Is there a "standard time" for delayed cord clamping?

[anthasam]

I guess the title sums up my question: Is there a "standard" length of time for delayed cord clamping? We are updating our birth plan and would like to be more specific about the clamping/cutting.

Last time we said, "until the cord stops pulsing", but I wanted to be a bit more specific this time around. (Mostly because DH and I were so distracted with the new baby we didn't pay much attention to the cord )

We are considering writing something like "cord to be cut after placenta is delivered" or perhaps "cord to be cut at least 15 minutes after birth of baby".

Any professional thoughts would be appreciated!
Thanks!

[MsBlack]

Maybe you might say--'at least 10 min after birth', since surely it will be done pulsing by then. And then, in the moment, let them know if you are ready or not for cord clamping/cutting--you can always say 'not yet', even if it's been 10min, if you don't want the disruption of that.

just a thought.

[doctorjen]

I think stating after delivery of placenta is good, too. Then you don't have to be watching the clock and trying to figure out if you're okay with cutting yet.
In my practice, I wait to cut until either the placenta is born, or it's obviously ready (there have been signs of placental separation.) Sometimes, in practice families ask me to cut before the placenta because they want baby to be weighed or something.

[nashvillemidwife]

We always say "when the cord stops pulsing", but isn't the baby pulsing blood back into his cord with his heart beat?

[Reha]

'When the cord stops pulsing' can be confusing, though. The cord can still be pulsing for a few hours near the base of the umbilicus, even though it is limp and 'empty' looking. I do know midwives, though, who wait for it to stop pulsing at the umbilicus (unless their clients wish otherwise), which can be 2 or more hours.

Our rule of thumb is: the earliest is once the placenta comes, or, if the placenta is born fast, until the majority of the cord looks 'unengorged' with blood...or anytime after the placenta is born that the parents want.

Average for most of our clients is 40-60 minutes. We very rarely initiate the conversation of clamping the cord. We just wait for the parents to bring it up most of the time.

[Marisa-Bradley]

no, the baby isnt pulsing blood back into the placenta.

The cord can stop pulsating 5 minutes after birth or 30+ minutes after birth. I would not specify a time. Besides I doubt they are going to double check your birth plan for the exact time that you requested. I always tell my students to remind them that you don't want it done right away, and then let them know when you are ready.

[nashvillemidwife]

Sorry, I didn't mean that the baby is actually pushing blood back into his cord, but what Reha said. The cord will continue to pulse at the umbilicus due to the baby's pulse.

[lorijds]

I wouldn't specify a time.

At the birth center I worked at, we always cut the cord before the placenta was born--midwife's preference, I guess, I dont' know. But we rarely cut it when it still looked functional. We waited until it looked flaccid and pale, when you couldn't palpate a pulse in the cord itself.

ETA--Sorry, that didn't completely address your question. Waiting until the cord was flaccid and pale could be anywhere from a couple of minutes to 15-20.

[mwherbs]

so medically I think that the range is 1-3 minutes is considered delayed, atleast that is the info written up in the lit -- so I would probably avoid even saying the word delayed because they will have a different definition. you could request that the cord stops pulsing before cut . We cut sometime after the placenta is out or sometimes after it has stopped pulsing --- if they think that a baby may need resuscitation then you will be lucky to get a 30 second delay---

[anthasam]

Thanks for all the replies.

With DD, she was purple and had some initial breathing issues. However, our midwife was still able to wait until the cord stopped pulsing and looked grayish. (DH confirmed this; he said the midwife got his ok before she clamped and he cut. I guess I was too busy staring at DD )

This birth will be attended by either that same midwife or her partner. I'm leaning toward having them check with us before clamping. DH can inspect the cord again and I can stare at the baby on my chest

[mwherbs]

yep at home we will try and resuscitate with the cord still in tact if- the placenta is still attached- but in the hospital I really haven't seen anyone resuscitate at bedside- always in the isolet

[kltroy]

There was a recent study published in JAMA about delayed cord clamping and the benefits. They used 2 minutes delay and showed that term babies who had this delay had higher hemoglobin up to 6 months later in life, along with some additional benefits.

Esp. if you're doing a hospital birth, you might specify "at least 2 minutes" so that someone gets out a stopwatch. I've heard of a lot of moms who say "until the cord stops pulsing" and at the time it seems like they waited a while, but when they go back and look at the video it was only like 40 seconds. Just a thought...

[anthasam]

Originally Posted by kltroy

There was a recent study published in JAMA about delayed cord clamping and the benefits. They used 2 minutes delay and showed that term babies who had this delay had higher hemoglobin up to 6 months later in life, along with some additional benefits.

Esp. if you're doing a hospital birth, you might specify "at least 2 minutes" so that someone gets out a stopwatch. I've heard of a lot of moms who say "until the cord stops pulsing" and at the time it seems like they waited a while, but when they go back and look at the video it was only like 40 seconds. Just a thought...

Thanks.

This will be the second hospital birth with the same midwives. They are on-board with waiting (they waited last time) - I just wanted to be more specific for the hospital staff. Some L&D staff seem to be in more of a rush than others. I was considering more like "at least 15 minutes", then we could always request it sooner if everything looks "done".

[courtenay_e]

The easiest way to do it, so nobody actually DOES have to watch a clock, is to say you want the placenta born before you clamp and cut. I almost always suggest this to clients of mine who are looking at a hospital birth. You might know and love the midwives, but can't be sure which staff you'll get. And as you suggested, mamas in just-birthed zen aren't watching a clock OR the cord. You're watching the baby. If the staff knows that it's okay to hand the attendant clamps once the placenta is born, you will all feel better about timing.

[JavaFinch]

I also will be requesting delayed cord clamping but am birthing in a hospital with an OB. My question is if I want to cut the cord after delivery of the placenta, can you do this safely if they give a shot of pitocin to deliver the placenta, or should I request they not do that? I thought I read somewhere that getting the pit lowers chance of (the mother) bleeding? Just looking for advice here. Thanks!

[courtenay_e]

Putting baby to breast also has the effect of protecting against hemorrage, and does not have the side effect of interfering with bonding. Yes, you can still cut the cord after the placenta has been birthed with pitocin, but pitocin has it's own side effects, and I would strongly suggest that you do some reading on them before you permit routine management of the third stage.

[anthasam]

Originally Posted by courtenay_e

The easiest way to do it, so nobody actually DOES have to watch a clock, is to say you want the placenta born before you clamp and cut. I almost always suggest this to clients of mine who are looking at a hospital birth. You might know and love the midwives, but can't be sure which staff you'll get. And as you suggested, mamas in just-birthed zen aren't watching a clock OR the cord. You're watching the baby. If the staff knows that it's okay to hand the attendant clamps once the placenta is born, you will all feel better about timing.

Sounds perfect. Thanks so much.

Last time we had an amazing L&D nurse! If I could request her, I will But, as you said, we really don't know about anyone else there!