Why Delay Cord Clamping?

It is difficult to accurately define delayed cord clamping when there are so many arguments on what it could mean. Some describe it as delaying for one minute, some say not until the cord stops pulsating, and others say not until the umbilical cord falls off naturally on its own (lotus birth). For the purpose of this article, let's just consider any version of delaying cord clamping (from one minute onward) as the definition, as we can begin to explore the benefits of "all of the above".

So what are some benefits to delayed cord clamping? According to research, some of the top benefits are decreased risk of anemia, better outcomes for pre-term infants, increased blood volume / smoother cardiopulminary transition, increased stem cells, and neurodevelopmental benefits. Some of these benefits can be offered to infants by just waiting 60 seconds to clamp the cord. Though some disagree on the length of time needed for various reasons, including cultural tradition. Let's look at timing and benefits in more detail.

1) Decreased Risk of Anemia
​Delaying cord clamping by just 30 - 180 seconds after birth can result in higher hemoglobin and hematocrit during the neonatal period, increase serum ferritin levels, and reduce the incidence of iron deficiency anemia at 4-6 months of age. According to ACOG (The American Congress of Obstetrics and Gynecology), "Physiologic studies in term infants have shown that a transfer from the placenta of approximately 80 mL of blood occurs by 1 minute after birth, reaching approximately 100 mL at 3 minutes after birth. This additional blood can supply extra iron, amounting to 40–50 mg/kg of body weight. This extra iron, combined with body iron (approximately 75 mg/kg of body weight) present at birth in a full-term newborn, may help prevent iron deficiency during the first year of life."

2) Increased Blood Volume / Smoother Cardiopulminary Transition
Studies have indicated that up to 1/3 of a baby's blood volume is stored in the placenta. More blood volume is not only important for higher iron stores, but also assists with healthy brain development and transition from life inside the womb. By delaying clamping, the lungs will also receive more blood, so that the exchange of oxygen in the blood can occur smoothly. Other pediatric researchers state the following: 
"The transition to newborn life at birth involves major cardiovascular changes that are triggered by lung aeration. These include a large increase in pulmonary blood flow (PBF), which is required for pulmonary gas exchange and to replace umbilical venous return as the source of preload for the left heart. Clamping the umbilical cord before PBF increases reduces venous return and preload for the left heart and thereby reduces cardiac output."

3) Increased Stem Cells
Stem cells can develop into many different cell types in the body during early life and growth. They also have the ability to serve as a repair system, can divide without any limits in order to replenish other cells - for as long as you are still alive! They play an essential role in immune, respiratory, cardiovascular, and nervous system development (among other functions). A huge part of the argument to delay cord clamping is the fact that the concentration of stem cells in fetal blood is higher than at any other time of life. Immediate clamping of the umbilical cord leaves about 1/3 of these critical stem cells in the placenta! Many people believe that these stem cells are a birthright to newborns.

4) Neurodevelopmental Benefits
There has been growing evidence about the neurodevelopmental benefits of delayed cord clamping as well. While there doesn't seem to be any difference in IQ, studies show that 4 year old children who's cords were delayed in clamping for more than 3 minutes had higher social and fine motor skills versus those who underwent clamping within 10 seconds of birth. Part of this reasoning may be due to the fact that their higher blood volume received is important for healthy brain development.

5) Better Outcomes for Pre-Term Infants
Pre-term infants benefit even more in delayed cord clamping. In ten trials done on delayed cord clamping versus immediate cord clamping in pre-term infants, the benefits of delaying included reduced need for blood transfusions for low blood pressure and anemia, and a significant reduction in the incidence of intraventricular hemorrhage (brain hemorrhage). Other research has also added that delaying clamping in preemies also lowers the risk of necrotizing enterocolitis (a life threatening bowel injury).

The option of delaying cord clamping is yours, and can be added to your birth plan - including many cesarean births! There are even potential options of delaying if you plan to donate or bank any cord blood (but that topic will be for another article) - although you are often still left with less of an optimal time to transfer all of the benefits to your newborn by going that route. 
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I will leave you with the recommendations from the WHO (World Health Organization) on umbilical cord clamping:
WHO recommendations
(1) In summary:
Delayed umbilical cord clamping (not earlier than 1 min after birth) is recommended for improved maternal and infant health and nutrition outcomes.
From 2012 WHO guidelines on basic newborn resuscitation
(2): In newly born term or preterm babies who do not require positive-pressure ventilation, the cord should not be clamped earlier than 1 min after birth.
When newly born term or preterm babies require positive-pressure ventilation, the cord should be clamped and cut to allow effective ventilation to be performed.
Newly born babies who do not breathe spontaneously after thorough drying should be stimulated by rubbing the back 2–3 times before clamping the cord and initiating positive-pressure ventilation.
From 2012 WHO recommendations for the prevention and treatment of postpartum haemorrhage
3): Late cord clamping (performed approximately 1–3 min after birth) is recommended for all births, while initiating simultaneous essential neonatal care.
Early umbilical cord clamping (less than 1 min after birth) is not recommended unless the neonate is asphyxiated and needs to be moved immediately for resuscitation.

Resources:
http://www.who.int/elena/titles/full_recommendations/cord_clamping/en/. Optimal timing of cord clamping for the prevention of iron deficiency anaemia in infants, 2012-2014.
http://www.ncbi.nlm.nih.gov/pubmed/24499758. McAdams RM, Time to Implement Delayed Cord Clamping, March 2014.
http://www.ncbi.nlm.nih.gov/pubmed/23407180. Raju TN, Timing of Umbilical Cord Clamping After Birth for Optimizing Placental Transfusion, April 2013.
http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Timing-of-Umbilical-Cord-Clamping-After-Birth. Committee Opinion, Timing of Umbilical Cord Clamping After Birth, 2014.
​http://archpedi.jamanetwork.com/article.aspx?articleid=2296145. JAMA Pediatrics, Andersson, Ola, MD, PhD, Lindquist, Barbro, PhD, Lindgren, Magnus, PhD, Stjernqvist, Karin, PhD, Domellöf, Magnus, MD, PhD & Hellström-Westas, Lena, MD, PhD. Effect of Delayed Cord Clamping on Neurodevelopment at 4 Years of Age A Randomized Clinical Trial, July 2015.
http://www.ncbi.nlm.nih.gov/pubmed/25671807. Hooper SB, Te Pas AB, Lang J, van Vonderen JJ, Roehr CC, Kluckow M, Gill AW, Wallace EM & Polglase GR. Cardiovascular transition at birth: a physiological sequence, May 2015.
http://www.scienceandsensibility.org/p/bl/et/blogid=2&blogaid=526. Sloan, Mark, MD, Common Objections to Delayed Cord Clamping - What's the Evidence Say? March 9, 2016.
https://en.wikipedia.org/wiki/Stem_cell. Wikipedia, Stem Cell, April 13, 2016.
http://stemcells.nih.gov/info/basics/pages/basics1.aspx. National Institutes of Health, Stem Cell Information, March 5, 2015.
http://www.npr.org/sections/health-shots/2015/05/26/409697568/delayed-umbilical-cord-clamping-may-benefit-children-years-later. Haelle, Tara, NPR, Delayed Umbilical Cord Clamping May Benefit Children Years Later, May 26, 2015.
http://www.ncbi.nlm.nih.gov/pubmed/24901269. Backes CH, Rivera BK, Haque U, Bridge JA, Smith CV, Hutchon DJ & Mercer JS, Placental transfusion strategies in very preterm neonates: a systematic review and meta-analysis. July 2014.
http://www.ncbi.nlm.nih.gov/pubmed/25984654. Nevill E and Meyer MP, Effect of delayed cord clamping (DCC) on breathing and transition at birth in very preterm infants. July 2015.
https://www.nlm.nih.gov/medlineplus/ency/article/007301.htm. Medline Plus, Intraventricular hemorrhage of the newborn, April 27, 2015.
https://cord-clamping.com/2011/09/08/cesarean-delayed-clamping/. Emerson, Kate, Cesarean Section and Delayed Cord Clamping, September 8, 2011.
http://fn.bmj.com/content/early/2014/12/24/archdischild-2013-305703.abstract. Hooper, Stuart B, Polglase, Graeme R & te Pas, Arjan B, A physiological approach to the timing of umbilical cord clamping at birth, December 2014.