What is the difference between “delayed cord clamping” and “optimal cord clamping” and why would this be more beneficial for babies at birth compared to “cord blood banking” or “stem cell collection?”
Delayed cord clamping, optimal cord clamping and stem cell collection. You’ve likely heard of them or their benefits, but how do you know which one to choose or is better for your baby?
Like many things in the pregnancy and parenting circle, there is so much noise that it can become confusing. This topic has had a wide range of research carried out, but again, sifting through it all can become overwhelming. Like many things regarding the health and well-being of your baby, this topic needs to be understood so that you can make the right choice for your baby. Please continue your reading and research beyond this article. When exploring the difference between delayed cord clamping and optimal cord clamping and why this would be more beneficial for babies at birth compared to cord blood banking or stem cell collection. It is important to understand the difference between the three and then understand what is happening at the time of birth for your baby.
Let’s explore…
When referring to delayed cord clamping (DCC) and optimal cord clamping (OCC), it is essential to distinguish between the two as often, they get put under the same label, or DCC is often called OCC. However, they are quite different.
Delayed cord clamping refers to the delay whereby clamps are applied to the umbilical cord after birth to stop the communication between the placenta and baby. DCC is now widely recommended in most hospitals and is recommended worldwide by the World Health Organization (WHO). WHO recommends that all babies born preterm, or term receive no less than 60 seconds of delayed cord clamping immediately after birth. This recommendation comes with substantial evidence to support the optimal health, nutrition, and well-being of the baby and mother.
Optimal cord clamping is used when the umbilical cord is left to constrict and close over (vessels) naturally without clamps or ties. Typically, optimal cord clamping occurs when the umbilical cord stops pulsating or when it has become white, and often, medical professionals or birth workers use the term ‘wait for white’.
OCC can range from five to fifteen minutes; with OCC, it is recognised that all cords close in their own time.
Another option that has become more known over the years is umbilical cord banking or stem cell collection.
This refers to the blood collected in the umbilical cord at birth, where early cord clamping happens. Early cord clamping is required to occur within 60 seconds once the baby has been birthed. It is important to note that DCC is not recommended when doing umbilical cord blood banking, and this is to ensure enough blood is collected for storage. Umbilical blood is collected by the hospital staff (Midwife or Obstetrician) or a trained cord blood collector. A needle is inserted into the umbilical cord vein, and the blood remaining in the placenta and the umbilical cord is drained; this can occur before or after the placenta has been birthed. However, it does need to occur within the initial minutes after birth. Once blood has been collected, it is stored (frozen) for potential future use.
Why is this an option?
Umbilical cord blood has been used to treat immune deficiency diseases, leukaemia, blood diseases, metabolic disorders, and thalassaemia since 1988, when the first transplant occurred. However, when weighing up your options, it is essential to understand that many diseases cannot be treated with stem cells, particularly if the condition is genetic.
When considering cord blood collection, there are two options: Private or public storage. The benefits and limitations of both must be considered when collecting blood from your baby’s umbilical cord. Many private companies use marketing towards collecting blood for your child or a family member to be used in the future should it be required to help treat conditions. Blood collected from a neonate cannot be used to treat genetic diseases or malignancies in the same individual as it contains the same genetic variant or premalignant cells that led to the condition requiring treatment. As it stands, there is no evidence to support this type of transplant, known as an autologous transplant.
A review of parents’ knowledge and awareness around cord blood banking found that parents had positive attitudes toward cord blood banking. However, when it came to understanding the uses of cord blood, knowledge and awareness were mixed, with some of the papers reviewed showing low awareness. A review by Peberdy, Young, Massey & Kearney, 2018 concluded that more information was required to be given to expectant parents to assist in making more informed choices around cord blood banking. Instead, it is recommended that if the family considers blood collection, that collection for public donation is best and private storage only be used if a known family member with a medical condition would benefit from a cord blood transplant. Private storage banks require significant fees to be paid, whereas public banks do not charge. Donating your baby’s cord blood to a public bank will be made available to anyone in need of medical indications for transplant of cord blood.
Now that we have explored what delayed cord clamping, optimal cord clamping and stem cell collection are, let’s explore why research supports placental transfusion over stem cell collection. Placental transfusion is an essential part of the birthing process that helps the baby to adapt internally during the transition from womb to world.
At the time of birth, significant internal changes occur for a baby as they begin the transition from womb to world or, as medically known, from foetal to neonatal life. During pregnancy, while your baby grows, blood flows through their heart and lungs quite differently from ours. This is quite a complex system and requires its own article, so it is only briefly explained for the purpose of this article.
Within your baby’s circulatory system, blood flowing from the body enters the right side of the heart. For us, this blood would then pump to the lungs, where our gas exchange occurs before returning to the left side of the heart to be pumped around the body. For a baby in utero, this blood bypasses the lungs. Instead, it travels through a hole (formally known as the ductus arteriosus) to the placenta, where gas exchange of oxygen, carbon dioxide and nutrients occurs. Oxygenated blood from the placenta then travels through the ductus venosus and foramen ovale, which bypasses the right side of the heart and lungs and instead is pumped around the body.
As babies take their first breath, their liquid-filled lungs become aerated, resulting in gas exchange occurring within the baby’s body rather than at the placenta. Blood flow within the heart and body also changes with the closing of those holes. As you can see, a lot is going on for your baby in such a short time.
A baby’s pulmonary circulation during pregnancy will contribute approximately 8% of the total cardiac output. When a baby is born, the pulmonary system will increase to 40-55% of the cardiac output. Leaving a baby attached to the umbilical cord without clamping allows the baby time to adjust and equilibrate blood volume, oxygen and overall cardiac output. DCC allows for the physiological changes mentioned above to occur at the time of birth. Evidence shows that when healthy-term babies have their cords clamped earlier than 60 seconds, it can result in the instability of circulation within the baby. Therefore, it is recommended that umbilical cords be left intact to allow expansion of the lungs with air and allow the resistance within the pulmonary system to stabilise during the transition (that is, the pressure and blood flow within the lungs). In doing this, the baby’s cardiac output remains steadier, avoiding potential large drops in heart rate and blood pressure during this time.
Recent studies have been looking into maintaining intact umbilical cords during resuscitation. Home birth midwives typically will keep an umbilical cord intact and not clamp the umbilical cord in a baby who is born unresponsive; instead, the baby is placed onto the mother’s chest or close to the mother on a flat surface for resuscitation to commence, allowing the baby to remain with its mother, receiving vital blood and oxygen. In hospitals, the process is different, yet in recent years, more evidence has led to promising results of babies left attached to the umbilical cord during any form of resuscitation.
Resuscitation with an intact cord allows for continual circulation and oxygenation, improving overall transition, Apgar scores and oxygenation. Another option to consider is cord milking in these circumstances, where the umbilical cord is stripped several times to speed up blood transfusion. When delayed cord clamping occurs during depressed periods with the baby, evidence shows that newborns have higher oxygenation levels and Apgar scores when left attached and receiving the placental transfusion during resuscitation. Furthermore, evidence suggests babies born with a tight nuchal cord or shoulder dystocia and born ‘floppy’ or not breathing are advised to have their umbilical cords left intact to promote reperfusion alongside resuscitation methods for improved optimal outcomes.
It is widely known that placental transfusion has many benefits. Cord blood contains red blood cells and millions of stem cells, which can help reduce age-related diseases from birth onwards. It contains oxygen and plasma, immunity cells, growth factors, and iron levels in cord blood, which can maintain an infant’s iron levels for 3-8 months of life. Evidence shows that anaemia was significantly reduced at 8 months post-birth in babies following DCC. Anaemia has been associated with affected growth and cognitive development in babies. DCC has also been shown to increase a premature baby’s survival rate by 30%. Research shows that babies who received DCC (1-3 minutes) showed higher birth weights of up to 100 grams than babies who received early cord clamping (30-60 seconds). Other research has found that placental transfusion at birth leads to approximately 80ml of extra blood a baby will receive when the cord is left alone. During stem cell collection, the blood required for collection is 40-60ml, with some requiring more, hence the need for early cord clamping.
A common worry among parents is the risk of jaundice following delayed or optimal cord clamping. Studies have investigated this, and the main potential risk was hyperbilirubinemia, better known to parents as jaundice in the newborn period. However, this risk has not been statistically significant. It is considered a low risk that does not outweigh the benefits of delayed or optimal cord clamping. The research is outdated, and further research into this link needs to be carried out.
Now, you’ve reached the end of this very long discussion. Still, as you can see, there is so much to cover and, as a parent, consider when deciding whether to opt for DCC, OCC or stem cell collection. All the current evidence points towards giving the baby their placental blood for optimal health and nutritional outcomes and that stem cell collection may benefit a baby in the future. Still, the likelihood is low due to the nature of the diseases where stem cell transfusions are carried out. As with all things, the decision is yours, and I hope this has helped to clear up or answer any questions you may have about it. You can find the links to all the research used to write this piece below.
My name is Vanessa Barnard, and I am the founder of Illoura Birth. I am a Childbirth and Newborn Educator, Doula training with the Doula Training Academy and Paediatric Nurse. My mission is to support families on the journey to meeting their babies with holistic and evidence-based information. My focus is to inspire and boost your confidence on this journey through pregnancy, birth & postpartum.
If you would like to learn more information, please get in touch with me:
Business Name:
Illoura Birth
Phone:
0413 763 373
Email:
[email protected]
Facebook:
https://www.facebook.com/illourabirth
Instagram:
https://www.instagram.com/illourabirth/
Website:
www.illourabirth.com.au
** Photography shown in this article is by Janet from Hyggelig Photography
REFERENCES
https://ranzcog.edu.au/wp-content/uploads/2022/06/Umbilical-cord-blood-banking.pdf
https://www.ogmagazine.org.au/22/3-22/physiological-based-cord-clamping/
- Peberdy, J. Young, D.L. Massey, and L. Kearney. (2018) Parents’ knowledge, awareness and attitudes of cord blood donation and banking options: an integrative review. BMC Pregnancy and Childbirth. 18:395.
WHO. Guideline: Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes. Geneva: World Health Organization; 2014.
Andersson. O., Mercer. J.S. (2021). Cord Management of the term newborn. Clin Perinatal. 48. 447-470. https://doi.org/10.1016/j.clp.2021.05.002
Hutchon, D.J.R. (2015). Ventilation, Chest Compression and Placental Circulation at Neonatal Resuscitation – ILCOR Recommendation 2015. Journal of Paediatrics and Neonatal Disorders. Vol 1, Issue 1.
Andersson, O., Rana, N., Ewald, U., Malqvist, M., Stripple, G., Basnet, O., Subedi, K., & KC, A. (2019). Intact cord resuscitation versus early cord clamping in the treatment of depressed newborn infants during the first 10 minutes of birth (Nepcord III) – a randomized clinical trial. Maternal Health, Neonatology, and Perinatology. 5(15). https://doi.org/10.1186/s40748-019-0110-z