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Picture the moment your baby is born. The umbilical cord is still connected on one end to your baby, and on the other end to your placenta, which is still attached to your uterine wall. Essentially, your baby is limited in how far they can go from your vagina because they are tethered by the umbilical cord. You want to delay clamping of the cord, but, you want to get skin-to-skin right away. This article breaks down the logistics and timing of how immediate skin-to-skin contact and delayed cord clamping can work together.

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This article breaks down the timing and logistics of immediate skin-to-skin contact and delayed cord clamping. I get lots of questions on the mechanics of how these two events can be compatible. This article clarifies how you can do both immediate skin-to-skin contact and delay the clamping of your baby’s umbilical cord.

Right before your baby is born there can be a lot of commotion, especially in a delivery room in a hospital setting. You will have nurses and doctors in and out of your room during labor and the number of hospital staff goes way up for the actual birth. It can be overwhelming the moment your baby is born, especially emotionally for you. In these minutes after birth a lot can happen. I want to give you a good idea of how the timing of all of this works so you know what to expect and you can plan accordingly.

Picture your baby is born, but the umbilical cord is still connected on one end to your baby, and on the other end to your placenta, which is still attached to your uterine wall. Essentially, your baby is limited in how far they can go from your vagina because they are tethered by the umbilical cord. But, you want to get skin-to-skin right away, right? Let’s look at the logistics of how these two things can work together.

Skin-to-skin Contact

Let’s have a quick refresher on the importance of skin-to-skin contact. Skin-to-skin means that your baby is not swaddled or clothed and their bare skin is placed belly down against your bare chest. A blanket is then put over you and your baby to keep both of you warm. There are so many benefits of skin-to-skin contact. The biggest benefits are that it stabilizes your baby’s heart rate, breathing, and temperature. It reduces stress in both you and your baby. Your baby instinctively wants to breastfeed and being skin-to-skin with you will foster that. Skin-to-skin also increases your interactions with your baby and increases the likelihood and length of breastfeeding. The first hour after birth your baby will be pretty alert and this time period is considered the most crucial for skin-to-skin contact. If you do choose to opt into some procedures many of them can be performed while your baby is on your chest.

The Function of the Umbilical Cord

The umbilical cord is your baby’s lifeline. This goes from your placenta to your baby’s belly button. The umbilical cord contains three veins. The umbilical vein carries nutrient-rich, oxygenated blood from the placenta to your baby. Two umbilical arteries carry deoxygenated, nutrient-depleted blood from the fetus to the placenta.

The Practice of Clamping and Cutting the Cord

At some point, after your baby is born, a clamp is put on their umbilical cord. This is a plastic piece that will be put on the cord pretty close to your baby’s belly button. Once the cord is clamped, no blood is flowing so the timing between clamping it and cutting it is insignificant. Usually cutting is done immediately after clamping it. The umbilical cord has no nerve endings so it is painless and neither you nor your little one will feel anything when this happens.

History of Clamping and Cutting the Cord

For most of human history, we did not clamp and cut the umbilical cord immediately. This became standard practice in the 1960s because it was thought to reduce the likelihood of postpartum maternal hemorrhage. The keyword here is thought. Although more research needs to be done to know the effect of delayed cord clamping on maternal outcomes, immediate clamping does not reduce hemorrhaging.

When is Immediate Clamping Necessary?

The main instance where immediate clamping would be necessary is in an emergency where you or the baby were in danger. In this case doctors may want to cut the cord to separate you and your baby to give either of you needed medical attention. If that were to happen, of course, cut the cord and get the medical attention you or your baby need. As long as you and baby are doing well after birth your care provider could delay clamping the cord.

Why Delay Cord Clamping?

If the cord is not clamped immediately at birth, blood will continue to flow between the placenta and your baby for a few minutes. The net blood volume transferred to the baby during this time is called ‘placental transfusion’.  Placental transfusion can give your baby about a fifth of their blood volume at birth. This may make a difference to the health of your baby. Placental transfusion drains the blood left in the placenta, which may help the placenta separate from the womb and may reduce overall blood loss at birth for the mom. There is so much evidence to support delayed cord clamping. There is a full episode on delayed cord clamping that gets into the details of your options and the evidence on delaying cord clamping.

How Long to Delay?

The big question is when to do this. Do you clamp and cut the cord immediately or wait 1 minute, or 3 minutes? Or do you want to wait until the cord stops pulsating, which is closer to 10 minutes?

The World Health Organization recommends late cord clamping, which is performed approximately 1–3 minutes after birth. The WHO does not recommend early umbilical cord clamping, which would be less than 1 min after birth unless there is an emergency where your baby needs to be moved immediately. This recommendation stands whether you are having a vaginal or cesarean birth, or whether your baby is born at term, or earlier.

The American College of Obstetricians and Gynecologists notes a study that in full-term infants (babies not born prematurely) there is a transfer of approximately 80 mL of blood from the placenta to your baby by 1 minute after birth. By 3 minutes, there is a total transfer of 100 mL. ACOG notes that systematic reviews of other studies have suggested that clamping the umbilical cord in all births should be delayed for at least 30–60 seconds.

Delayed Clamping for a Cesarean or Premature Birth

There is evidence that delayed clamping is still beneficial if your baby is born prematurely http://www.cochrane.org/CD003248/PREG_early-cord-clamping-versus-delayed-cord-clamping-or-cord-milking-for-preterm-babies or if you have a cesarean birth.

Delayed cord clamping also does not interfere with placenta encapsulation. Overall, except for a medical emergency, you can delay cord clamping in any birth scenario.

Is the Umbilical Cord Long Enough?

Picture your baby is born, but the umbilical cord is still connected on one end to your baby, and on the other end to your placenta, which has not come out yet. Essentially, they are limited in how far they can go from your vagina because they are tethered by the umbilical cord. A common question is whether the cord is long enough to allow your baby to be on your chest before the cord is cut.

At birth, the umbilical cord will be about 20 inches, or 50-70 centimeters long. I know this seems really short but it is definitely long enough for you to get skin-to-skin with your little one.

Chances are right after birth you are not going to be lying flat on your back, you will be sitting up, or in a reclined position. When you are holding your baby, their head is going to be on your chest. This means their belly, where the umbilical cord is attached, is going to be lower, near your belly. So now when you think about the distance from around your belly button to the placenta, which is still attached to your uterine wall right after birth, it is much shorter than 20 inches. For the majority of babies, the umbilical cord should be plenty long enough to be skin-to-skin before it is cut. Not all umbilical cords are identical and it is possible your baby’s cord is shorter than 20 inches. If this is the case, it is possible you would need to keep your baby a little bit lower, so you are not putting a strain on the cord.

The Positioning of Your Baby Before the Cord is Clamped

In the past, it was thought that you needed to keep the baby lower than the placenta so that gravity could help with the transfer of blood. This is not true. A randomized study of almost 400 babies compared keeping newborns at the level of the vagina and at the mother’s abdomen or chest. The researchers found no difference in the amount of blood transferred between the two groups. Evidence shows your baby can immediately be put on your chest after birth before the cord is clamped and cut.

There really is overwhelming evidence of the benefits to both delayed cord clamping and getting skin-to-skin immediately after birth, and you can do both. I do recommend that you discuss all of this with your doctor or midwife to make sure you are on the same page well before you go into labor work out all of the details with your care provider, and include these items in your birth plan.

 

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