Evidence Base and Links


Cardiovascular transition at birth: a physiological sequence (2015)

Neonatal resuscitation: evolving strategies (2015)

Placental Transfusion at Birth: Do We Have All of the Answers? (2015)

Review: A physiological approach to the timing of umbilical cord clamping at birth (2014)

Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trial (2014)

Ventilation before Umbilical Cord Clamping Improves the Physiological Transition at Birth (2014)

Providing newborn resuscitation at the mother’s bedside: assessing the safety, usability and acceptability of a mobile trolley (2014)

Neonatal Outcome Following Cord Clamping After Onset of Spontaneous Respiration (2014)

Review: Placental transfusion strategies in very preterm neonates: a systematic review and meta-analysis (2014)

The Timing of Cord Clamping and Oxidative Stress in Term Newborns (2014)

Umbilical blood flow patterns directly after birth before delayed cord clamping (2014)

Time to implement delayed cord clamping (2014)

Beliefs and practices of obstetric care providers regarding umbilical cord clamping (2014)

Promoting physiologic transition at birth: re-examining resuscitation and the timing of cord clamping (2013)

Review: Timing of umbilical cord clamping after birth for optimizing placental transfusion (2013)

Latest Cochrane Review: Effect of timing of umbilical cord clamping of term infants on mother and baby outcomes – Summary (2013)

Rethinking Placental Transfusion and Cord Clamping Issues (2012)

Delayed cord clamping for prevention of iron deficiency anemia in term infants (2012)

Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial (2011)

Timing of umbilical cord clamping: effect on iron endowment of the newborn and later iron status (2011)

Measuring placental transfusion for term births: weighing babies with cord intact (2010)

Late vs Early Clamping of the Umbilical Cord in Full-term Neonates – Systematic Review and Meta-analysis of Controlled Trials (2007)

Neonatal transitional physiology: a new paradigm – Mercer J & Skovgaard R (2002)

Nuchal cord management and nurse-midwifery practice – Mercer et al. (2005)

Nuchal cords: sharing the evidence with parents – Reed et al. (2009)

Evidence-Based Practices for the Fetal to Newborn Transition: The Timing of Umbilical CordClamping


1973: Cashmore J. Usher RH. (1973) Hypovolemia resulting from a tight nuchal cord at birth. Pediatr. Res: 7:339.

1985: Shepherd A., Richardson C., Brown J. (1985) Nuchal cord as a cause of neonatal anemia. Am J Dis Child;139:71–3: Anemia in the tight nuchal cord group was usually observed early, and in three infants was manifest by hypotension, necessitating transfusion.

1987: Vanhaesebrouck P., Vanneste K., De Praeter C., Van Trappen Y., Thiery M.(1987) ‘Tight nuchal cord and neonatal hypovolaemic shock’, Archives of Disease in Childhood, , 62 1276-77

1988: Dunn(1988) Tight nuchal cord and neonatal hypovolaemic shock. Arch Dis Child. 1988 May; 63(5): 570–571.

1991, Schorn and Blanco recommended use of the somersault technique to facilitate birth where the umbilical cord is short or looped tightly around the neck, in order to avoid clamping and cutting the cord.

1994, Iffy and VaradiCerebral palsy following cutting of the nuchal cord before delivery’ : documenting five cases of pre-birth cord severance followed by a delay in delivery ranging from 3 to 7 minutes. The authors wrote:

All of these infants were born with a low APGAR score. Subsequently, they displayed manifestations of cerebral palsy and two of them also had permanent brachial plexus lesion. This series of incidents indicates that an unexpected arrest of the shoulders may inadvertently compound the problem that the severing of the cord prior to the delivery of the body entails.”

1999, Reynolds published a family physician practice tip for performing the somersault maneuver, describing it as a “simple way to assist in the birth of a baby with a tight cord”.

2001, Iffy, Varadi and Papp ‘Untoward neonatal sequelae deriving from cutting of the umbilical cord before delivery’, documenting four cases where:

“…following the delivery of the fetal head, the physician electively cut the nuchal cord of the fetus… The writers conclude that the practice of severing the umbilical cord prior to the delivery of the body of the fetus, proposed in some textbooks as a routine procedure, is a dangerous technique, which should be avoided. They also point out that the medical literature has not discussed this problem.”

2005, Mercer,  Skovgaard, Peareara-Eaves and Bowman ‘Nuchal cord management and nurse-midwifery practice’. The authors wrote:

“Cutting the umbilical cord before birth is an intervention that has been associated with hypovolemia, anemia, shock, hypoxic-ischemic encephalopathy, and cerebral palsy. This article proposes use of the somersault maneuver followed by delayed cord clamping for management of nuchal cord at birth and presents a new rationale based on the available current evidence.”

2007, ReedNuchal Cords: Think Before You Check’, :

“Given the lack of evidence to support cutting a nuchal cord, and the medico-legal evidence against, this procedure could pose a risk management problem for practitioners and Trusts.”

2008, Singh and SidhuNuchal Cord: A Retrospective Analysis’:

“…having tight cord around the neck had significantly higher proportion of fetal distress and low Apgar scores at one minute…[the definition of tight cord in this study] When the nuchal cord had to be clamped and cut before delivery, it was called “tight”.”

2008, Mercer, Erikson-Owens and Skovgaard ‘Cardiac asystole at birth: Is hypovolemic shock the cause?’. Featuring two cases studies of immediate clamping and pre-birth cutting of a nuchal cord with serious shoulder dysocia (approximately 6 minutes), the writers hypothesise:

“Immediate cord clamping maintains the hypovolemic state by preventing the physiologic and readily available placental blood from returning to the infant. Loss of this blood initiates an inflammatory response leading to seizures, hypoxic-ischemic encephalopathy, and brain damage or death.”


RCOG UK  Clamping of the Umbilical Cord and Placental Transfusion (Scientific Impact Paper No. 14)

World Health Organization Guideline: Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes (2014)

The Human Umbilical Cord the umbilical cord and its development, composition and function

Choices about clamping your baby’s umbilical cord: A decision aid for women having a vaginal birth

Choosing how to birth your placenta: A decision aid for women having a vaginal birth


RCOG/ RCM Joint Statement on Umbilical Cord Blood Collection and Banking Aug 2011


Cord Clamping Info – Dr Judith Mercer

Academic OB/GYN blog & videos of Nicholas Fogelson MD

Common Objections to Delayed Cord Clamping – What’s The Evidence Say? Mark Sloan MD (2012)

Hands off the cord – Birth Matters NZ (2012)

The Placenta: essential resuscitation equipment – Reed R (2010)

Nuchal Cords: the perfect scapegoat – Reed, R (2010)

Leaving Well Alone: A Natural Approach to the Third Stage of Labour – Buckley, S (2005)

Why Do Babies Cry? The Anatomical and Physiological Changes During the Moments After Birth – Morley, G (2002)

Leaving A Baby’s Umbilical Cord to Stop Pulsating (Delayed Cord Clamping) Facebook page


How the Cord Clamp Injures Your Baby’s Brain

Discussion: Umbilical cord clamping after birth

Discussion: Why do obstetricians and midwives still rush to clamp the cord?


Neonatal resuscitation: evolving strategies (2015)

Blood gas values in clamped and unclamped umbilical cord at birth (2014)

Is It Time to Rethink Cord Management When Resuscitation Is Needed? (2014)

Could early cord clamping harm neonatal stabilisation?

Neonatal Resuscitation: Life That Failed – Morley, G. (2011)

The following articles do not address cord clamping – the timing and intervention of cord clamping is not mentioned, despite it being common practice to immediately clamp and separate the baby from the placenta/ transfusion /blood/ oxygen supply, in order to commence resuscitative efforts:

Resuscitation at birth and cognition at 8 years of age: a cohort study

Risk factors at delivery and the need for skilled resuscitation.

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