Delayed cord-clamping should happen ON the mother’s abdomen

In hospital births, early cord clamping is one of the first interventions the newborn experiences. Physicians routinely cut the cord moments after birth, often before giving the baby to her mother.

I recently attended a planned hospital birth of a client who transferred out of my care shortly before her birth. We transferred her care to our small, local, natural birth-friendly hospital. A gracious family practice physician took over her care. Two of my client’s main hopes for her birth were delayed cord clamping (of at least a minute or two), and to receive her baby immediately from the hands of the doctor.  The doctor and I discussed the mother’s wishes more than once while she labored, and she was amenable to both. I had such high hopes for this baby’s entrance; We were going to have a somewhat physiological experience here!

After a few pushes baby comes out, pink and happy, and I’m watching, waiting…… still waiting for baby to be in mom’s arms. The doctor holds the baby down by the mother’s thighs, taking ample time to do unusual and unnecessary things. First, she bulbed the vigorous baby four or five times, then leisurely picked up a piece of gauze and slowly wiped the baby’s face. The energy shifted in the room from pure joy and excitement to mistrust and anger. She had previously agreed to give the baby immediately to the mother and now she was stalling. We were all very confused. What was she doing?

Meanwhile the mother was pleading desperately to have her baby: “Please, pleeeease, give me my baby.” I will never forget the sound of this mother begging to hold her baby. It caused me visceral pain. Every second of it broke my heart. I pray I will never again be in a situation where I, or anyone else, would withhold a newly born baby from her pleading mother.

After mother and baby were settled and nursing I seized a brief moment to talk to the doctor in the hallway. I asked her why she did not honor the mother’s desire to immediately hold her baby, as she had previously agreed to. She stated that she did honor the mother’s request to immediately receive her baby (“immediately is often a relative in the hospital), but that she also was attempting to honor her request for delayed cord clamping — requests that, in her mind, were mutually exclusive. She argued that she could not give the baby to the mother while the cord was intact because the baby’s blood would back flow into the placenta. In her mind, the delayed clamping needed to happen first, then the mother could have her baby. The two things could not happen simultaneously. We all know that thousands of babies are placed on their mother’s bellies every day, and probably have been since humans started having babies, but somehow the rules have changed.

A typical midwife-attended homebirth, where the cord is not prematurely cut and the baby receives her full blood volume. The parents decide when they are ready to cut the cord, with baby still nestled on mom.

I was stumped. Of all the bizarre medical model theories and logic I’ve encountered, this one was new to me. Typically physicians oppose delayed cord clamping because they believe the baby will receive too much of his or her own blood volume through the cord. This doctor was afraid that baby would not receive enough of her own blood because it would back-flow into the placenta if the baby was on the mother’s abdomen.

After debriefing with some of my peers I discovered that fears about blood draining out of the baby is not uncommon. But since the medical community largely opposes ‘delayed cord clamping,’ the question about where the baby should be while waiting to cut the cord rarely comes up in OB-attended births.

To be fair, there is some logic in the belief the blood will backflow out of the baby. If a woman gives birth and someone holds the baby up two feet above the mother’s body for any length of time, yes, common sense tells us the force of gravity will encourage blood flow downward, away from the baby. However, there are two problems with application of this logic.  First, suspending the baby above the mother should never happen. There is no valid reason to suspend a baby feet above her mother moments after birth. You may have seen this in birth scenes from the 80’s, but this is not an appropriate or even reasonable practice. Second, we now know that a complex feedback process  determines when the cord vessels close and thereby minimizing blood flow out of the baby and maximizing blood flow into the baby. It has very little to do with the position of the baby in relationship to the placenta.

Nature came up with a perfect design here. We can’t outsmart this one. Keeping the baby at the level of the mother’s abdomen is practical, normal, and biologically best. Fortunately for babies born in the hospital , some contemporary evidence-based OBs are coming around to accepting what midwives and mothers have long known: leaving the cord intact allows the baby to receive her full blood volume along with all the stem cells, red blood cells, oxygen, immune-boosting antibodies, and whatever other undiscovered life-giving properties our blood supplies.


20 thoughts on “Delayed cord-clamping should happen ON the mother’s abdomen

  1. My doctor said that he could not allow me to do delayed cord clamping (wait ~2 minutes or until it stops pulsing, whichever comes first) for this exact same reason. He was unwilling to look at any evidence otherwise. My son was borderline low on iron at 1 year and I regret not “insisting” on that detail of my birth plan.

    • If it makes you feel any better, 2 of my 3 home born babies were borderline low iron at 1 year. Don’t blame yourself. The doctor, on the other hand, should know better, but they don’t.

  2. Hannah, I am sorry to hear this! My sense is that awareness around premature/early cord clamping is just *beginning* to reach into the world of birthing women in the US. I personally know of a few physicians who have been willing to evaluate the research and change their practice accordingly, although a few is far too many. It breaks my heart that so many babies are coming into this world without their full blood volume.

  3. I just spoke to my OB on Monday about delayed clamping. It is my hope that I am able to have some info for her to be at ease with allowing the baby to be on my abdomen while the cord and placenta continue to do it’s job. She said she could delay clamping, if she hung out with the baby…or she could milk the cord. I’d love to be able to show her something her ‘educated’ mind could accept. I see her again on Wednesday. Thanks for your article.

  4. I horrified that this kind of misinformation is prevalent among so called specialists. My last too babies were born at home, on both occasions the placenta was birthed(in water) and the cord allowed to atrophy before we even looked at cutting the word. With my middle child the cord was cut out of practicality. i.e I needed to get out of the pool and there were too many things to hold including the placenta and with my last baby we intended on a lotus birth (where the cord is left attached to the placenta until it withers and falls away usually 5-7 days after birth) however the cord was very short and their were breastfeeding issues which made it tricky. I was lucky that I had incredibly knowledgable and empowering midwives but the idea of someone, even a Dr telling you what you can and cannot have at your birth is horrifying. Your baby, your body, your birth. I’d have a lawyers letter in hand if necessary stating that cutting of the babies cord without your permission will be considered assault. What Drs, Midwives and Obs need to appreciate is that they are offering a service, thier service is NOT complulsary, they are their to do a job and assist you in the birth of your child NOT control you into the type of birth that is convenient and suited to them.

    • Yes, as birth attendants, are hired to perform a service. (Ideally, to safeguard the mother and baby’s experience and keep a watchful eye for anything out of the ordinary that may benefit from some kind of help, intervention or medical assistance) But care providers also must be able to practice within their comfort level. They are assuming responsibility, legally and ethically, for a healthy mother and baby. This is why is it is SO important for women to shop around (if they have options) for a care provider who shares their values around pregnancy and birth, and who can readily honor their wishes for their birth — comfortably. This is what we should aim for in the provider-woman relationship — a trusting, mutually respectful experience based on shared hopes and values around birth for both the mother and baby. We have a long way towards achieving in this country!

  5. As a hospital based midwife I’ve heard this often from doctors. It is a common misconception as they are taught to keep the baby at the level of the placenta, OR clamp immediately. I’ve seen many a doctor slowly bulb suction, stimulate baby, wipe face, delay delay delay, then put atleast one clamp on before giving the baby to mom. I must say its better than the one doc I worked with who would yell at any nurse who tried to give baby to mom instead of taking to the warmer “its not a toy, put it in the warmer!” What?!?

    It always blew me away, as a nurse learning about birth, how some absolutely insisted on keeping baby at the level of the placenta, or clamping, yet others would put babies right up with mom. I never saw higher or lower levels of anemia, polycythemia, or anything else in either group. That’s why as a midwifery student when the midwives I was learning from not only gave babies to moms w/o clamping but also had the evidence to support it I was relieved. There was no doubt in my mind which way I would practice, and I was surprised others didn’t know the evidence.

    C Dickson
    Nursing the Issues blog:

  6. I did not delay the cord clamping with my first child. My second child, the midwife (hospital birth) just put my baby right on my belly and had no problem delaying the clamping! My oldest child was diagnosed with Leukemia a week after his 2nd birthday. If I have another child, I would like to bank the cord blood for my son with cancer in the event he would ever need a stem cell transplant. I would also like to delay the cutting if possible but banking the cord blood is my top priority. Can you bank/donate cord blood when you delay the clamping?

    • Mary, I am sorry to hear that your oldest child has been diagnosed with Leukemia. In my opinion, you may wish to look into placenta encapsulation rather than cord blood bank. You can delay cutting of the cord for up to 4 hours and then encapsulate the placenta. Do your research to see the benefits of this for your first child. My brother & SIL had two children clamped immediately so they could do cord blood banking, but in both cases, there was not enough blood to bank so the infants missed out on blood that was rightfully theirs at birth, all for nothing. You could also look into the benefits of expressed breast milk with its anti cancer benefits. Donated breast milk is available for free through Human Milk For Human Babies.

  7. This was my experiene with my 7th child. With my first 6 I really had no idea on the differences on clamping vs not clamping. My ob said he waited until the cord stopped pulsing before clamping, but looking back it was a very short amount of time so I doubt that it had completely stopped pulsing. My 6th baby ended up in the NICU b/c she inhaled fluid on her way out and wasn’t able to clear it immediately. I really feel like had we delayed the clamping of the cord it may have given her enough time to clear it.

    With my 7th baby I had wanted to wait to clamp the cord until I had delivered the placenta. The nurses were kind of horrified over this and kept asking “aren’t you worried about too much blood going back to the placenta and hemorrhaging?” Then the dr agreed to not clamp until the placenta was delivered, but only with her being left down by him to help prevent clotting or something like that. I agreed b/c it was very important to me that this delay be done. I ended up having him clamp after about 7mins or so b/c she was getting cold.

    Now I am due with baby 8 and I have it in my birth plan that I want the cord to not be clamped until the placenta is delivered and that I will have the baby placed on me right after birth. I also want to nurse him right away. I made sure my ob agreed to this and signed the birth plan, I told him if he didn’t I would have to change providers. He really is a good Dr. just a little too medical minded sometimes. He said he knew I had researched this, but he went to school for it, blah blah blah. He also doesn’t think nursing will be possible while the cord is still attached b/c it will be too short. I will worry about that when we get to that point.

    I am so glad this article was posted as it’s pretty much what happened with my last birth.

  8. My OB isn’t letting me delay cord clamping because of this reason. I would really like to see some studies that proves him otherwise. He said if I wanted all the blood from the cord into the baby that he would push the blood from the cord into baby, but I don’t know if that could hurt my baby or not. I just REALLY want the cord to not be clamped until it stops pulsating.

    • I don’t have the studies at my fingertips, so hopefully someone else can share them, but yes – “milking” the cord can result in polycythemia and greater risk of jaundice (some jaundice can be normal, but too-high bilirubin levels pose danger).

      Bringing some studies to your doctor is a good idea; however, if delayed cord clamping and immediate contact are important to you and your doctor isn’t willing to budge, I suggest shopping around a bit for a birth attendant that will honor your well-educated wishes.

  9. I am so sorry to hear that Becky. Whenever I read the words, “My doctor won’t let me,” I wonder just who “owns” our bodies. If my doc ever forbade anything I wanted to do, I would find a new doctor. As it is, he has always said that if there is anything we want to try, let him know & he’ll refer. (Elder son suffered from post vaccinal encephalitis. Has been drug free for about 25 yrs now.)
    I hope your OB does honour your request. Best wishes for the birth.

  10. See the above link to the academic OB/Gyn blog. He’s a practicing MD at a teaching university who has actually reviewed the hard research in this area (wow!) and realized that there is NO reason to clamp the cord prematurely and MANY reasons to wait at least until it has stopped pulsing. There was a study done in the early 70s by Yao and Lin (sp?) that disproved that whole silly myth about the baby’s blood draining back into the placenta. Any modern OB should be embarrassed to claim that such a thing is a concern and to be ignorant of the many important benefits of allowing the baby to receive his full blood volume. Additionally, in the UK and Canada, I believe, a change is being proposed re babies who need to be resuscitated after birth. They are doing the resuscitation while the baby is still attached to the cord and just next to the mother and having greatly improved outcomes for those babies. Allowing a physiologic transition and not immediately (prematurely) clamping the cord is helping these fragile babies tremendously. I’m hoping that practice may eventually make its way here. Finally, remember: It is YOUR BABY and your doctor doesn’t have to agree or “let” you decide how your baby is treated. Share some of this research and make it clear that you ** do not consent** to premature cord clamping. If your MD refuses, get a new one fast. Best wishes to you and your baby!

  11. Oh, and “milking” the cord is not necessary or helpful, and may be potentially harmful, as it’s not the natural flow or volume of blood for the baby’s body to process. Just leave it alone, as nature intended! I know it’s hard for them not to DO something all the time, but seriously, just LEAVE IT ALONE!!!

  12. I once got accused of having caused a baby to get severely jaundiced because I left the baby lying under a standing mother. The woman delivered this way and waited with picking her baby up.
    The story you are telling is absurd and makes med think about the healthcare professionals coming a long way from even thinking about the physiological ways in a logical way. I think about that a lot. How did people do it before there were even midwives around and they survived, didn’t they?!

  13. Premature cord clamping happens because medical people do not understand fetal circulation. It is a sort of tricky process, because after the baby receives its full complement of blood, all sorts of things happen inside: the naturally occurring hole in the heart is able to close (fetal hearts have a bypass of sorts, because the heart does not pump much blood to the lungs, because the lungs are not yet in use); the umbilical arteries clamp down, shunting blood to the kidneys (kidneys are not used much by the fetus, because the placenta takes care of most of the waste removal); the liver receives blood which had mostly bypassed in fetal life. And on and on!

    Arteries are arteries – the Wharton’s Jelly keeps gravity from prematurely shutting off the cord. The arteries pump from the baby’s heart, and arteries are under pressure and do not close down without pressure. The umbilical vein brings the blood back from the placenta. When the baby does not receive his full complement of blood, all sorts of systems are neglected.

    If there was just a little more time spent on teaching fetal circulation, maybe health care professionals would be more informed?

  14. I’d really love a link to the 1970’s study by Yao and Lin related to the lack of necessity in holding the baby parallel to the placenta. My doctor apparently gives moms the option of delayed cord cutting OR baby on the belly, and I’d like to go into the discussion armed with scientific data, if possible. I read the above blog written by the OB/Gyn, but he didn’t seem to know if there was a marked risk.

  15. I know I am not a doctor, definately not an OB or a midwife. I AM a RN though, and this is all very surprising to me to find out that we have to fight this fight. In nursing school (2002) we were taught that you absolutely did not cut the cord until it stopped pulsating. Maybe newer docs will be taught the same, and it’s mainly the old ones we have to push up to date. i don’t have any children yet, but glad that I am learing more about what I myself might have to demand from a doctor one day.

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