Delayed clamping of the umbilical cord: a review with implications for practice.

S.N., a healthy 22-year-old gravida 2 para 1 at 38 2/7 weeks’ gestation, was admitted to the hospital in active labor. Her history and prenatal course were uncomplicated. Contractions began 10 hours before her arrival at the hospital. Her vaginal examination on arrival was 5 cm dilatation, 50% effaced, and –2 station of the vertex, with intact membranes. Her contractions were occurring every 3 to 5 minutes. Shortly after hospital admission, epidural analgesia was initiated at the patient’s request. Four hours later, the frequency of her contractions was every 4 to 6 minutes, and a pelvic examination revealed minimal progress at 6 cm dilatation, 80% effacement, and –1 station. In an attempt to increase the frequency of her contractions, an amniotomy was performed and oxytocin augmentation was initiated. An hour later, her contractions were occurring every 3 to 4 minutes, lasting 60 to 90 seconds. Three hours later, she was fully dilated and the baby’s head was at +1 station in an occiput anterior position. At this point, she was instructed to begin pushing with each contraction. Twenty minutes later, S.N. gave birth via normal spontaneous vaginal delivery to a healthy baby boy. The umbilical cord was clamped within 30 seconds of birth, which is routine practice at this hospital, and the baby was brought directly to the warmer. There was no previous discussion with S.N. concerning the timing of the umbilical cord clamping. The placenta spontaneously delivered 5 minutes later, at which point routine oxytocin infusion was initiated via intravenous infusion. The baby boy weighed 3075 g and had Apgar scores of 9 and 9, at 1 and 5 minutes, respectively. There were no labial or perineal lacerations, nor excessive bleeding. The mother’s blood type was Rh-positive. Breastfeeding was not attempted in the immediate postpartum period because of maternal exhaustion. Postpartum day one, the baby was both bottle-feeding with formula and breastfeeding. The baby’s newborn examination and laboratory values were within normal limits. The family left the hospital on the second postpartum day, satisfied and doing well.