The Society of Obstetricians and Gynaecologists of Canada issued Technical Update No. 472 on 6 October 2026. It reviewed literature from April 2020 to May 2026 and graded the evidence with GRADE, addressing whether to milk the intact umbilical cord in babies of 35 weeks or more who are non-vigorous.
The update describes a sequence: about 15 seconds of deferred clamping with warming and tactile stimulation, and if the baby remains non-vigorous, intact cord milking may be considered. The aim is fewer cases of moderate to severe hypoxic-ischaemic encephalopathy and less need for cardiorespiratory support. The evidence reviewed did not show a meaningful rise in harms such as jaundice needing phototherapy.
This reverses a common habit of clamping immediately and carrying a floppy baby to the resuscitaire. The update is permissive ('may be considered'), and the abstract does not give effect sizes, so local neonatal teams will need to agree a protocol. This update is restricted to 35 weeks and beyond and says nothing about more preterm babies.
- Applies only from 35 weeks 0 days onwards, after warming and stimulation have failed.
- Allow about 15 seconds of deferred clamping before deciding the baby is non-vigorous.
- Agree with the neonatal team who milks the cord and who starts resuscitation.
- Document cord management at every birth where the baby needed help.
Why it matters
It challenges the reflex to clamp and cut immediately when a term baby is born flat.
Don't overread it
The recommendation is conditional and the summary reports no effect sizes; it is not a mandate.
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