Podcast Summary: Delayed Cord Clamping UPDATE (With Med Student Guest Host)

Podcast: Dr. Chapa’s OBGYN Clinical Pearls
Episode Title: Delayed Cord Clamping UPDATE (With Med Student Guest Host)
Date: December 13, 2025
Host: Dr. Chapa
Guest Host: Rin, third year medical student, Texas A&M

Overview

This episode dives into the evolving guidelines and practical debates around delayed umbilical cord clamping (DCC) at birth. Dr. Chapa is joined by Rin, a third-year medical student, to break down the timeline of recommendations from leading clinical organizations (ACOG, AAP, AHA), discuss real-world clinical dilemmas—like whether to clamp at 30 or 60 seconds—and highlight the nuance and clinical impact of seemingly small changes in guidance. Along the way, the pair illustrate how medical practice is constantly updated in response to new evidence and why guideline harmonization between different professional societies remains an ongoing challenge.

Key Discussion Points & Insights

1. The Real-World Dilemma: How Long Should We Delay Cord Clamping?

• Setting the Scene:
  The episode is inspired by a disagreement during a C-section in which one resident suggested clamping at 30 seconds and another argued for 60 seconds. This reflects an ongoing, practical issue as guidelines change.
  (C, 02:49–03:19)

• Why It Matters:
  Small differences in timing—30 vs. 60 seconds—can have real implications for neonatal outcomes, especially for preterm babies.
  (C, 12:21–13:58)

“30 seconds when you're connected to a water hose that's still running full steam—that's a lot.”

—Dr. Chapa [12:46]

2. Three Strategies for Umbilical Cord Management

• Immediate Clamping: Clamp within 15–20 seconds of birth.
• Delayed Cord Clamping (DCC): Wait 30–60 seconds or more (up to 3 minutes by some recommendations).
• Cord Milking: Actively strip blood through the cord towards the newborn to quickly transfuse placental blood.

Source:
C & B, 04:25–05:50

3. Timeline: Evolution of Delayed Cord Clamping Guidelines

2012 – ACOG

• Initial support for DCC—only for preterm infants (<37 weeks), due to improvement in neonatal outcomes.

2016 – ACOG

• Broadened recommendation: DCC now supported for all healthy infants, including term.

2020 – ACOG Committee Opinion #814

• DCC “should be at least 30 seconds.” No requirement to delay up to 60 seconds.
• (C & B, 06:50–07:24)

2022 – ACOG

• Language shift: “Management of placental transfusion,” emphasizing the purpose over just “delayed clamping.”
• (C, 07:30)

“Now it's just not delayed cord clamp, which is what it is...We're trying to have placental transfusion of blood to the child, which helps prevent, in preterm infants, IVH, necrotitis and enterocolitis. They have less need for blood transfusion...”

—Dr. Chapa [08:00]

2025 – The Recent Updates

• September 2025 – ACOG Update

  • Guidance for preterm neonates (<37 weeks): At least 60 seconds of delayed cord clamping recommended.
  • For term newborns (≥37 weeks): Either 30 or 60 seconds acceptable—leave to clinical judgment.
  • Cord milking may be an option for later preterm and non-vigorous term infants.
  • (B, 13:58–14:38)

• October 2025 – AAP/AHA Joint Guidance

  • Broader guidelines (in CPR/resuscitation statement) touch on DCC, recommending at least 60 seconds of DCC for most newborns who do not require immediate resuscitation, including term infants.
  • Pushes for harmonization towards “60 seconds” as the emerging gold standard.
  • (B, 10:19–10:27; B, 13:58–14:38; C, 14:38–15:55)

“With the allowance for cord milking at 28 weeks for above, according to AAP, they say no, no, no, for term, if they don't need resuscitation, it should be at least the 60. It sounds minor...But the point is we should have recs that agree.”

—Dr. Chapa [14:38]

4. The Core Differences Between ACOG and AAP/AHA (2025)

• ACOG:

  • For term newborns: Either 30 or 60 seconds DCC is acceptable—“You pick, it’s going to be OK.”
  • For preterm (under 37 weeks): 60 seconds.

• AAP/AHA:

  • For all newborns who don’t need resuscitation: At least 60 seconds is preferred.

“ACOG says 30 or 60. AAP as of October of 2025 now says it really should be 60 seconds overall. So, guys, yesterday in the C-section, we left it as, yes, it's true. Just do the 60 seconds. That seems to be where we are going.”

—Dr. Chapa [15:05]

5. On Consensus, Medical Uncertainty, and Change

• Medicine is always evolving with new data, leading to differences even among top professional societies. Medical students, residents, and attendings must remain flexible and up-to-date.
• The “splitting hairs” over 30 or 60 seconds is not trivial; real-world practice is directly shaped by such details.

“Medicine is always changing. The science is always updating, and this is a perfect example of this...Not everybody has to agree and it's not necessarily disagreeing. It's just a different flavor of seasoning.”

—Dr. Chapa [03:20; 05:50]

“You'd think they'd have it figured out a decade and a half later.”

—Rin [09:10]

“Shouldn't we all agree?”

—Rin [15:55]

Timestamps of Key Segments

• [00:37–01:44] – Rin’s Introduction: Importance of evolving evidence and the example of cord clamping.
• [02:47–03:19] – Real clinical scenario: Residents debate 30 vs. 60 seconds.
• [04:25–05:50] – The three strategies for cord management.
• [06:43–08:00] – Timeline: From 2012 to 2022 ACOG recommendations.
• [08:48–09:13] – The September 2025 ACOG update.
• [10:19–10:27] – The October 2025 AAP/AHA guidance.
• [12:21–13:58] – Why it matters: Practicalities and physiology of DCC.
• [13:58–14:38] – Rin reads the ACOG 2025 recommendations word-for-word.
• [14:38–15:55] – Comparison with AAP and real-world takeaways.
• [15:55–16:29] – Reflections on consensus and the evolution of practice.

Notable Quotes & Moments

• Dr. Chapa (on practice evolution):
  “Medicine is always changing. The science is always updating, and this is a perfect example of this.”
  [03:20]

• Dr. Chapa (on guideline disagreements):
  “It's not necessarily disagreeing. It's just a different flavor of seasoning.”
  [05:50]

• Rin (on guideline updates):
  “Yeah, you'd think they'd have it figured out a decade and a half later.”
  [09:10]

• Dr. Chapa (on the 30 vs. 60-second debate):
  “30 seconds when you're connected to a water hose that's still running full steam—that's a lot.”
  [12:46]

• Rin (on the value of consensus):
  “It sounds like we're splitting hairs, but shouldn't we all agree?”
  [15:55]

Conclusion & Clinical Takeaway

• The Trend: 60 seconds of delayed cord clamping is becoming standard, especially for preterm and now even for term infants, per the latest pediatric guidance.
• ACOG currently allows 30–60 seconds for term infants (clinician discretion); AAP/AHA advocate "at least 60 seconds" for all who don’t require immediate resuscitation.
• Real-world advice: When in doubt, 60 seconds is safe and increasingly supported by the latest evidence.
• Broader lesson: Stay updated—medicine and guidelines do not stand still!

This summary captures the lively, practical, and evidence-based discussion between Dr. Chapa and med student Rin as they walk listeners through both the evolving evidence and the everyday clinical debates around delayed cord clamping.