A Canadian obstetric technical update reviewed evidence published from 2020 to May 2026 on intact umbilical cord milking for infants of 35 weeks' gestation or more who are not vigorous at birth, rating it with GRADE.
It concludes that in late preterm and term infants who remain non-vigorous after about 15 seconds of deferred cord clamping, drying and stimulation while kept warm, milking the intact cord may reduce moderate-to-severe hypoxic-ischaemic encephalopathy and the need for cardiorespiratory support. The evidence reviewed did not suggest a significant rise in adverse outcomes, including jaundice requiring phototherapy.
The technique pushes placental blood into the baby in a few seconds, without the delay of full deferred clamping in a baby who needs resuscitation. It applies to non-vigorous babies of 35 weeks or more, not to extremely preterm infants, where cord milking has raised safety concerns. Delivery room teams should agree a local protocol before using it, and resuscitation must not be delayed to perform it.
- Applies only to infants of 35 weeks or more who remain non-vigorous after brief stimulation.
- Consider intact cord milking where the team is trained and it does not delay resuscitation.
- Do not apply this to extremely preterm infants.
- Agree a joint obstetric and neonatal protocol before introducing it.
- Monitor for jaundice as usual afterwards.
Why it matters
It offers a way to give the depressed newborn placental blood without delaying resuscitation for full deferred clamping.
Don't overread it
The update says 'may be considered'; the evidence is not strong enough for a routine recommendation.
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