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Rethinking Placental Transfusion and Cord Clamping Issues

Mercer, Judith S. PhD, CNM, FACNM; Erickson-Owens, Debra A. PhD, CNM

The Journal of Perinatal & Neonatal Nursing: July/September 2012 - Volume 26 - Issue 3 - p 202–217
doi: 10.1097/JPN.0b013e31825d2d9a
FEATURE ARTICLES: Continuing Education

A brief delay in clamping the umbilical cord results in a placental transfusion that supplies the infant with a major source of iron during the first few months of life. Cord circulation continues for several minutes after birth and placental transfusion results in approximately 30% more blood volume. Gravity influences the amount of placental transfusion that an infant receives. Placing the infant skin-to-skin requires a longer delay of cord clamping (DCC) than current recommendations. Uterotonics are not contraindicated with DCC. Cord milking is a safe alternative to DCC when one must cut the cord prematurely. Recent randomized controlled trials demonstrate benefits for term and preterm infants from DCC. The belief that DCC causes hyperbilirubinemia or symptomatic polycythemia is unsupported by the available research. Delay of cord clamping substantively increases iron stores in early infancy. Inadequate iron stores in infancy may have an irreversible impact on the developing brain despite oral iron supplementation. Iron deficiency in infancy can lead to neurologic issues in older children including poor school performance, decreased cognitive abilities, and behavioral problems. The management of the umbilical cord in complex situations is inconsistent between birth settings. A change in practice requires collaboration between all types of providers who attend births.

College of Nursing, University of Rhode Island, Kingston, Rhode Island; and The Warren Alpert Medical School of Brown University, Providence, Rhode Island

Debra A. Erickson-Owens, PhD, CNM, College of Nursing, University of Rhode Island, White Hall, 2 Heathman Road, Kingston, RI 02882 (

Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Submitted for publication: February 17, 2012; accepted for publication: May 1, 2012.

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.