The umbilical cord serves as the lifeline between a pregnant person and their developing fetus, providing oxygen and nutrients. This temporary organ contains two arteries and one vein encased in Wharton’s jelly. Once the baby is delivered and takes their first breath, the placenta and cord become functionally obsolete, as the baby’s circulatory and respiratory systems take over. For the mother, the cord remains physically connected to the placenta, which must still be expelled from the uterus. The events that follow focus on the management and delivery of this remaining tissue.
The Decision to Clamp and Cut
The first deliberate action involving the cord is the decision about when to clamp and cut it. Historically, immediate clamping, occurring within seconds of birth, was common practice. Current medical recommendations, however, favor delayed cord clamping for most healthy newborns. This delay allows a significant volume of blood, rich in iron and stem cells, to transfer from the placenta to the infant.
Delayed clamping is defined as waiting at least 30 to 60 seconds, or until pulsations in the cord have largely ceased. This practice improves the newborn’s red blood cell volume and iron stores for the first several months of life. Although primarily centered on infant health, this decision is made by the mother and her care team during birth planning.
The actual clamping procedure involves placing two clamps on the cord a few inches apart to stop the blood flow. The cord is then cut between these clamps by a medical professional or a family member. This process is entirely painless for both the mother and the baby because the cord contains no nerve endings. Once separated, a small umbilical stump remains on the baby, while the longer section of cord remains attached to the placenta inside the mother.
Delivering the Placenta
The final phase of birth, often referred to as the third stage of labor, involves the expulsion of the placenta, or “afterbirth,” which is still connected to the umbilical cord remnant. The placenta separates from the uterine wall as the uterus begins to contract down to its pre-pregnancy size. Separation is signaled by physical changes, including a sudden gush of blood and a noticeable lengthening of the cord outside the body.
Management of this stage follows two main approaches: active or expectant management. Active management is the most widely adopted method and involves the prophylactic administration of a uterotonic drug, most commonly synthetic oxytocin, given via injection soon after birth. This medication stimulates strong uterine contractions, which hastens placental separation and reduces the risk of excessive bleeding.
Following drug administration, the healthcare provider typically applies controlled cord traction. This involves gentle pulling on the cord while simultaneously pressing down on the lower abdomen to guide the placenta out. Expectant management involves waiting for the placenta to separate naturally through maternal pushing efforts and gravity, without medication or traction. While expectant management may take up to an hour, active management usually reduces this time and lowers the amount of blood lost.
Post-Delivery Examination and Tissue Handling
Once the placenta and attached cord are delivered, medical staff perform a thorough examination of the tissue. They inspect the placenta to ensure it is complete and intact, checking for any missing fragments that may have been retained in the uterus. The tissue is also examined for its size and the structural integrity of the vessels to identify potential abnormalities.
After the examination, the mother must decide the fate of the tissue, including the cord blood remaining within the placenta. One option is cord blood banking, which involves collecting the blood for its rich supply of hematopoietic stem cells. This can be done through a public bank, where the blood is donated for use, or a private bank, where it is stored for the family’s exclusive use, often involving a fee.
If the cord blood is not banked, the mother may choose to have the placenta disposed of through routine medical waste protocols. Alternatively, some parents opt for cultural or personal practices, such as placental encapsulation or burial of the placenta. These decisions are typically communicated to the healthcare team before labor begins.
Potential Complications Affecting the Mother
The primary risks for the mother related to the placental site center on the uterus’s ability to contract effectively after delivery. A Retained Placenta occurs when the entire organ or fragments fail to separate and exit the uterus within an expected timeframe, typically 30 minutes. If placental tissue remains attached, it prevents the muscle fibers of the uterus from clamping down completely on the supplied blood vessels.
The most serious complication arising from a failure to contract is Postpartum Hemorrhage (PPH), which is excessive bleeding following childbirth. This condition is a leading cause of maternal morbidity and requires immediate intervention. Signs of PPH include persistent, heavy vaginal bleeding or symptoms of low blood pressure such as dizziness and a rapid heart rate.
Immediate treatment for PPH often involves vigorous uterine massage to manually encourage contraction and the administration of strong uterotonic medications, such as additional oxytocin or misoprostol. If a retained fragment is confirmed as the cause of bleeding, the medical team may need to perform a manual removal of the tissue or, in some cases, a surgical procedure to empty the uterus.