Umbilical cord milking is where the cord is pinched and “milked” during the third stage of labor in order to quickly push blood into the baby (as you would squeeze ketchup out of a packet, or honey out of a honey stick). Starting as close to the placenta as possible, moving towards the baby, a care provider milks the cord several times before the cord is finally clamped and cut, usually within 20 seconds. Umbilical cord milking is also sometimes called “stripping the cord”.
Warning! Umbilical Cord Milking Is Not What You Think
What is Delayed Cord Clamping?
Delayed cord clamping, on the other hand, is the practice of postponing cutting a newborn’s umbilical cord instead of immediately cutting it after birth. In recent years, ACOG and the AAP have both backed the practice of delayed cord clamping at birth for term and preterm infants. (This is wonderful news as when I began birth work it was a fight for women to have this request granted.)
Delayed cord clamping is awesome! It…
- Allows babies to have full access to the blood they were meant to have
- Decreases anemia in the first year of life helping babies to get smarter, faster
- Can be done in a minute (preferably 3-5!)
- Can help premature babies stay healthy
- Is what nature intended!
The Problem with Umbilical Cord Milking
In my community, and perhaps in yours too, many care providers now provide cord milking in lieu of delayed cord clamping. On the surface, it makes complete sense. Why wait minutes for blood to make its way to baby if you can push it through in seconds?
However, as you may have already guessed by the title of this article, delayed cord clamping and umbilical cord milking do not provide the same benefits.
The truth is that umbilical cord milking is NOT the same thing as delayed cord clamping. Umbilical cord milking could leave babies with too high of a hematocrit level (too many red blood cells) aka polycythemia. (SOURCE)
Polycythemia can be associated with the following symptoms (SOURCE):
- Respiratory distress and cyanosis
- Neurologic abnormalities including lethargy and jitteriness
- Poor oral feeding or feeding intolerance
- Poor urine output or renal failure
Also, cord milking does not give babies as much blood volume as delayed cord clamping does. (SOURCE) Delayed cord clamping for at least 3 minutes, on the other hand, maximizes a baby’s blood volume without experiencing the high hematocrit.
An Alternative to Delayed Cord Clamping?
According to the American Academy of Pediatrics, more research is needed on the benefits of umbilical cord milking. And oddly enough, they even go on to describe umbilical cord milking as the “practice of rapidly transferring umbilical cord blood to the infant used when a delay in umbilical cord clamping after birth is not possible.”
I am surprised by this statement because care providers in my community are doing this as an alternative to delayed cord clamping, not just when its impossible. And the upsetting part is that these same care providers tout this practice as the best evidence based choice, or more often, not even informing their patients of what’s happening.
The Benefits of Umbilical Cord Milking
Umbilical cord milking provides a greater placental transfusion, as demonstrated by higher initial hemoglobin, higher blood pressure, and improved systemic blood flow and urine output for infants delivered by cesarean delivery. It may be preferable in preterm infants delivered by cesarean delivery, particularly in newborns when immediate resuscitation is needed.
Although more larger trials are needed to confirm our observations, umbilical cord milking should be considered as a beneficial option for preterm infants delivered by cesarean delivery.
If I’m understanding the research correctly, and I think I am, the only time cord milking could be beneficial is at the birth of a preterm infant born by cesarean. At all other births, delayed cord clamping is preferred.
One Opinion on Umbilical Cord Milking
During my kid’s well visit a year or two ago I had a discussion with our doctor, a family doctor that also practices obstetrics, to get his take on the whole thing. In his opinion, the reason why obstetricians use umbilical cord milking across the board is because they want to do the same thing from room to room, instead doing one thing for one family and another for a different family.
As much as I appreciated his honest thoughts, I was a bit taken aback by the potential negligence of this philosophy of care. Is it too much to ask to do one thing for a premie born by cesarean birth and another in different circumstances?
However, I think he was being too kind to his comrades. In my opinion, doctors prefer umbilical cord milking because it takes 20 seconds compared to a minimum of one minute for delayed cord clamping. These care providers are in a hurry, don’t want to wait, and according to them, umbilical cord clamping is basically the same thing as delayed cord clamping.
Another Opinion on Umbilical Cord Milking
I had a recent conversation with a CNM (certified nurse midwife) that works at a local hospital in my community and she had some good thoughts about umbilical cord milking that I’d like to share. As a general rule, she will facilitate delayed cord clamping whenever possible. However, when DCC isn’t an option (some preterm deliveries, cesarean births, babies born with tight nuchal cords or perhaps when resuscitation is about take place, etc.) she has seen more favorable outcomes when umbilical cord milking is administered compared with straight immediate cord clamping.
Since there are no research studies on these specific instances, her choices are a reflection of her many years of experience and intuition. I really appreciate her willingness to provide individualized quality care instead of the routine “same thing for every room” mentality that I mentioned above.
Informed Consent is Critical
Now, I’m a calm person and it takes quite a bit for me to get feisty. But a lack of informed consent, misinformation, or flat out lying to patients gets me mad.
Taking advantage of ignorance and/or the hustle and bustle of the delivery room to place care provider’s convenience above the health and wellness of a new baby… I think it’s fair to say it ticks me off.
Of all things to ask for in the delivery room, delayed cord clamping is one of the simplest things to provide a patient. Simply do nothing and wait.
Umbilical Cord Milking Is Not What You Think
In summary, the evidence supports umbilical cord milking for preterm infants born by cesarean. All other babies, assuming normal circumstances, should receive delayed cord clamping. I know it can be challenging for some care providers to wait the recommended 2-5 minutes until the cord stops pulsing. However, the benefits outweigh the inconvenience.
Grab a cup of hot tea, do no harm, and simply wait. Healthy babies are worth it.
“If I don’t know my options, I don’t have any.” – Diana Korte
PS – If after reading this article you find yourself thinking that your OB may not be the best fit, that may be a sign that you need to fire your OB.