on the mother's legs or abdomen (ACOG). During this waiting period, newborn care and support should begin. Newborn babies should be dried, stimulated for their first breath or cry, and their temperatures kept normal (ACOG). Spontaneous respirations, including crying, can help to facilitate placental transfusion due to intrathoracic pressure shifts. Recent studies suggest immediate cord clamping before the onset of spontaneous breathing may adversely affect cerebral perfusion during the transition from fetus to neonate (Katheria et al.).


Immediate cord clamping is a practice that disrupts a normal physiologic process that likely offers lasting protective benefits to the newborn (Katheria et al., 2017). Teams caring for women during childbirth are encouraged to consider implementation strategies to initiate delayed umbilical cord clamping for all births of vigorous term and preterm babies. Nurses can take the lead in sharing the recommended change in practice and associated benefits with their colleagues.




American College of Obstetricians and Gynecologists. (2017). Delayed umbilical cord clamping after birth (Committee Opinion No 684). Obstetrics and Gynecology, 129(1), e5-e10. doi:10.1097/AOG.0000000000001860 [Context Link]


Katheria A. C., Lakshminrusimha S., Rabe H., McAdams R., Mercer J. S. (2017). Placental transfusion: A review. Journal of Perinatology, 37(2), 105-111. doi:10.1038/jp.2016.151 [Context Link]