Delayed cord clamping: what it gives your baby and how to ask for it in Singapore

Delayed cord clamping means your doctor waits two to three minutes after birth before clamping and cutting the umbilical cord, instead of doing it straight away. In that time blood keeps flowing from the placenta to your baby. SGH's obstetricians say a full-term baby gets an extra 80 to 100ml of blood this way, carrying enough iron to last about three months, which lowers the risk of anaemia. The trade-off is a higher chance of newborn jaundice. SGH has described the practice as uncommon in Singapore, but says many obstetricians will do it on request when the birth is uncomplicated. So if you want it, ask your gynae early and write it into your birth plan.

What happens when the cord is clamped

At birth, an extra volume of your baby's blood is still in the placenta. Until the cord is clamped, it keeps pulsing back to your baby, and the pulses stop on their own several minutes after birth. Clamping early stops that transfer; waiting lets most of it finish.

Clamping was first brought in to lower the mother's risk of serious bleeding after birth, and for convenience the cord was usually clamped within a minute. An SGH consultant notes that immediate clamping has never been universally accepted as part of managing the third stage of labour, when the placenta comes out. Our stages of labour guide explains where that stage fits.

Immediate and delayed clamping compared

Figures are from SGH's obstetrics and neonatal doctors writing on HealthXchange.

The benefits for full-term babies

The main gain is iron. SGH says delayed clamping lowers the risk of anaemia and raises the number of red blood cells in newborns. Babies most likely to benefit are full-term babies at risk of anaemia, and babies whose mothers are iron-deficient. If you've been told your iron is low in pregnancy, that's worth raising with your doctor.

Premature babies

For babies born early, SGH links delayed clamping to a smaller risk of bleeding in the brain (intraventricular haemorrhage) and of necrotising enterocolitis, a serious bowel condition. An SGH neonatologist adds a caution. Research has found less brain bleeding just after birth in babies born before 33 weeks, she says, yet no clear difference in how those babies fared in the end. SGH's obstetrician would only recommend it for premature babies in uncomplicated births that don't need immediate resuscitation.

The downsides: jaundice and open questions

The extra red blood cells raise your baby's chance of jaundice. That's the yellowing that comes from bilirubin, a substance made when red blood cells break down. SingHealth says jaundice is common in newborns and usually peaks between three and five days old, which is why your baby should be seen by a nurse or doctor then. If the level is high, your baby has phototherapy under blue lights. Our newborn jaundice guide covers the checks and treatment.

SGH also points out that there's no agreed standard for the best time to clamp, and that the effects on mothers haven't been studied enough. Even so, it says delayed clamping should pose very little risk to the mother when there are no other complications.

When your doctor won't delay

Delayed clamping and cord blood banking

The Singapore Cord Blood Bank says cord blood is collected after the cord has been clamped and cut, from the part of the cord still attached to the placenta. Donated cord blood is only banked if it meets the bank's checks on volume and cell count. Delaying the clamp sends more of that blood to your baby and leaves less in the cord, so talk to both your obstetrician and your chosen bank about how they handle the two together. Our cord blood banking guide compares public donation and private banking.

How to ask for it

• Raise it at a third-trimester visit, when you go through your birth plan. Our 33 weeks pregnant guide covers what to plan that month.
• Ask how long your doctor usually waits, and whether they'll do it if you need a caesarean or an assisted birth.
• Say whether you're donating or banking cord blood, so everyone knows which comes first.
• Note if your partner wants to cut the cord once it has stopped pulsing.
• Write it into your birth plan, with a line that you accept immediate clamping if your doctor needs it.

Frequently asked questions

How long is delayed cord clamping?

SGH describes it as clamping and cutting the cord two to three minutes after birth, rather than straight away. There's no agreed standard for the exact timing, so ask your doctor what they do.

What are the benefits of delayed cord clamping?

A full-term baby gets an extra 80 to 100ml of blood and about three months' worth of iron, which lowers the risk of anaemia. In premature babies it's linked to less bleeding in the brain.

What are the disadvantages of delayed cord clamping?

A higher chance of newborn jaundice, which sometimes needs phototherapy. It also leaves less blood in the cord if you're banking or donating cord blood.

Can I ask for delayed cord clamping at a Singapore hospital?

Yes. SGH says many obstetricians will do it on request in uncomplicated births. Agree it with your gynae beforehand and write it in your birth plan.

Is delayed cord clamping safe for the mother?

SGH says it should pose very little risk to the mother when there are no other complications. It isn't done if you're bleeding heavily.