While investigating options for the birth of your multiples, you may come across the idea of delayed cord clamping. While delayed cord clamping at birth has been considered best practice at different times in obstetrical history, it’s experiencing a recent resurgence due in part to the World Health Organization’s 2012 maternal and infant health recommendations.  This article is going to look at what exactly is delayed cord clamping, what the benefits of delayed cord clamping are for both full-term and preterm newborns, and how delayed cord clamping can factor into a multiples delivery.

What is delayed cord clamping?

Delayed cord clamping at its most basic is allowing a pause between the birth of an infant and the clamping and cutting of the umbilical cord. Organizations define the minimum amount time necessary to wait differently; the American College of Obstetrics and Gynecologists recommends waiting “at least 30-60 seconds after birth in vigorous term and preterm infants”, WHO calls for cord clamping to occur “more than one minute after the birth or when cord pulsation has ceased,” and the American College of Nurse-Midwives’ position is that cord clamping delayed by 2-5 minutes should be “the standard of care in all birth settings.”

What are the benefits?

There are a number of benefits to the practice of delayed cord clamping. At the time of delivery, as much as 25-30% of a term infant’s total blood volume is in the placenta. Waiting several minutes, or until the cord ceases pulsing, allows placental transfusion to complete which has proven to increase iron stores for newborns at birth through to 6 months of age, which may positively impact development. Infants born prematurely benefit most from the additional blood volume, as delayed cord clamping has been shown to decrease rates of intraventricular hemorrhage and necrotizing enterocolitis, increase cardiovascular stability, and improve blood pressure. There are several instances where delayed cord clamping may not be advised, such as cases that involve placental complications or newborns needing immediate resuscitation, but those should be managed on a case-by-case basis. Some groups, including the American College of Nurse-Midwives, call for cord milking to be used as a safer alternative to delayed cord clamping in emergency situations.

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Delayed cord clamping with multiples

Unfortunately many studies on delayed cord clamping did not include multiples pregnancies, so ACOG states that “there is not sufficient evidence to recommend for or against delayed umbilical cord clamping in multiple gestations.” If delayed cord clamping is something that you’re interested having as part of your multiples birth plan, it’s advised to begin the conversation with your care team early. Since multiples generally are born before full-term, they can no doubt benefit from delayed cord clamping, but each case needs to be looked at individually to ensure the safety of all babies and the birth parent.

About the author

Emily Lindblad is Twin Love Concierge’s and Three Birds Family Education & Postpartum Care’s Postpartum Doula and Certified Newborn Care Specialist – providing perinatal support and education to Massachusetts families of multiples and Triplet parents worldwide. Emily is also the mother of triplets and knows first-hand that welcoming multiple newborns can be a daunting task. By providing practical tools and assistance, Emily provides families with the skills and confidence needed to successfully transition to life with twins, triplets, or more. For more information on our Triplet and Boston classes /services or to contact Emily, please email emily@twinloveconcierge.com