Delayed cord clamping (DCC) is a method that can improve outcomes for the newly born infant who only requires routine neonatal care and does not need resuscitation right after birth. Immediate cord clamping and transfer to the neonatal delivery team is critical for high-risk newborns, especially preterm infants.

Umbilical cord clamping procedure.

Studies show that the team may delay cord clamping for longer than 30 seconds for term and preterm infants who only require routine newborn care and do not need resuscitation.⁵ The benefits of DCC include:

• Increased neonatal blood pressure
• Increased neonatal blood volume since placental blood continues to pump into the infant
• Reduced need for blood transfusions
• Decreased mortality
• Reduced risk of a brain hemorrhage
• Reduced prevalence of iron-deficiency anemia
• Potential improvement in neurodevelopment

In most cases, delayed cord clamping has more benefits than risks. However, the risks associated with delayed cord clamping include:

• Delayed onset of resuscitation efforts 
• Increased risk of high red blood cell concentration
• Increased risk of jaundice

Placenta previa, placenta abruptio, and cord avulsion are absolute contraindications for delayed cord clamping. In these cases, the team should clamp the cord as soon as the neonate is delivered. 

Physiology of Delayed Cord Clamping

When a baby is born, the placenta retains a significant volume of blood. If there is no disruption in circulation from the mother into the placenta and the umbilical cord, placental gas exchange between the mother and the infant continues. This functional blood transfusion during the first minute of transitional circulation is beneficial to the baby.

Procedures for Delayed Cord Clamping

A healthcare provider starts a timer once the baby is delivered and places the baby on the mother’s chest or abdomen for skin-to-skin contact. A warm and dry blanket or towel can be used to warm and dry the newly born. Very preterm infants can be wrapped in polyethylene plastic to assist them in maintaining temperature. 

Clamping the umbilical cord is delayed for 30 to 60 seconds if the newly born, term or preterm, is vigorous at birth. While performing DCC, healthcare providers monitor the baby’s tone and breathing.

If a baby is nonvigorous at birth, the obstetrician and the neonatal team can still perform DCC while the obstetrical team dries, warms, suctions, and stimulates the baby. If the infant does not improve after these initial interventions, the team clamps the cord and transfers the newly born to a radiant warmer for resuscitation by the neonatal delivery team.