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What Doulas Need to Know About Delayed Cord Clamping in 2026
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A delivered placenta and umbilical cord resting on a blue surgical drape, with the cord curled into a heart shape on the right side.

What you’ll learn in this post

  • What delayed cord clamping actually means, and why the definition varies by hospital and by provider
  • How the current guidelines from ACOG, ACNM, WHO, and AAP compare, and where they disagree
  • What national data shows about how often US hospitals actually do delayed cord clamping, and why the answer varies by state
  • What the evidence shows for term babies, preterm babies, and cesarean births
  • How cord milking fits in, and when it is and is not recommended
  • A simple way to help your clients ask the right questions of their provider without overstepping your scope
  • Where placenta policies intersect with cord timing, and why that is a separate conversation

When I started attending births in the 1980s, early cord clamping was the default. The cord was clamped and cut almost as soon as the baby was out, often before anyone in the room had taken a full breath. Nobody called it an intervention. It was just what happened.

At that time, most of the push to wait came from clients, not from providers. I sat in a lot of prenatals where a client would ask about waiting to cut the cord, and the physician would say something like, “Sure, we can do that, but we’ll need to hold the baby above the heart.” The next client I worked with would hear, “At the level of the heart.” The one after that would hear, “Below the heart.” Three different answers from three providers in the same hospital in the same month.

The research eventually caught up. The placenta and cord work like a pump. Blood transfers to the baby through pulsation, not gravity, and the position of the baby relative to the placenta does not meaningfully change placental transfusion for a healthy term newborn. That finding took years to reach the people holding the babies. Some providers are still catching up.

The evidence has moved. The guidelines have moved. In most US hospitals in 2026, some form of delayed cord clamping is the default. But “delayed” covers a wide range, and that range is where most of the miscommunication between clients and providers lives. This post is for the doulas I train and the doulas out there working with clients right now. I want you to know what the guidelines actually say, where they disagree, what the research shows, and how to help your clients have a useful conversation with their provider without stepping outside your scope.

What is delayed cord clamping

Delayed cord clamping, sometimes called deferred cord clamping, is a range, not a single timing. That is the first thing to understand. It is also why so many clients end up feeling unheard. When a client says, “I want delayed cord clamping,” they might mean:

  • Wait until the cord stops pulsating
  • Wait until the cord turns white
  • Wait until the placenta is delivered
  • Wait as long as possible

When a provider says, “Yes, we do delayed cord clamping,” they might mean:

  • 30 seconds
  • 60 seconds
  • Two minutes
  • “Until I feel ready to cut it”

Those two columns can both be true at the same time, and the birth can still end with someone feeling like they were not listened to. I have seen 17 seconds called “delayed” by providers in real rooms. If the client wanted the cord to stop pulsating, 17 seconds is not what they meant.

This is not a villain story about providers. It is a definition problem. And the fix is simple enough that you can hand it to your clients in a single prenatal conversation.

What the current guidelines say

Different organizations define delayed cord clamping differently, and it helps to know who says what.

American College of Obstetricians and Gynecologists (ACOG). ACOG recommends delaying cord clamping for at least 30 to 60 seconds in vigorous term and preterm infants. This recommendation, in Committee Opinion 814, applies to both vaginal and cesarean births.

In July 2025, ACOG issued a Clinical Practice Update specific to preterm babies. It calls for deferring cord clamping at least 60 seconds in preterm babies born before 37 weeks who do not need immediate resuscitation. Longer delays of 120 seconds or more should be planned with the neonatal team in advance.

World Health Organization (WHO). WHO recommends clamping no earlier than one minute after birth, and suggests one to three minutes for all births while starting essential newborn care at the same time.

American College of Nurse-Midwives (ACNM). The ACNM position statement, last updated in July 2021, uses the term physiologic-based cord clamping and calls for it as the standard of care across all settings, all modes of birth, and for term and preterm babies. For term babies, ACNM recommends at least three to five minutes, with five minutes or longer preferred when the baby is skin to skin. For preterm babies, the range is 30 to 180 seconds. ACNM goes further than ACOG does, and it is worth knowing that when a client wants to ask about a longer delay.

American Academy of Pediatrics (AAP) and Neonatal Resuscitation Program (NRP), 8th edition. These endorse delayed cord clamping for vigorous term and preterm babies. The American Heart Association and AAP 2023 focused update on neonatal resuscitation also states that for non-vigorous term and late preterm babies born at 35 to 42 weeks, intact cord milking may be reasonable compared with early clamping. This matters because the delivery room team is working from the resuscitation guideline, not the obstetric one.

Put together, the floor is 30 to 60 seconds, and many care teams wait longer when the baby is stable. When a client says their provider “does delayed cord clamping,” what that means at their specific hospital is a real question. Thirty seconds and five minutes are both inside the definition.

How often do hospitals actually do delayed cord clamping

Here is where it gets interesting, and where I want you to pay close attention if you are a doula working in hospital settings.

There is a real gap between what hospitals say they do and what actually happens in the delivery room. Two studies are worth knowing about.

The first is national. The Centers for Disease Control and Prevention analyzed the 2018 Maternity Practices in Infant Nutrition and Care (mPINC) survey, a biennial census of US hospitals providing maternity care. The question they asked hospitals was simple: how many of your healthy newborns have the cord clamped more than one minute after birth? Across 2,042 hospitals, only 50 percent said “most” (80 percent or more) of their healthy newborns received delayed cord clamping. That is half of US hospitals meeting the threshold for most babies. (Nakayama et al., Obstetrics and Gynecology, 2021)

The state-by-state variation was dramatic. The median across states was 52 percent, but the range went from 29 percent to 100 percent. Your client’s zip code matters. A doula working in a state at the low end is operating in a very different environment than a doula working in a state at the high end.

A few other patterns from that survey worth noting:

  • Baby-friendly designated hospitals were barely different from non-designated ones (52.7 percent versus 49.1 percent). Baby-friendly status does not tell you what you might hope it tells you about cord practices.
  • Hospitals with cesarean rates of 35 percent or higher reported delayed cord clamping for most babies only 37.1 percent of the time, compared with 61.0 percent at hospitals with cesarean rates below 25 percent. Hospital culture around intervention timing tends to travel together.
  • Birth volume did not make a meaningful difference. Small and large hospitals landed in similar ranges.

The second study is a close-up of one hospital. A quality improvement project at a university hospital obstetrics service, published in Pediatric Quality and Safety in 2021, observed 34 random deliveries before any intervention to see how often the 30-second standard was actually being met. The answer was 12 percent. Four of 34. This was after the WHO recommendation and after the Neonatal Resuscitation Program guidance, though before ACOG’s recommendation was released. (Pauley et al., Pediatric Quality and Safety, 2021)

Their interventions were not complicated. They discussed the guidelines at grand rounds. They talked with delivery room nurses at shift changes. They put timers in the delivery rooms. They added a checkbox to the electronic health record. Within six weeks of finishing those changes, the rate of delayed cord clamping rose to 96 percent. One hospital, one small team, inexpensive fixes, and a nearly complete turnaround.

I share these two studies with my students for three reasons. First, the national picture tells you this is not a solved problem. Half of US hospitals, at best, are doing this for most babies. Second, the state and cesarean rate variation tells you where your clients give birth matters, and where a client moves to matters. Third, the Marshall study tells you the gap is closable when hospitals pay attention. Twelve percent to 96 percent in a few weeks, with timers and a checkbox.

What this means for you as a doula: when your client asks their provider about cord clamping practices at their specific hospital, you are not being paranoid. You are helping them gather real information. And when a client tells you, “My hospital does delayed cord clamping,” the next question is always, “Have you asked what that looks like in practice?”

Why the delay matters for the baby

At term, a baby may have about one third of their total blood volume in the placenta when labor begins. During birth, that blood moves back to the baby through ongoing cord pulsation. Clamping too early interrupts that transfer.

For term babies, delayed cord clamping raises hemoglobin at birth and improves iron stores for the first several months of life. Iron supports cognitive, motor, and social development in the first year and beyond. ACOG notes these extra iron stores may help prevent iron deficiency in the first year of life. There is a small increase in the rate of jaundice that needs phototherapy, and hospitals that delay clamping are generally already set up to monitor and treat for that.

For preterm babies, the benefits are more pronounced. Delayed cord clamping reduces intraventricular hemorrhage, necrotizing enterocolitis, and the need for blood transfusion. The 2019 Cochrane review by Rabe and colleagues found about a 39 percent reduction in the need for blood transfusion in preterm infants with delayed clamping.

Long-term follow-up research is still small but promising. The Swedish trial by Andersson and colleagues showed small improvements in fine motor and social skills at age four. Mercer and colleagues published work in 2018 looking at four-month ferritin and brain myelin content in term infants, with delayed clamping associated with higher ferritin and more myelin in key brain regions. These are small, carefully done trials, not blockbuster results, and I talk about them that way with clients. The benefits are real and worth waiting for. They are not miraculous.

Does delayed cord clamping cause postpartum hemorrhage

No. This was the original reason hospitals clamped early, and the concern has been put to rest in current guidelines. The Purisch 2019 JAMA trial in term cesarean births specifically showed no significant difference in maternal hemoglobin change between immediate and delayed clamping.

The two real considerations are the small rise in neonatal jaundice that may need phototherapy, and the need to individualize in certain clinical situations. ACOG lists those situations as needing immediate resuscitation, some multiple gestations, certain congenital anomalies, placenta previa, and antepartum hemorrhage. Those are clinical judgment calls, not reasons to skip the conversation.

What is cord milking, and when is it used

Umbilical cord milking is different from delayed clamping. The provider grasps the cord near the placental end and gently strips blood toward the baby before the cord is clamped. It takes seconds and can be done when waiting is not practical, for example when a baby needs to be moved to a warmer quickly.

The evidence has sorted itself out over the last several years.

  • Very preterm babies (before 28 weeks): Cord milking is not recommended. A large 2019 trial found an increased risk of severe intraventricular hemorrhage in this group compared with delayed clamping. Delayed clamping is the intervention of choice when feasible.
  • Preterm babies between 28 and 36 6/7 weeks: ACOG’s 2025 update says cord milking is a reasonable alternative when delayed clamping cannot be done.
  • Non-vigorous term and near-term babies (35 to 42 weeks): The MINVI trial found cord milking reduced the need for delivery room cardiorespiratory support compared with immediate clamping. Two-year follow-up showed no difference in neurodevelopmental outcomes.

The short version for clients: delayed clamping is the first choice when the baby is stable. Cord milking is a tool that lets the team transfer some blood volume when waiting is not possible, and the evidence for its use is gestational age specific.

Delayed cord clamping at cesarean birth

This is the piece clients ask about most, and it is the piece where hospital practice has changed the most. A decade ago, most cesarean births included immediate cord clamping, often by default. That is no longer the ACOG recommendation, and it is no longer how most US hospitals approach it.

ACOG Committee Opinion 814 applies the delayed clamping recommendation to cesarean births. The Purisch 2019 trial in term cesareans found no significant increase in maternal blood loss with a 60 second delay. Systematic reviews published in 2024 and 2025 support the same conclusion: a delay of 30 to 60 seconds, and often longer, is safe at cesarean for the pregnant person and beneficial for the baby.

Practical considerations at cesarean include surgical drapes, the distance between the surgical field and the warmer, and the neonatal team’s setup. Some hospitals have developed workflows where the baby stays near the pregnant person while the cord continues to pulse. Others do a shorter delay at the field before handing the baby off. The workflow varies by hospital.

For clients planning a cesarean, especially a scheduled one, this is a conversation to have with the OB in advance. Ask what the standard practice is at that hospital, and whether a specific length of time is feasible. Ask the same question for an unplanned cesarean, because the answer may be different under urgency. Clients often assume delayed clamping is off the table at cesarean and are surprised to learn it is not.

One thing worth flagging here. The CDC survey I mentioned earlier found that hospitals with cesarean rates of 35 percent or higher reported delayed cord clamping for most babies only 37 percent of the time, compared with 61 percent at hospitals with cesarean rates below 25 percent. Hospitals with higher intervention rates overall tend to have lower delayed clamping rates, even for vaginal births. If your client is birthing at a high-cesarean-volume hospital, it is worth asking the question with particular care.

How doulas can help without stepping outside their scope

Here is the conversation I teach my students to have with clients at a prenatal visit. It is short, it keeps you clearly in your lane, and it sets the client up for a better exchange with the provider.

Ask your client two questions:

  1. When you say you want delayed cord clamping, what are you picturing? Are you thinking one minute, three minutes, until the cord stops pulsating, or until the placenta is out?
  2. Have you asked your provider what their standard practice is at this hospital?

Then suggest they ask their provider two questions at a prenatal:

  1. What is your usual practice with the cord after birth, and how long do you typically wait?
  2. Does that change for a cesarean, and what does the timing look like if so?

That is it. You are not prescribing a timing. You are not telling the provider what to do. You are helping your client match their expectation to the provider’s practice, or flagging a mismatch early enough to do something about it.

This is also a really useful first advocacy conversation for your client. It is a lower-stakes topic than many other birth planning conversations, which makes it a good practice round. A client who learns how to ask their provider about cord timing at 32 weeks gets better at asking harder questions later. Quick wins matter for building that client-provider relationship, and this is a quick win for most people.

If your client is interested in pushing back on a mismatch, that is advocacy work, and I have more on that in my piece on recognizing medical gaslighting and advocating against disrespectful care.

A note on placenta policies

While we are on the topic, a small but important adjacent issue. Many hospitals have their own rules about placentas, and those rules are not really about delayed cord clamping, but they often come up in the same conversation. Some hospitals send placentas to pathology by default. Some require specific timing for release. Some have paperwork requirements.

If your client has specific wishes for their placenta, whether that is taking it home, encapsulation, or anything else, that is a conversation for the client to have directly with their provider and their hospital. It is not a conversation for you to take on.

I want to be clear about this for my students: I do not carry placentas. I do not middleman placenta logistics. If a client is working with an encapsulator or another placenta service, that service almost always has its own protocols for pickup, timing, and handling. That is their scope, not mine. Your scope as a doula is to help your client ask the right questions in advance so they know what their hospital allows, and to make sure someone who is not you is handling the actual logistics.

This is one of those moments where staying in your scope protects you, protects the client, and keeps the roles clean in a moment when people are already stretched thin.

The short version for clients

My job as a doula is to share what the evidence shows, help clients form the questions they want to ask their providers, and support whatever informed decision they make. Prescribing a specific cord timing is not my role. The version I share in childbirth class and in prenatal visits sounds something like this:

Delayed cord clamping lets more of the baby’s own blood return from the placenta before the cord is cut. It is now the standard recommendation from ACOG, ACNM, WHO, and the AAP, with ACNM going the furthest by recommending physiologic-based clamping for all births. The usual timing in the hospital is at least 30 to 60 seconds, often longer when the baby is stable. It applies to vaginal and cesarean births. The main consideration for term babies is a small chance of needing phototherapy for jaundice. Most hospitals already handle this well.

Then I give them the two questions for their provider. That is the whole conversation.

Birth work is full of these moments where a small, specific, well-timed question saves a client a lot of heartache. Cord timing is one of them. It is worth getting right.

Sources and further reading

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