Delayed cord clamping is the practice of waiting at least one minute, and up to three minutes, after delivery to clamp and cut the umbilical cord. Because circulation between the placenta and infant continues for a few minutes after birth, delaying the cord clamping allows more blood to flow to the newborn (WHO 2014). Evidence shows that the additional blood increases the newborn’s iron stores for approximately the first six months of life, which decreases the risk of infants developing iron deficiency (McDonald et al. 1996; Berglund and Domellöf 2014). Delayed cord clamping provides similar benefits for both preterm and term deliveries, but preterm births have additional benefits, including a reduction in common complications of preterm birth (e.g., intraventricular hemorrhage and necrotizing enterocolitis). Delayed cord clamping should not be practiced if the newborn requires resuscitation in a country where national policy does not support resuscitation of the newborn with the cord intact at the mother’s side.
Measurement and data sources
It is important to determine if delayed cord clamping is done and how widely it is practiced in your country (e.g., private versus public facilities, trainings, supervision checks). If a policy is in place for delayed cord clamping, check to see if documents to support implementation are available, such as protocols, guidelines, provider job aids, and strategies for rollout.
Research and evaluation studies may assess the percentage of births in a specific health care facility where delayed cord clamping was practiced. Outside these studies, quantitative data on the scale of the practice may not be available. Also, identify and review the quality of maternal and neonatal health care surveys or assessments, which may sometimes include data on delayed cord clamping through direct observation of childbirth and other methods. If you can, conduct key informant interviews with the Ministry of Health staff and/or health care providers to determine how widely delayed cord clamping is practiced in your country. Because many routine hospital surveys do not collect information on delayed cord clamping, it may be useful to advocate for including that data in scheduled maternal and neonatal health and nutrition surveys (e.g., interviews with providers, review of records, etc.). Adding a column in the delivery room register is one option for collecting routine data on delayed cord clamping.
- It’s unlikely that you will find quantitative data that can be generalized to all the maternity facilities in the whole country.
- Qualitative studies and reports from a specific country region may help shed light on reported practice, obstacles, and facilitators of delayed cord clamping to inform implementation strategies in a specific region. However, information from research studies, key informant interviews, quality of care documents, and other sources may not be nationally representative.
Berglund, Staffan, and Magnus Domellöf. 2014. “Meeting Iron Needs for Infants and Children.” Current Opinion in Clinical Nutrition and Metabolic Care 17 (3): 267–72. doi:10.1097/MCO.0000000000000043.
Chaparro, Camila M., Lynette M. Neufeld, Gilberto Tena Alavez, Raúl Eguia-Líz Cedillo, and Kathryn G. Dewey. 2006. “Effect of Timing of Umbilical Cord Clamping on Iron Status in Mexican Infants: A Randomised Controlled Trial.” The Lancet 367 (9527): 1997–2004. doi:10.1016/S0140-6736(06)68889-2.
Chaparro, C.M., and C. Lutter. 2007. “Beyond Survival: Integrated Delivery Care Practices for Long-Term Maternal and Infant Nutrition, Health and Development.” Washington, D.C.: Pan American Health Organization. http://www.paho.org/hq/dmdocuments/2009/CA_beyond_survival.pdf?ua=1.
Hutton, Eileen K., and Eman S. Hassan. 2007. “Late vs. Early Clamping of the Umbilical Cord in Full-Term Neonates: Systematic Review and Meta-Analysis of Controlled Trials.” JAMA 297 (11): 1241–52. doi: 10.1001/jama.297.11.1241.
McDonald, Susan J, Philippa Middleton, Therese Dowswell, and Peter S Morris. 1996. “Effect of Timing of Umbilical Cord Clamping of Term Infants on Maternal and Neonatal Outcomes.” In Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004074.pub3/abstract.
Maternal and Child Health Integrated Program (MCHIP), USAID and WHO. 2014. Delayed Clamping of the Umbilical Cord to Prevent Infant Anemia. Washington, DC: Maternal and Child Health Integrated Program.
PAHO. 2007. Beyond survival: Integrated delivery care practices for long-term maternal and infant nutrition, health and development. http://new.paho.org/hq/dmdocuments/2009/CA_beyond_survival.pdf.
WHO. 2012. Guidelines on Basic Newborn Resuscitation. Geneva, Switzerland: WHO.
———. 2014. Guideline: Delayed Umbilical Cord Clamping for Improved Maternal and Infant Health and Nutrition Outcomes. Geneva: WHO.
———. “Optimal Timing of Cord Clamping for the Prevention of Iron Deficiency Anemia in Infants.” E-Library of Evidence for Nutrition Actions, WHO. Accessed June 23, 2014. http://www.who.int/elena/titles/cord_clamping/en/.