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What is 'Wait for White'

Delayed Cord Clamping


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14/10/2018

What is 'Wait for White'

How Long Should Cord Clamping be Delayed? This depends on who you ask...

  • The American College of Obstetricians and Gynecologists (ACOG) says at least 30-60 seconds.
  • The World Health Organization recommends at least 1 minute, or until the cord has stopped pulsing.

Ideally, providers should wait until the umbilical cord is completely drained, limp and white in colour.

  • At the 1 minute mark, the baby will receive 50% of the cord blood
  • At the 3 minute mark, the baby will receive 90% of the cord blood
  • At around the 5 minute mark, the baby gets all of the necessary cord fluids

Optimal/Deferred or Delayed Cord Clamping provides so many benefits, giving infants the best start in life, providing the best woman-centred care and contributing towards the mental and emotional health of families.

Umbilical cord blood is the source of a baby’s lifeblood up until birth. It contains many critical cells, like stem cells, red blood cells, and white blood cells (including cancer-fighting T-cells) that help fight disease and infection.

The Benefits:

For the Baby:

  • Normal, healthy blood volume for the transition to life outside the womb
  • A full count of red blood cells, stem cells and immune cells

For the Mother:

  • Keeps the mother-baby unit intact
  • May prevent complications with delivering the placenta

For very preterm Infants:

  • Fewer days on oxygen and ventilation
  • Fewer transfusions
  • Lower rates of intraventricular haemorrhage and late-onset sepsis.

A review of large studies on delayed cord clamping shows the following additional benefits:

  • Higher blood pressure
  • Higher hematocrit levels
  • More optimal oxygen transport and higher red blood cell flow to vital organs
  • Reduced infant anaemia
  • Increased duration of breastfeeding

In a normal birth, delayed clamping is achieved by leaving the umbilical cord intact during the placental transfusion and not clamping until the cord has stopped pulsating.

Once the baby has begun to breathe and achieved a normal circulating blood volume, the cord ceases to pulse (cord appears white and flaccid). It can take around 3 to 7 minutes for a baby to transition and to establish a physiological blood volume, but this process can take longer for some babies.

In surgical deliveries (caesarean section), a ‘delay’ in clamping can be achieved (except in cases where there is incision or damage to the placenta). The baby can be held below the level of the placenta to assist with the transfer of blood from the placenta to the baby. The delay in clamping might be a minimum of 40 seconds or even longer, depending on the circumstances of the birth. With a ‘lotus’ caesarean section the placenta may remain attached to the baby, without clamping the cord.




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