Infant Mental Health Week: The importance of Delayed Cord Clamping (DCC) and its impact on brain development
The Royal College of Midwives
Published 10th June 2016
Conception to birth is a miracle.
The first golden hour after delivery is a time that can never be replicated. Wherever possible the first hour of a baby’s life should be devoted to optimal cord clamping, skin to skin, early feeding and time alone for the parents and baby to bond.
Research has shown that what happens during the first 60 minutes of a baby’s life can maximize that bonding experience between mother and child and that the uninterrupted contact between mother and baby during this “golden hour” after birth is critical to the child’s growth and development.
In this blog for infant mental health I place specific emphasis on the importance and benefits of optimal cord clamping which is necessary to prevent iron deficiency anaemia which is fundamental in promoting optimum neurological and physical development of the new-born.
Judith Mercer writes “Sensitive periods in brain development require adequate iron stores. Poor iron stores in the first year of life are known to harm the developing brain as myelination, hippocampus, and cortical brain development peak. Murine pups with iron deficiency have been shown to have hypomyelination and neurologic damage. In humans, abnormal white matter development (myelination) has been associated with a variety of developmental disorders ranging from dyslexia to autism thus making it a key area of interest for further study. The persistence of poorer cognitive, motor, affective, and sensory system functioning in children who were anaemic as infants highlights the need to study ways to prevent iron deficiency in infancy. Delayed cord clamping or milking the cord at birth may make an important contribution in the prevention of iron deficiency. (2014)
Delaying cord clamping (DCC) for at least one minute but preferably until the cord has stopped pulsating is the optimal management of the umbilical cord after delivery. Delayed/optimal cord clamping is recommended by NICE (2014) and WHO (2013) and allows the natural transition from intra-uterine to outer-uterine life enabling the baby to receive their full blood benefit of approximately 30% of their intended blood volume. The baby gains up to 214g of weight in the first five minutes with the cord intact and unclamped. (Farrar 2011).
Pre-term babies benefit most from delayed cord clamping with decreased rates of Intraventricular brain haemorrhages, necrotising enterocolitis and late onset sepsis…the effects of all can impact on the physical and subsequent mental well-being of the infant and child.
A study by Ola Andersson has shown that ICC causes iron deficiency anaemia at 4 months of age. (2011).
“Delayed cord clamping is recommended practice and research by Ola Andersson (2010) showed that “delayed cord clamping, compared with early clamping, resulted in improved iron status and reduced prevalence of iron deficiency at 4 months of age, and reduced prevalence of neonatal anaemia, without demonstrable adverse effects. As iron deficiency in infants even without anaemia has been associated with impaired development, delayed cord clamping seems to benefit full term infants even in regions with a relatively low prevalence of iron deficiency anaemia.”
In a further study on the same group of children Andersson concluded that “delayed CC compared with early CC improved scores in the fine-motor and social domains at 4 years of age, especially in boys, indicating that optimizing the time to CC may affect neurodevelopment in a low-risk population of children born in a high-income country.” (2015).
Babies who receive their full blood benefit also receive their full quota of stem cells which are known as the building blocks for the future well-being of the infant. Judith Mercer asks the question “Does placental transfusion and the transfer of stem cells at birth play a role in the prevention of some diseases in infancy, childhood, and later in life?” More studies are required. (2014)
Unfortunately immediately clamping the baby’s cord (ICC) which I reiterate, deprives the baby of approximately 30% of their intended blood volume is still prevalent practice in the UK. Immediate cord clamping is a non-evidence based intervention which has been practiced widely in the UK for 50-60 years and despite research showing that ICC leads to increased iron deficiency in babies which is known to impact on neurological development continues to be routine practice in some hospitals across the UK.
All health professionals and parents should be educated and fully informed about the benefits of leaving the cord to complete its function. Immediate cord clamping is a non-evidence based intervention which ethically requires parental consent after informed choice and should only be performed in very specific situations.
Andersson O, Hellstrom-Westas L, Andersson D, Domellof M. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial. BMJ. 2011;343:d7157.
Andersson O, Lindquist B, Lindgren M, Stjernqvist K, Domellöf M, Hellström-Westas L. Effect of Delayed Cord Clamping on Neurodevelopment at 4 Years of Age: A Randomized Clinical Trial. JAMA Pediatr. Published online May 26, 2015.
Farrar D, Airey R, Law GR, Tuffnel D, Cattle B, Duley L. Measuring placental transfusions foe term babies: weighing babies with cord intact. BJOG. 2011;118:70-75.
Mercer J S, Erickson-Ownes D A. Rethinking Placental Transfusion and Cord Clamping Issues. J Perinatol. 2012;26:202-217.
NICE (2014) Intrapartum care: care of healthy women and their babies during childbirth. Accessed 06th June 2016.
World Health Organization. Delayed clamping of the umbilical cord to reduce infant anaemia. 2013. Available from: Accessed 06th June 2016.