A technical update from the Society of Obstetricians and Gynaecologists of Canada reviewed evidence from 2020 to May 2026, graded with GRADE, on intact umbilical cord milking for infants of 35 weeks' gestation or more who are non-vigorous at birth.
The update concludes that in term and late preterm infants who remain non-vigorous despite stimulation, milking the intact cord may reduce moderate-to-severe hypoxic-ischaemic encephalopathy and the need for cardiorespiratory support, without a clear rise in adverse outcomes such as jaundice needing phototherapy. The suggested sequence is about 15 seconds of deferred clamping with drying, warming and stimulation, then milking if the baby is still non-vigorous.
The update describes itself as an abstraction of the evidence rather than a full methodological review, and the recommendation is permissive — 'may be considered'. Cord milking is not advised in extremely preterm infants, where earlier trials raised concern about brain haemorrhage. Units should agree a protocol before using it, so that milking never delays resuscitation.
- Consider intact cord milking for a non-vigorous infant of 35 weeks or more after brief deferred clamping and stimulation
- Do not let cord management delay the start of ventilation when it is needed
- Keep the baby warm and stimulated during the brief deferred-clamping period
- Avoid cord milking in very and extremely preterm infants
- Agree a written unit protocol with obstetric and neonatal teams before adopting it
Why it matters
It offers a simple, no-cost step at the moment when a non-vigorous baby's outcome is being decided.
Don't overread it
This is a permissive recommendation from an evidence abstraction, not a mandate to change resuscitation algorithms.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for emergency & critical care, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free