Optimal cord management is the delayed clamping of a baby’s umbilical cord after birth. It helps prevent a sudden drop in the baby’s blood pressure by allowing extra blood from the placenta to replace the blood that flows into the baby’s lungs when they take their first breaths. It also helps increase the amount of iron the baby receives.

Evidence shows in preterm babies of less than 34 weeks gestation, delaying the clamping of the cord for a minimum of 60 seconds after birth, reduces death by nearly a third. However, the practice was previously found to be variable between organisations and uptake was low.

To help increase delayed cord clamping across the NHS, in April 2021 the National Patient Safety Team’s Maternity and Neonatal Safety Improvement Programme, began a new programme working with the Patient Safety Collaboratives.*

The programme included sharing best practice case studies, bringing maternity teams from different organisations together to learn from each other, a dedicated national action learning event and the creation of an online resource hub. 

This has led to an increase from 33% to 58% of babies receiving this intervention nationally. Between April 2020 and January 2023 up to 465 babies born at less than 34 weeks gestational age potentially survived because their umbilical cord was clamped a minute or more after birth.

The use of optimal cord clamping will be further supported by its inclusion in . This will be a national policy vehicle to increase improvement and make the practice of delayed cord clamping business as usual. The National Neonatal Audit Programme (NNAP) also collects data on this intervention and informs stakeholders nationally of improvements, process and outcomes, further increasing awareness.

The Maternity and Neonatal Safety Improvement Programme is part of the wider National Patient Safety Improvement Programmes, which are a key part of the NHS Patient Safety Strategy, to deliver safety and quality improvements across the NHS in England. The impact of these programmes play a major part in progress towards meeting the ambition of the NHS Patient Safety Strategy, to save an additional 1,000 lives and £100 million per year. Find out more on our NHS Patient Safety Strategy webpage.

The delaying of cord clamping is one of seven interventions that form part of the Maternity and Neonatal Safety Improvement Programme’s preterm optimisation pathway. You can find out more about the programme.

• Future NHS collaboration platform: Maternity and Neonatal Safety Improvement Programme
• British Association of Perinatal Medicine: Optimal Cord Management Toolkit
• The AHSN Network: patient safety

*The Patient Safety Collaboratives are an improvement arm of 15 academic health science networks, who support with driving improvement and managing change at system level. The National Patient Safety Team work collectively with the collaboratives, who help to tailor our improvement programmes based on local situations which vary from place to place. The collaboratives are a conduit for the national team and local providers and their role in the delivery of the national programme is vital.