How Long Should You Delay Cord Clamping

When you were born at home, your parents would have waited until you cried (or perhaps even longer) before taking off that first diaper. They knew it was important to give you time to get used to being out of the womb, so they wouldn’t cut into your skin too quickly — otherwise those nasty blood vessels would be pinched shut. The same is true with your baby’s umbilical cord.
The umbilicus serves as both an anchor point and conduit between your child and the outside world. Your little one latches on to this life-giving connection, which connects him or her to everything from oxygen to nutrients and waste removal. This vital lifeline also provides an easy way for doctors to find and access your baby, and may help prevent infection.
While the umbilicus will eventually fall away, cutting it too soon can cause complications ranging from bleeding to nerve damage. To avoid these issues and ensure optimal outcomes, many hospitals worldwide recommend delaying the clamping of the umbilical cord until enough fluid has been produced to fill the lungs and provide adequate circulation. In fact, the American College of Obstetricians and Gynecologists (ACOG) now recommends a delay in umbilical cord clamping for at least 30–60 seconds after birth in vigorous term and preterm infants.
“It takes about two minutes for the body to produce all the red cells needed for a healthy pregnancy,” says Dr. Michael Eisenberg, professor of obstetrics and gynecology at Columbia University Medical Center. “If we don’t wait the full 60 seconds, the infant won’t receive this benefit.”
While some babies are more active than others, typically only a few minutes pass between delivery and when the umbilical cord is clamped. But why? How long should you wait? And what happens if you do choose to clamp sooner? Read on to learn how long you should delay cord clamping.
Delaying Umbilical Cord Clampage
Umbilical cords vary in length by up to 2 inches (5 centimeters), but once you’ve delivered your baby headfirst, there’s no need to worry about timing. However, if your bundle of joy arrives feet first, you’ll want to consider waiting until the rest of his or her body emerges before clamping.
Clamping before your baby makes its first appearance risks damaging the delicate membranes surrounding the placenta. Once your child exits the birth canal, he or she is completely exposed to air and therefore susceptible to sudden changes in temperature and pressure levels. Cutting into the umbilical cord before your baby is fully formed could result in low blood flow and hypoxia, causing brain injury, while excessive heat could lead to hyperthermia.
Other factors come into play when determining whether or not to delay clamping. For example, having a large amount of amniotic fluid present helps protect the baby from hypovolemic shock, which occurs when rapid cooling causes the heart rate to slow down, decreasing blood volume to the kidneys. Additionally, because high amounts of fluid present within the uterus serve as insulation, less heat is lost through conduction during colder weather and more heat is retained during warmer months. A higher water content also means your little one’s ears are better protected against noise pollution.
Finally, delayed clamping offers a psychological boost to new parents, allowing them to take their time getting acclimatized to life outside the warm confines of the mother’s belly. It’s a nice break from the intensity of labor and birthing process, and it gives everyone a moment to breathe and relax.
So, when does it make sense to clamp early? If you’re delivering via cesarean section, cutting the cord prior to removing the placenta is necessary due to sanitary concerns. Otherwise, it’s generally recommended to hold off until the attending nurse or doctor indicates completion. That said, if you’re going to perform a routine episiotomy, then you can safely clamp earlier without any risk to mom or baby.
With all this information in mind, here are a few tips for making informed decisions regarding when to clamp the umbilical cord:
Check for pulse or heartbeat — Both pulses are strong indicators of life. When you see either one, wait until the cord stops pulsating before clamping.
Observe respiration — Breathing is another great indicator of life. Wait until your baby begins breathing independently before clamping.
Take note of color — While the cord appears pink when still attached to the placenta, it turns blue once separated from the placenta. Delayed clamping allows the baby time to adapt to the change in environment before cutting into it.
Avoid overzealous clamping — Make sure to use gentle pressure rather than hard yanks, as this increases the likelihood of hemorrhaging and trauma.
Catch it right — If you decide to clamp the cord prior to giving birth, make sure someone else is nearby to catch the drop. Also, keep yourself safe by using lanyards instead of hanging loops (which can pull loose).
for more detailed instructions on how to properly cut and tie off the umbilical cord, read our article on the topic.
According to the ACOG Committee on Accreditation, midwives and nurses who practice at freestanding birth centers and outpatient surgical facilities are allowed to delay clamping the umbilical cord for up to four minutes under certain circumstances. These include cases where the patient’s condition requires close monitoring, such as preeclampsia, premature rupture of membranes, fetal distress, placental abruption, chorioamnionitis, postpartum hemorrhage, severe maternal illness, congenital malformations, maternal death, etc., or if there is concern about the presence of meconium staining.

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