Delayed Clamping of the Umbilical Cord: A Review with Implications for Practice

Gina Eichenbaum-Pikser, CNM, MSN; Joanna S. Zasloff, CNM, MSN

Disclosures

J Midwifery Womens Health. 2009;5(4):321-326. 

In This Article

Definition of Delayed Cord Clamping

There is currently no set definition of "delayed" cord clamping and clamping times vary significantly between studies. Table 1 shows the wide range of parameters used when discussing delayed clamping. Rabe et al.'s[6] Cochrane metaanalysis defined delayed clamping as a delay of 30 seconds or more after birth. Van Rheenen et al.'s[7] randomized controlled trial (RCT) comparing delayed versus immediate cord clamping in term infants recommended waiting 3 minutes before clamping, unless the state of the infant required earlier intervention, in which case the recommendation is to wait 60 seconds with the infant between the mother's legs. In a systematic review by Van Rheenen and Brabin,[8] delayed cord clamping was defined as waiting until the umbilical cord had stopped pulsing (mean clamping time was 305 sec). In an RCT looking at the effect of the timing of cord clamping on neonatal venous Hct by Cernadas,[9] there were 2 different "delayed" groups—one group clamped at 1 minute and the other at 3 minutes.

Although some studies and many midwives use the cessation of cord pulsing as a marker for when the cord should be clamped, there is no standard measure for this, either. It is unclear whether this means waiting until there is no pulse left at all or waiting for the pulse to become weak, which is both variable and subjective.

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