Delayed Cord Clamping: The Sweet Spot
One of my clients was told that delayed cord clamping might give her baby jaundice! This is scary to hear, especially if you don’t know what jaundice is, or that a certain amount of it is typical after birth.
Let’s talk about what the research actually says about timing, jaundice risk, and what to do when delayed clamping isn't an option
If you've done any birth prep at all, you've probably heard about delayed cord clamping. And if you're like most of my clients, you have it on your birth plan, highlighted and underlined.
I love that about you guys.
But here's the thing — I've noticed there's sometimes a gap between what parents understand about delayed cord clamping and what the research actually shows. And when that gap exists, it can lead to unnecessary stress, guilt, or confusion when birth doesn't go exactly as planned.
So let's talk about it — the real benefits, the nuances around timing, the jaundice question, and what options exist when delayed clamping isn't possible. No judgment, just information to help you feel informed and empowered.
Why Does Delayed Cord Clamping Matter?
When your baby is born, about one-third of their blood volume is still in the placenta and cord. Waiting to clamp allows that blood to transfer to your baby — and it's not just blood, it's iron-rich blood that supports brain development and prevents anemia in those early months.
The American College of Obstetricians and Gynecologists (ACOG) recommends delaying cord clamping for at least 30-60 seconds for both term and preterm infants. For preterm babies especially, the benefits extend to better circulation, fewer blood transfusions, and lower risk of serious complications.
So yes — delayed cord clamping is a good thing. We want baby to get their blood! But (and this is important) more is not always better.
The Timing Sweet Spot: When Longer Isn't Always Better
This is where the research gets really interesting — and where I think parents deserve more nuanced information.
A study published in Early Human Development looked at different timing intervals for cord clamping in healthy term infants. What they found was that delaying for less than 90 seconds improved babies' blood counts without increasing jaundice requiring treatment. But when they extended the delay from 90 to 120 seconds, they saw a trend toward higher risk of jaundice requiring phototherapy and polycythemia (too many red blood cells).
Another study focusing specifically on cesarean births found similar results — delaying 30-60 seconds improved hemoglobin levels without increasing phototherapy rates. Going beyond 60 seconds didn't provide additional hematological benefits.
What does this mean for you? The 30-60 second window that ACOG recommends isn't arbitrary — it's the sweet spot where babies get the benefits without the increased risks. Waiting 3-5 minutes might sound like "more is better," but that might not be the whole story. AND It’s so important to remember if your baby literally only gets 45 seconds and you’re laying on the operating table thinking - “But their IRON STORES!” - there is a (usually) a really really good medical reason your provider decided it needed to be cut earlier than you had hoped.
Let's Talk About Jaundice
Jaundice comes up a lot in conversations about cord clamping, and I want to address it head-on.
Yes, there is a small increase in jaundice requiring phototherapy with delayed cord clamping. ACOG acknowledges this and recommends that providers ensure systems are in place to monitor and treat neonatal jaundice when practicing delayed clamping.
But here's some context: mild jaundice is incredibly common and very treatable. For most healthy term babies, the benefits of improved iron stores and blood volume outweigh the small increased risk of needing some time under the bili lights.
That said, there are some situations where the risk-benefit equation shifts:
Babies of diabetic mothers: Research shows that delayed cord clamping increases jaundice risk specifically in babies born to mothers with diabetes, while having no significant effect in babies from non-diabetic pregnancies. This doesn't mean delayed clamping is off the table — just that closer monitoring may be warranted.
The takeaway? Delayed cord clamping is still beneficial for most babies, but timing matters, and individual circumstances should guide decision-making.
What If Delayed Cord Clamping Isn't an Option?
Here's where I really want you to take a deep breath and release any guilt you might be carrying.
Sometimes delayed cord clamping truly isn't possible. Maybe your baby needed immediate resuscitation. Maybe there was a complication that required quick action. Maybe you had a cesarean and the surgical team wasn't able to accommodate delayed clamping.
First: your baby will be okay. Early cord clamping is not harmful — it was standard practice for decades, and countless healthy humans are walking around today who had their cords clamped immediately.
Second: there's an alternative worth knowing about.
Umbilical Cord Milking: A Faster Alternative
Umbilical cord milking (UCM) involves gently squeezing the cord toward the baby 2-4 times before clamping. It takes about 20 seconds — much faster than delayed clamping — and can transfer a similar volume of blood to your baby.
A 2023 review in Frontiers in Pediatrics explains that cord milking is being considered as a practical option when babies need immediate respiratory support or when delayed clamping isn't feasible due to cold operating rooms or urgent resuscitation needs.
Research comparing UCM to delayed clamping in term infants shows similar benefits for hemoglobin levels, and a large 2023 trial found that in babies born between 28-32 weeks, UCM was noninferior to delayed clamping for serious outcomes.
One important note: cord milking is not currently recommended for extremely premature babies (under 28 weeks) due to safety concerns identified in the PREMOD2 trial. But for term and late-preterm babies, it's emerging as a safe, quick alternative when delayed clamping can't happen.
What This Means for Your Birth Plan
If I could sit across from you right now with a cup of tea, here's what I'd want you to walk away with:
Delayed cord clamping is beneficial — and 30-60 seconds is the evidence-based sweet spot for most babies. You don't need to push for longer.
Timing matters. Going beyond 90-120 seconds may increase jaundice risk without additional benefits.
Context matters. If you have gestational diabetes or other risk factors, have a conversation with your provider about monitoring.
Alternatives exist. If delayed clamping isn't possible, cord milking can provide similar benefits in a fraction of the time.
You haven't failed if delayed clamping didn't happen. Your baby's health and safety always come first, and there are many, many factors that contribute to a thriving newborn.
The Bottom Line
Birth rarely goes exactly as planned, and that's okay. What I want for you is to feel informed, not stressed. To know enough to have good conversations with your care team. And to release any guilt around decisions that were made in the moment for the health of you or your baby.
You're doing great, mama.
References
Qian Y, et al. "Timing of umbilical cord clamping and neonatal jaundice in singleton term pregnancy." Early Human Development. 2020. PMID: 31927308
Wang M, et al. "Effects of delayed cord clamping on neonatal jaundice, phototherapy and early hematological status in term cesarean section." Italian Journal of Pediatrics. 2021. PMID: 34039384
ACOG Committee Opinion No. 814: "Delayed Umbilical Cord Clamping After Birth." Obstetrics & Gynecology. 2020.
Zhang X, et al. "Differential effects of delayed cord clamping on bilirubin levels in normal and diabetic pregnancies." European Journal of Pediatrics. 2022. PMID: 35751710
Koo J, et al. "Umbilical cord milking-benefits and risks." Frontiers in Pediatrics. 2023. PMID: 37144151
Katheria A, et al. "Umbilical Cord Milking Versus Delayed Cord Clamping in Infants 28 to 32 Weeks: A Randomized Trial." Pediatrics. 2023.
