Visit any online message board for pregnant women, and you'll find one of the most hotly debated topics is when to clamp and cut the umbilical cord. The idea behind "delayed cord clamping" (DCC) is that allowing blood to flow from the placenta to the baby for a few minutes after birth has health benefits for the tiny newborn.
A 2015 study by researchers in Sweden published in JAMA (Journal of the American Medical Association) Pediatrics backs up this theory, proving the advantages extend into childhood.
Research has found that delaying clamping for at least a minute after birth allows more time for blood to move from the placenta. And that significantly improves iron stores and hemoglobin levels in newborns and does not increase the risks to mothers.
Doctors usually clamp the umbilical cord in two locations, near the infant's navel and then farther along the cord, then cut it between the clamps. The timing of the procedure has been controversial for years, and the new analysis adds to a substantial body of evidence suggesting that clamping often occurs too quickly after delivery.
"I suspect we'll have more and more delayed cord clamping," said Dr. Jeffrey Ecker, the chair of committee on obstetrics practice for the American College of Obstetricians and Gynecologists.
Newborns with later clamping had higher hemoglobin levels 24 to 48 hours postpartum and were less likely to be iron-deficient three to six months after birth, compared with term babies who had early cord clamping, the analysis found. Birth weight also was significantly higher on average in the late clamping group, in part because babies received more blood from their mothers.
Delayed clamping did not increase the risk of severe postpartum hemorrhage, blood loss or reduced hemoglobin levels in mothers, the analysis found.
"It's a persuasive finding," said Dr. Ecker. "It's tough not to think that delayed cord clamping, including better iron stores and more hemoglobin, is a good thing."
The Swedish research published in JAMA (Journal of the American Medical Association) Pediatrics backs up this theory, proving the advantages extend into childhood.
The study found that although their overall development was the same, four-year-olds whose cords were clamped three minutes after birth had better fine motor skills, like drawing and fastening buttons, than those whose cords were cut within ten seconds.
"The main benefit is improved fine motor function," Dr. Ola Andersson, the study's lead author and a pediatrician and researcher at Uppsala University in Sweden, says.
The results support the researchers' 2011 study, which showed that DCC babies were less likely to be iron deficient at four months old, because the extra blood they received at birth increased their iron stores. Iron is important for brain development, and the new study reveals the lasting effects of the iron boost from DCC.
"The brain develops motor skills in infancy that you can notice later," Dr. Andersson says. "See it as the roads are built but not really used until later in life."
When the researchers broke down the results by sex, they found that boys benefited from DCC even more than girls.
"We discovered that boys have lower iron stores at birth and are more prone to have iron deficiency at four months," Dr. Andersson says. "That could mean that delayed cord clamping will be of greater advantage."
Dr. Ryan McAdams, a neonatalogist at Seattle Children's Hospital and a professor of pediatrics at the University of Washington, believes that the increase in iron from DCC is critical for babies.
"Starting life with an adequate amount of iron may promote better growth and neurodevelopment," he says. "This study is certainly encouraging, especially considering the intervention for improving long-term fine motor development took three minutes, was free, and was safe." Previous studies haven't shown any significant risks of DCC, besides a possible increase in jaundice.
Although the study didn't examine if there are further benefits to waiting even longer than three minutes to cut the umbilical cord, Andersson says,
"My belief is that it depends on the completion of the placental transfusion [of blood to the baby], which is usually completed after three minutes but can take longer." He says that an OB or midwife should be able to tell when the umbilical cord turns from thick and blue to thin and white, which means the transfer of blood is done.
Want to make sure delayed clamping happens for your baby?
"Discuss early in pregnancy, and provide the doctor with studies," Andersson advises.
Also, write it down as part of your birth plan, and give a copy to the labor nurse when you get to the hospital. As with any birthing preference, you may have to advocate for your choice during labor, or have your partner or doula do it for you. But McAdams says that's why it's best to get on the same page with your doctor beforehand.
"I think all physicians or midwives caring for pregnant women should spend time discussing DCC," he says. "The birth experience will be improved for the parents and the healthcare providers if they have a conversation clarifying the mother's birth plan, discussing the various delivery options available, and listening to each others concerns."
McAdams says that the potential benefits of DCC greatly outweigh the risks. "When dealing with the precious lives of newborns, we should not waste this opportunity by quickly clamping the cord when a few minutes of patience may lead to improved long-term fine motor skills," he says. "You only get one chance to clamp the umbilical cord. In this case, there is wisdom in waiting."