By Birth & Baby University · Last updated: October 2026 · 5 min read
Cord clamping is one of the few birth practices with a recent, explicit change in professional guidance. It is also an easy topic to oversimplify. This article covers what term and preterm babies gain from a short wait, what the trade-offs are, and how a doula can support a family who wants to discuss timing with their clinicians.
Key takeaways
- ACOG recommends waiting at least 30 to 60 seconds before clamping in vigorous term infants (Committee Opinion 814, reaffirmed 2026), and, since its July 2025 update, at least 60 seconds for preterm babies born before 37 weeks who do not need immediate resuscitation.
- In term babies, later clamping was associated with higher hemoglobin and iron stores, and with a small increase in jaundice needing phototherapy.
- In preterm babies, deferred clamping reduced death before hospital discharge in a 2023 individual participant data meta-analysis of 48 randomized trials.
- Timing is a clinical decision, and it changes if the baby needs immediate help. Doulas support the conversation, not the decision.
What the research says
Term babies
A Cochrane review of 15 trials with 3,911 mother-baby pairs compared early clamping (usually within 60 seconds) with later clamping. For mothers, there was no significant difference in severe postpartum hemorrhage (RR 1.04, 95% CI 0.65 to 1.65) or in hemorrhage of 500 mL or more (RR 1.17, 95% CI 0.94 to 1.44). For babies, there were no significant differences in mortality or in most morbidity outcomes. Birthweight was on average 101 g higher with later clamping, and hemoglobin was higher at 24 to 48 hours with later clamping, though that difference was not seen later. Babies with early clamping were more than twice as likely to be iron deficient at three to six months (RR 2.65, 95% CI 1.04 to 6.73), though the estimate is wide and heterogeneity was high. Fewer babies in the early clamping group needed phototherapy for jaundice (RR 0.62, 95% CI 0.41 to 0.96). In the only trial reporting neurodevelopment, no overall difference was found.
Preterm babies
A 2023 individual participant data meta-analysis in The Lancet pooled 48 randomized trials with 6,367 infants born before 37 weeks. Deferred clamping, compared with immediate clamping, reduced death before discharge (odds ratio 0.68, 95% CI 0.51 to 0.91; high-certainty evidence). Cord milking compared with immediate clamping showed no clear difference in death (OR 0.73, 95% CI 0.44 to 1.20; low certainty), and no clear difference was found between milking and deferred clamping. The benefit appeared consistent across subgroups including gestational age, type of delivery and multiple birth. This updates an earlier 2018 meta-analysis of 18 trials, which had found lower hospital mortality with delayed clamping (RR 0.68) and noted polycythemia and hyperbilirubinemia as potential harms.
What the professional guidance says
For term babies, ACOG Committee Opinion 814 (December 2020; ACOG’s page shows it reaffirmed in 2026, with an interim update to the language on cord milking) says delayed clamping appears beneficial, recommends a delay of at least 30 to 60 seconds in vigorous infants, and advises that settings adopting delayed clamping in term infants have mechanisms to monitor and treat neonatal jaundice. It notes that the ability to provide delayed clamping varies by institution.
For preterm babies, ACOG’s July 2025 Clinical Practice Update updates that opinion. It recommends deferring clamping for at least 60 seconds in neonates born before 37 weeks who are not deemed to need immediate resuscitation, and says cord milking is a reasonable alternative to immediate clamping for babies born at 28 0/7 to 36 6/7 weeks who do not receive deferred clamping. It lists clinical situations in which immediate clamping should be considered or care individualized: babies needing resuscitation or deemed nonvigorous, multiple gestations, fetal malformations, placenta previa, antepartum hemorrhage, diabetes in pregnancy, hypertensive disorders, cord abnormalities, fetal growth restriction, category III fetal heart rate tracings and meconium-stained fluid. ACOG explains that a longer deferral of 120 seconds or more was linked with a larger reduction in death, but rested on five small trials with adherence as low as 67 percent, so it chose a minimum of 60 seconds. The 2025 update replaces the 30 to 60 second preterm figure from 2020.
Where sources differ
For term babies, ACOG describes a small increase in phototherapy-requiring jaundice with delayed clamping, while the Cochrane review found fewer babies needing phototherapy in the early-clamping group. The two statements agree: jaundice is a recognized trade-off of later clamping, which is why teams are advised to monitor for it. Iron benefits come from trials with high heterogeneity, and whether they translate into lasting developmental benefit is not settled.
What this means for doulas
- Encourage a conversation before labor. Help clients ask their clinician what the practice’s usual timing is and what would change it.
- Explain the exceptions. Babies who need resuscitation or immediate care, and some emergencies, may have the cord clamped sooner. ACOG’s 2025 list of situations needing individualized care also includes multiples, placenta previa, bleeding before birth, diabetes or hypertensive disorders in pregnancy and fetal growth restriction. A birth preference is not a guarantee.
- Do not tell clients what is safe. Questions about a particular pregnancy, such as prematurity, multiples or a baby with risk factors, are for the care team.
- Be accurate about benefits. Say “associated with higher iron stores in the first months” rather than “better brain development.”
Putting the evidence into practice
- Offer a short prenatal handout or script that helps clients ask: “What is your usual practice? Does it differ for cesarean or for a preterm baby? Who monitors for jaundice after birth?”
- Record the preference in a birth plan as a request, with understanding that conditions can change it.
- After birth, normalize what was done and avoid second-guessing clinicians in the moment.
- Keep your own reading current. ACOG changed its preterm guidance in July 2025.
The bottom line
A short delay is supported by professional guidance for vigorous babies, with clearer survival benefit in preterm infants and iron-related benefits in term infants, balanced against more jaundice. Doulas can help families prepare questions and understand why timing may change on the day, without making clinical decisions.
This article is for professional education. It is not medical, legal or tax advice. Check the standards of your certifying organization and the rules where you work.
Sources and further reading
- McDonald SJ, et al. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2013. Read the source
- Fogarty M, et al. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology 2018. Read the source
- American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Delayed Umbilical Cord Clamping After Birth: Committee Opinion No. 814. Obstetrics & Gynecology 2020. Read the source
- American College of Obstetricians and Gynecologists Committee on Clinical Consensus-Obstetrics. ACOG Clinical Practice Update: An Update to Clinical Guidance for Delayed Umbilical Cord Clamping After Birth in Preterm Neonates. Obstetrics & Gynecology 2025. Read the source
- Seidler AL, et al. Deferred cord clamping, cord milking, and immediate cord clamping at preterm birth: a systematic review and individual participant data meta-analysis. Lancet 2023. Read the source
Helping families prepare questions for their care team is part of doula practice. See the training and mentorship options on the For Doulas page.
More for professionals: the Professionals Blog.
Leave a Reply