By Rachel Wilson, Midwife
Inside the womb, baby’s circulatory system includes the cord and placenta. Between 30-50% of baby’s blood volume is in the cord and placenta at the time of birth. This blood belongs in baby’s body, and this blood will be returned to baby’s body via nature’s clever design if the process is not interfered with. When baby takes their first breaths and activates their pulmonary system, blood will cease to leave baby’s body, and instead will be pulsed back into them due to pressure changes. They require this optimal blood volume to help fully expand their lungs. If there is not enough blood volume to support this lung expansion, then blood will be diverted from other vital organs. Optimal cord clamping will also return 1 billion stem cells to baby, which are the vital building blocks of life, and an additional 60% more red blood cells. This has been shown to reduce the risk of anaemia (low iron) in bbaies throughout their first year of life, reducing the risk of neurodevelopmental delay. Optimal cord clamping also reduces the risk of sepsis (severe infection) and intraventricular haemorrhage (bleeding of the brain) in pre-term babies. It also provides vital oxygen to all babies as their lungs are inflataed and regular respirations established. This makes for a calmer, more gentle transition to the world.
Unfortunately, it is common practice in many medical settings to clamp the cord soon after birth. Some practitioners will also claim to support delayed cord clamping, but define this as leaving the
cord intact for 1 minute after birth, which is not necessarily optimal cord clamping, as the process will typically take longer than this.
Optimal clamping of the umbilical cord after birth involves delaying cutting of the cord until:
- the cord has ceased pulsating
- the cord has turned white and visible empty of blood
- baby has established breathing
- OR until the placenta has been born, as blood can now no longer transfer to baby.
Babies requiring resuscitation, should ideally be resuscitated with the umbilical cord intact, as they will still be receiving oxygen via the cord, thus improving outcomes for these babies.
However this is most easily achieved in a homebirth setting, where resuscitation equipment is portable. In a hospital setting, some hospitals around the world are implementing ways to provide
resuscitation without clamping the cord, however in Australia, most hospitals will have to clamp the cord to transfer baby to a fixed resuscitation table. Babies are less likely to require
resuscitation however, if they are able to receive their full volume of blood, as this supports lung expansion and respiration. The cord remaining intact, will also allow them to receive oxygen
during this important transition from cord to lung breathing.
There are some companies advertising ‘stem cell storage’ or ‘cord blood banking’, and we frequently see a lot of misinformation given to parents surrounding this. In order for baby’s stem
cells to be stored, the cord will need to be cut immediately following birth, and baby’s blood will be be drained from the cord and taken to storage. This deprives babies of vital blood and oxygen
at birth, which can lead to a range of medical issues and consequences, as outlined in this article. A small number of families may benefit from this, where there is a known medical need. However,
for the majority of babies, it is unlikely the stored blood will ever be used, it is a costly process with no guarantees and some possible legal implications, and the risks will outweigh any benefit.
The following quote from Darwin, highlights long known wisdoms around the natural processes of birth, which our medicalised society now often chooses to interfere with, without any evidence to
say we should. The current evidence fully supports optimal cord clamping, and aligns with what the wise Midwives and birth workers have known for millennia.
“Another thing very injurious to the child is the tying and cutting of the navel string too soon: which should always be left till the child has not only repeatedly breathed but till all pulsation in
the cord ceases. As otherwise the child is much weaker than it ought to be, a portion of blood being left in the placenta which ought to have been in the child.” (Darwin 1801)
Andersson O, Hellstrom-Westas L, Andersson D et al (2011). Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months. BMJ 2011 343: d7157.
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.
Buckley, S (2005). Gentle Birth, Gentle Mothering. One Moon Press, Brisbane.
Darwin E (1801). Zoonomia: Or the laws of organic life. London.
Hooper SB, Polglase GR, Te Pas AB (2015). A physiological approach to the timing of umbilical cord clamping at birth. Archives of Disease in Childhood – Fetal & Neonatal Edition 100(4), F355-360.
Hutchon DJR (2016b). Ventilation, chest compression and placental circulation at neonatal resuscitation – ILCOR recommendation 2015. Journal of Paedatric Neonatal Disorders 1(1): 1-6.
McDonald SJ, Middleton P, Dowswell T et al (2013). Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD004074. DOI: 10.1002/14651858.CD004074.pub3
Mercer JS (2001). Current best evidence: a review of the literature on umbilical cord clamping. Journal of Midwifery and Women’s Health 46(6): 402–14.
Mercer J & Erickson-Owens D (2010). Evidence for neonatal transition and the first hour of life. In: Walsh D, Downe S (eds). Essential midwifery practice: intrapartum care. Wiley, 81-104.
Mercer J, Skovgaard R, Erickson-Owens D (2008). Fetal to neonatal transition: first do no harm. In: Downe S (eds). Normal Childbirth: evidence and debate. Churchill Livingstone, 149–74.
Rabe H Diaz-Rossello JL Duley L Dowswell T (2012). Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant
outcomes. Cochrane Database Syst Rev. 2012; 8 (CD003248)
Royal College of Obstetricians & Gynaecologists. Clamping of the umbilical cord and placental transfusion: scientific impact paper No 14. 27 Feb 2015
Vain NE, Satragno DS, Gorenstein AN et al (2014). Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trial. The Lancet, doi: 10.1016/
Wickham S (2007). Cord Blood Banking: Who Benefits? TPM 10(7):42.