The Third Stage of Labor is one that is often forgotten. This is the span of time between the birth of the baby and the expulsion of the placenta. The typical medical birth looks like this for the third stage: baby emerges, cord is clamped immediately, baby is taken by a nurse to a warmer, mother is injected with pitocin, cord is tugged and the placenta is pushed out through force such as a nurse or the doctor pushing on the abdomen.
While I find a lot wrong with that whole picture I want to focus on the part that really effects your baby the most (in my opinion) – immediate cord clamping.
First, and fundamentally – when the cord is cut within seconds this allows that baby to be taken from the mother. It is proven that skin-to-skin directly after birth, and for the first hours, is best for mother and baby barring medical emergency. If the baby is still connected to you, they can’t take baby and you get skin-to-skin.
But the most important aspect of cord clamping to me is the loss of blood to your newborn. “Blood Loss?” you might say – after all, the cord is clamped off at both ends, so this is not a messy process. The blood loss I am talking about is all the blood that has been left in the cord and placenta, and that belongs to your baby. Up to HALF of your newborn’s blood is still waiting to go into the body when the cord is clamped immediately.
Let us get a quick education in how the cord reacts if left alone. The cord will normally pulse (deliver blood to the baby) for about three minutes after the birth – sometimes longer. The cord then clamps itself. Yep, that’s right – it does the job for you.
This amazing cord contains Wharton’s Jelly. During pregnancy and birth this jelly protects the arteries and veins in the cord – this is why knots and tangled babies are fine the majority of the time – the Wharton’s Jelly keeps the cord firm and unable to collapse. After the birth the Jelly slowly “clamps” down on the arteries first, then the umbilical vein. The cord will slowly turn from heavy and firm (and colored) to limp and white. At this point it can be cut with little to no mess at all – no medical clamps needed!
Now back to the immediate clamping of the cord – which is common medical practice.
The immediate effects of this are pretty common sense – after all, what would you do with half your blood missing? Your body could not move oxygen as well, could not clean out impurities as fast, and your iron levels would be horrible. Oh, and you would most likely need major medical care. Luckily newborns are pretty tough – but why do we take the risk?
To get the “visual” of this issue, here is a great and quick video that shows visually the blood volumes we are talking about here. I also have found an amazing resource in this group of videos by an OB/GYN who lectured on this subject during Grand Rounds. It is in four parts and long, but very worth the time to watch. (And perhaps to pass along to your OB/GYN?)
Jaundice is one of the big questions that comes up with delayed clamping. After all, doesn’t more blood mean more blood to “clean” to get rid of bilirubin? In fact, when women talk with me about what their doctors have to say about delayed cord clamping, they normally say this is brought up as the #1 reason to not delay.
However, studies show that while jaundice is slightly increased, it is a benign increase. In other words – more “tan” babies but no increase in SICK babies. After all, not all jaundice is harmful, in fact it is pretty normal. There was no increase in the amount of babies needing phototherapy or other clinical issues relating to jaundice.
Blood iron levels are something that pediatricians watch in little ones. Many parents are told that infants need extra iron during the first six months, be that from formula (which has added iron) or from drops given to the breastfed infant.
However, one has to wonder if this issue has cropped up due to the practice of immediate cord clamping, since studies show better iron levels in infants who have delayed cord clamping. Even better – this effect lasts until about six months of age – the age many babies are ready to start solids and therefore get more iron in a natural way.
When studies looked at infants within 24 hours after birth, at 2-3 months of age, and at six months, all the studies showed higher iron and ferritin levels for those with late-clamping. This seems to say that our babies were made by design to store enough iron to keep themselves healthy until they start solid foods. Of course, this only happens if we let nature take its course as intended.
Another effect of early cord clamping is less oxygen. This makes sense – after all, your blood carries your oxygen. If you don’t have enough blood, you don’t have enough oxygen. This is why many midwives will call the cord/placental unit a “resuscitation kit” – if baby is having trouble starting up right away that extra blood and oxygen from the placenta and cord can help the lungs get to work – and provide the baby with oxygen in the meantime (like the placenta has been doing for the past 40 or so weeks).
These studies even show that preterm infants are better off getting delayed clamping if at all possible. Cesarean section births were included and the benefit is pronounced for these infants as well – no doubt due to the higher instance of resuscitation needed after cesarean sections.
Loss of oxygen and proper blood flow at birth could also be a risk factor for Autism later, though no major studies have been done relating to cord clamping and Autism.
With all the evidence pointing to leaving the cord alone for at least 3 minutes (or heck, why not until the placenta emerges – or longer!) – even for a cesarean section or preterm infants – why are we still cutting cords willy nilly? Your guess is as good as mine. But the good news – we can change this – talk to your care provider, show them the information. Change some minds – and maybe some births.
Resources used for this post:
Third Stage of Labour – Benefits of A Natural Approach; By Dr Sarah J Buckley, (c) 2005
Late vs Early Clamping of the Umbilical Cord in Full-term Neonates – Systematic Review and Meta-analysis of Controlled Trials; By Eileen K. Hutton, PhD; Eman S. Hassan, MBBCh, 2007
Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomized controlled trial; Ola Andersson, consultant in neonatology, Lena Hellström-Westas, professor of perinatal medicine, Dan Andersson, head of departments of pediatrics, obstetrics and gynecology, Magnus Domellöf, associate professor, head of pediatrics; 2011
Recommended Reading
Overcoming Placenta Previa, NICU, & Hospital Policies to Birth a Beautiful, Healthy Baby Boy
Tree of Life, Vernix, and a Bubble of Support
From Braxton Hicks to Immediate Transition: Backseat Car Birth of Kenan John!- The Tree of Life aka the Naked Placenta
The Birth Story of Violet Marie – Part 2
Birth Of Elsie {Homebirth Story With Siblings}- The Birth of Sicily Rose {Postpartum Hemorrhage, Vanishing Twin Syndrome}
- An Inspiring Natural {Hospital} Birth
The Birth Story {PART 2} 
A Healing Home Birth {BWF Admin Tamara}
26 Comments
Bev
Something to consider on the jaundice issue is whether or not the baby had a vit K injection. This increases the chances of jaundice as well. We delayed cord clamping/cutting and did not get the vit K my baby had NO jaundice at all.
Allison
I’m fascinated by the fact that the cord will clamp itself! I tend to lean towards the thinking that the body was created to what is needed on its own. And as someone who had one unplanned unassisted homebirth (doctor arrived within 15 mins) I always wondered what would have happened to me 2000 years ago. What would have happened with the placenta and cord? I think about animals in nature. They certainly don’t have someone coming along and clamping their cords! Great info!
kelly e
I am wondering if the increase of cord clamping has to do with cord blood banking. Instead of letting baby get the blood they need now, lets hold it in a bank for later. Not sure if this is why the increased clamping, but i was adamit about my dr delaying. I am sure I didn’t get as long as I wanted, but I know it was at least delayed.
Mama Bice
Immediate clamping has been going on much longer than cord blood banking. While some people do think that banking is more important, I personally believe that he evidence shows that the blood is much more beneficial to your baby *right now* than later down the line, or to be used in research studies.
Jessie - Rabid Little Hippy
Our first and second babies were relatively typical Australian hospital births (not as heavily managed as in the USA) with immediate cord clamping and in the case of our 2nd, my daughter, she was a compromised baby who needed help to establish breathing (if I only knew then what I know now…). Our eldest had jaundice and took a long time to start gaining weight at acceptable levels (again, if only I knew then…) and our daughter needed to do some sunbaking for her jaundice although she gained weight well. Our 3rd, a homebirth with delayed clamping, no jabs or injections or any interventions whatsoever currently weighs in like a 30 month old and he’s just gone 18 months. He did have some jaundice but his weight gain was phenomenal. He was exclusively breastfed til 12 months and has since had cows milk only so no formula weight gain. My theory? He’s gained weight as he should as his little body wasn’t trying to replace the missing blood from the placenta. He’s been the easiest of our 3 kids to handle, the most placid, most peaceful and although he still doesn’t sleep through (can’t have everything) he’s incredibly healthy and robust. I have a friend who’s daughter also had delayed cord clamping who also gained weight like crazy.
Maya
We decided to donate our daughter’s cord blood to a public bank, so her cord was clamped early to get a good amount of blood for donation. If we had not been able to donate, we would have gone with delayed clamping. Just wanted to mention that early clamping can be a good thing if you’re planning to donate your baby’s cord blood!
Melissa
I had no idea about delayed cord clamping with my first, but the midwife told me she would wait until it stopped pulsating before she cut (I was 16 at the time) my second and third were cut almost immediately, my third being 5 weeks early, second was an induction at 37 weeks after my waters broke 4 days before, both my 2nd and third were very drowsy after birth,and for a few days I needed to wake them to bf, my second is showing signs of autism, not sure about my third she’s a little too young to say, my first however, has had no health problems (other than a lung infection after birth from breathing in poo) he’s healthy happy and advance, my second is a good weight for his height, but his height isn’t even on the chart he’s so little! He has lots of allergies (slight allergies, to salicylates,lactose etc) so for any future babies I will most definitely ask for delayed cord clamping!!
Anna
gave birth at an aussie hospital 3 weeks ago. Had a student middie supported by 2 full qualifieds, with an OB who stuck her head in every so often. It may be that uni’s are now teaching what you are talking about, but I distinctly remember the student noting aloud to her supervisor that the cord was nearly done pulsing. so my little one got all her cord blood. she also had oral vit K. small amount of jaundice for a couple of days, not enough to worry about as far as the hospital was concerned. She is healthy happy and EBF! so maybe this next gen of midwives will give better outcomes for aussie babies. I hope USA catches up for their sake.
Nerissa
The practice here in New Zealand is to delay cord clamping. It was instilled in me as a student midwife by local midwives and something I continue now as a new graduate midwife. I too have had to ask an OB/GYN to keep his fingers to himself (in a hurry to clamp and cut cord) until the cord had stopped pulsating only because it was not practice in his own country. It does not take long and in emergencies where better to get your oxygen for a baby in transition from intrauterine and extrauterine life. Because the delayed cord clamping research is favourable for babies it is encouraged by my workplace and many other Health Boards in New Zealand. I do hope that the rest of the world catches on to the delayed clamping, it only seems natural to give babies all that is theirs 🙂
Danielle Lindquist
Neither of my boys had jaundice at all, both had vitamin K shots immediately and both were handled completely different when born. My older son had immediate cord clamping and was taken to a warmer right after that. My youngest one had his cord left on and open for 5 min and then was left directly on my skin for 45 min before taken to the warmer. Both kids turned out the same with no complications, both were 2 weeks early.
L & D nurse
I would like to correct the part about Pitocin being given before the placenta is delivered in this article. Pitocin is NEVER given before the placenta is delivered (at least the hospital where I work)!!!!! Just sayin.
Mrs. BWF
I can be given throughout labor, which is before placenta is delivered. As far as after delivery, well not sure about everywhere, but after my 3rd birth they did cord traction, made me bleed out and then did pitocin. I don’t recommend that either.
Samantha Bice
It is very common to give a mother an injection of Pit in the leg or hip right after the baby comes out. Maybe not at *your* hospital, but it is pretty common place in most of the country. And if the labor is pit induced/aided, then obviously it is in there before the placenta is delivered. They say they do it to get the uterus to clamp down faster and spit out the placenta.
Hana
After my vbac, they gave me pitocin to deliver my placenta fast. They said I was losing a lot of blood. I don’t know if that was the case, but they followed everything else on my birth plan (even delayed clamping when I was certain the Dr would never do it because he never did before), so I didn’t feel like arguing. I barely even noticed anything until I felt the placenta pass, so it didn’t matter a whole lot to me anyway.
Bee
administering synthetic oxytocin immediately post-birth it’s part of active management of third stage is routine in pretty much every Australian hospital.
Nicolette
Reading this post brought me to tears.
My baby was delivered via c section. Not only would they not let her father cut her cord, they wouldn’t delay clamping. I didn’t want the csection to begin with, the whole thing was traumatic for me and I suspect even my baby. She has had a few health concerns mentioned in this post and until now I didn’t realize that waiting to clamp her cord could have made all the difference for her in that respect. It makes me sick the way doctors take away all the control from the mothers.
I’m doing so much reading and research for my next birth, it will be at HOME if I can help it.
I love reading this blog. I’ve found hope, and gone from a woman who was terrified to ever experience childbirth again to one who can not wait to birth again and experience a real healing of the soul.
Thank you for all that you do, BWF!
emily
I hope you experience the birth you want. And this site has made me excited to birth too!
Sarah Reeves
http://bubblewrappedbirth.blogspot.com/2012/07/silas-and-his-placenta-september-27-2011.html
Here’s a link to some awesome pictures after out 5th birth. We did our first physiological cord clamping with him. His cord wasn’t cut for many hours after the birth. Feel free to use this link or any of the pictures if you’d like.
Sarah Reeves
http://bubblewrappedbirth.blogspot.com/2012/07/silas-and-his-placenta-september-27-2011.html
Here’s a link to some awesome pictures after our 5th birth. We did our first physiological cord clamping with him. His cord wasn’t cut for many hours after the birth. Feel free to use this link or any of the pictures if you’d like.
April Gaisford
With my first daughter, I asked to delay cord clamping. My OB at the time told me there was no benefit to it. He said something like it went against gravity and was more work on my body to delay clamping. I hadnt done enough research at the time, so I caved. At one year, the dr said my daughter had low iron. Now, being pregnant with my second and having done more research, I am adament on delayed cord clamping. Thanks for sharing!
Crystal Brown
Reading this has made me decide to do the delay clamp and the skin on skin time. My first pregnancy I was 19 and didn’t know much about my options. When my daughter was born then laid her on my stomach while the doctor cut the cord so fast and took her. I laid there for an hour before getting to actually touch my daughter because they had her in the warmer. We had problems breastfeeding and not getting the lach right to where I ended going to formula. No one there was helping me. So this time I am now 27 and plan on delay clamping and skin to skin if I can help it. I hope so since my delivery will be in a Military Hospital. Im not sure how different they are compared to civilian.
Kristy W
Crystal…..are you sure your not posting as me??? Haha Our stories are EERILY similar. I was 19 for my first, didnt know my options etc, and am on #2 now at 27 and we have decided to go with delayed clamping. What’s even more odd? On top of the age similarity…..my husband is military! We won’t be giving birth at the naval hospital but everything except birth will be there and one of the OB is always on rotation at the hospital so I will have one of them for the birth so I’m wondering just the same about this and placenta encapsulation!! I had tears in my eyes reading your post only because it sounds JUST LIKE my experiences!
Taryn
This may sound crazy, but i also have a very similar story! haha. My first was at 20, he was an induction, i had no idea of my options, i was lucky enough to hold him for maybe 5 seconds after birth, then he was taken away. My second was in May, i had a natural birth but was taken to the nearest hospital by EMS, where i knew no one. When Rhett was born they took him away and i didn’t even get to look at him for the first hour. They also gave me pit after birth without telling me. The nurse handed me my son an hour after he was born and said “feed him then we’ll take him for a bath” i felt like a cow, if that makes any sense. They didn’t care about how i felt or me bonding with my child. Then they took him for a bath in the nursery, i asked to come, they said ” no sorry, there’s a sick baby in there” i said well, can i watch through the window? The nurse said ” no, the curtains will be closed” UNBELIEVEABLE. Both times we had terrible problems with breast feeding. We are Air Force, and when we have our third, i will do anything i possibly can to have the birth i want.
Molly
Do you know where I can find the Ground Rounds part 2. I would like to provide both videos to the nurses and doctors on the Labor and Delivery unit I work on.
Mama Bice
All four videos are on that link, just one under another. 🙂
Amanda
Wow! this is really good to know!