A technical update from the Society of Obstetricians and Gynaecologists of Canada reviewed evidence from 2020 to May 2026 on intact umbilical cord milking for infants born at 35 weeks or later who remain non-vigorous despite stimulation. It graded the evidence using GRADE.
The update concluded that in this group, intact cord milking may reduce moderate to severe hypoxic-ischaemic encephalopathy and the need for cardiorespiratory support. The evidence reviewed did not suggest a meaningful rise in adverse outcomes, including jaundice needing phototherapy. The sequence it describes is about 15 seconds of deferred clamping with drying, warming and stimulation, then cord milking with the cord intact if the baby is still non-vigorous.
This matters because a non-vigorous baby has traditionally meant immediate clamping and a move to the resuscitaire. The update offers an option that keeps placental transfusion going in that window.
It is a may-consider option, not a mandate, and it depends on local neonatal resuscitation protocols and on the team being trained in the technique. Check your unit guidance and the neonatal team's view before adopting it.
- Applies to babies at 35 weeks or more who stay non-vigorous after brief stimulation.
- The described sequence: about 15 seconds of deferred clamping with drying, warming and stimulation, then intact cord milking.
- Agree the technique and who performs it with your neonatal team before using it.
- Do not delay resuscitation steps your unit protocol requires.
- Watch for jaundice as usual; the review did not find a clear increase.
Why it matters
Immediate clamping for a non-vigorous baby is no longer the only evidence-based option at term.
Don't overread it
This is a may-consider recommendation from one society; it does not apply to babies under 35 weeks.
The statistics, in plain English
The update summarises graded evidence rather than a single trial, and its wording is that milking may reduce encephalopathy; that phrasing reflects evidence that is promising but not definitive.
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