When to Clamp the Baby's Umbilical Cord (if you do it at all!)
Look at that beautiful cord!
This photo was snapped nine minutes after her baby was born. See that blood still in there? This is a great example of why it's important to practice optimal or physiological (aka "delayed") clamping of the cord and why that should be the standard practice in any setting. Despite abundant evidence to the contrary in many hospitals it is still often clamped within seconds or minutes. It takes approximately 17 years for new and better evidence-based practice to actually be implemented in hospitals (think about that for a moment!) so perhaps it's not surprising when hospital staff is not enthusiastic about waiting or even say it's not important.
That blood still flowing is full of OXYGEN, stem cells, iron, and nutrients that belong to and in your baby. At the moment of birth, the placenta and cord still contain up to 30% of the baby's blood. It is designed to still pump into the baby, nourishing them and building up their supplies for the healthiest newborn and infancy possible. The research is now abundant that leaving a cord for at least a few minutes is best practice for a healthier baby. (Another great article here.)
In fact, we should change the way we speak about “cord blood” because our language matters and influences how we believe and behave. That 1/3 of blood still circulating in the placenta and cord at birth is the THE BABY’S BLOOD. The cord is the beautiful delivery device but the blood doesn’t belong to the cord nor is it meant to stay there. The baby needs all their blood for optimal health, oxygenation, iron stores, circulation, clotting, stem cell transfer, and more. It's also theorized that those stem cells are responsible for better healing and recovery for the baby after birth. It’s not cord blood any more than the blood currently in your toe is “toe blood” or if you go to donate blood they tap into “arm blood.” It’s YOUR blood! The blood in the human body is mobile and doesn’t just stay in one part and the same goes for our babies.
Along the same lines, the term “optimal” or “physiological cord clamping” rather than “delayed” is more appropriate. Delayed implies that cutting immediately is the biological norm when really, we should be seeing immediate clamping and cutting as intervention in a natural and important process. Study after study shows what should be common sense: A baby does best when they have all their blood. It sounds almost ridiculous when we put it that way, right? All of us do best when we have all our blood!
If baby needs extra help transitioning and breathing, it is even more important that their main supply of oxygen not be cut. It makes sense that babies do better when any resuscitation is done with the cord intact. It is almost always possible to give the baby extra help while the cord is still supporting baby and baby stays on or right next to mom though that is not the norm in most American hospitals. Other countries make use of a cart that pulls right up next to the bed where baby can receive any help transitioning while still being attached to the cord and placenta.
There should be no rush and the cord should not be clamped or cut until it appears white, limp, and no more blood is pulsing through. When it’s left alone, the cord technically doesn’t even need to be clamped since it clamps itself and nothing will come out if it’s empty. There is no magic universal minute when the cord is emptied. It should be determined individually by looking at and feeling the cord. The cord will get completely limp, almost white, about half to a quarter the original size. Some may be done after 4-5 minutes, some may take 15 or more!
If putting this on a birth plan, "wait for white" is a more helpful term since “delayed” is subjective to the provider. Many medical providers still believe that means waiting only 1 minute. Better yet, make it clear before and during birth that you don't want it clamped until you have examined it and are comfortable. The medical system is often in a rush to pack up and get everything done immediately after baby is out but you and baby deserve to have that sacred time, unhurried and without being rushed for the sake of your baby's long term health and in honor of those precious moments.
There are a few myths surrounding umbilical cord physiology that still sometimes get thrown about (often by medical personnel who should know better). The blood will NOT flow back into the placenta and be "taken away" from the baby as some people have told mothers. That's not how the physiology works once baby is out and breathing. At that point the blood is only flowing one direction, into the baby. Another myth: you have to hold the placenta above the baby or if the placenta is still in, hold the baby below mom's body because of gravity. This is also not a physiological thing! Just like our bodies can pump blood upwards and all our blood isn't pooled at our feet, so too can the vessels in the cord. There is also no evidence to suggest an increased risk from jaundice from allowing the baby to have all his or her blood. And yes, optimal cord clamping can also be done at a cesarean birth.
Another wise thing to consider in your planning is that the cord and placenta go where you want them to, not sold or donated for research or to pharmaceutical or cosmetic companies without your consent. This is a common practice in hospitals which is indicative of just how potent and powerful those stem cells are. Finding out what a hospital typically does with the cord and placenta might require a few phone calls and is something you'd want to learn before birth since there's a good chance the hospital staff at the birth won't even be certain. They are either incinerated, thrown out as medical waste, or sold to pharmaceutical, research, or cosmetics companies. Sometimes they go to pathology to be inspected if there was thought to be a medical issue with it (after that incinerated, thrown out as medical waste, or sold). You can find more information about other options for your placenta in this post.
For some mothers there is also the option of not cutting at all and instead choosing to do a cord burning. This wouldn't likely be an option in the hospital but it's an interesting one to learn about and consider in a birth center or at home. Instead of a quick scissor snip, a candle is used to burn through the umbilical cord, making for a slower, more intentional, and richly symbolic transition to life outside the womb. There’s no need to clamp the cord at all as the flame cauterizes it. Depending on how many candles are used it may take anywhere from 5 to 20 minutes to burn through and there may be a slight burning odor as well. There is no harm to the baby doing this and there are no New Age practices inherently connected to it. It’s perfectly acceptable within the Christian faith. Cauterizing is regularly used all sorts of ways medically and we know candles and fire are often used within our faith tradition and culture to highlight important truths. Cord burning may sound foreign or weird to us in our modern western culture but our ancestors or people in other cultures would probably say the same about using scissors! It's even more profound and beautiful if a blessed candle (a sacramental!) is used to honor the significance and sacredness of this moment.
Absolutely discuss cord clamping and cutting with your provider before birth. Make sure you’re on the same page and that your husband or doula know to keep an eye out for hurried staff rushing to clamp during this critical time. It is incredibly hard in those seconds and moments after you have just pushed out a baby to be cognizant enough to advocate for yourself or even be aware of what is happening. So make sure your provider clearly knows not to clamp until you say so. You are the mother of that baby and you are the "owner" of the cord that is quite literally attached to your body! Making sure you know the design of God for birth, your options, the reasons behind them, and having your choice honored and respected is critical to a better and healthier birth experience for both you and your baby.