Every year, throughout the world approximately 140 million infants are born1. At each birth a decision is made by the birth attendant regarding when to clamp and cut the umbilical cord. This decision ideally promotes newborn health and wellbeing. The latest available evidence supports delayed or deferred cord clamping (DCC) as a safe and beneficial practice for newborns of all ages, all modes of deliveries, and in all birth settings2,3. The current literature for term infants describes numerous benefits including better oxygen levels immediately after birth and earlier breast feeding4, increased birth weight5, higher hemoglobin and hematocrit levels and less iron deficiency during infancy6,7, enhanced brain myelin volumes out to 12 months of age8,9, and reports of better motor and social development scores at four years of age, especially for boys10. For term infants needing resuscitation, Andersson et al (2022) reported that a three minute delay in cord clamping resulted in higher 5 and 10 minute Apgar scores and better neurodevelopment scores at two years of age than in infants who had immediate cord clamping (ICC)11,12. In a pragmatic cluster-randomized crossover trial comparing cord milking (four times) for non-vigorous infants to ICC (n = 1730), Katheria reported less need for cardiopulmonary resuscitation, a lower incidence of hypoxic ischemic encephalopathy (HIE), and less need for therapeutic hypothermia for infants in the milking group13. For preterm infants, the benefits of a brief delay in cord clamping include a reduction in mortality by 30% within the NICU stay and reduced risk of death or major disability out to two years corrected age14,15. The available evidence also suggests lower rates of intraventricular hemorrhage (IVH), fewer gastrointestinal issues, lower blood transfusion requirements, and necrotizing enterocolitis2,14,16 Despite this evidence, uptake of DCC into mainstream practice is moving slowly in many areas of the world.6,17, 18, 19

While many providers report a positive perception of placental transfusion and DCC, it often does not translate into practice, thus creating a large gap between evidence and practice20. Change is a slow process, and the consequences for infant health can be far reaching. It can take up to 17 years to adopt available evidence into day-to-day practice21. The very slow adoption of antenatal steroids for lung maturation is just one example22. Although the professional statements advising DCC for preterm infants occurred fairly rapidly23, the slow movement of research into clinical practice has had a negative impact when adopting DCC to improve the health of newborns and children24. Adopting evidence-informed guidelines to shape practice and focusing on factors that foster or impede the practice of DCC can assist with accelerating practice change. Involving midwives and nurses as partners in an interdisciplinary approach to plan, implement and sustain DCC in the birth setting can increase and accelerate success25, 26, 27, 28, 29.