INTRODUCTION

A new question to ask your hospital.

Congratulations on your pregnancy.

Many parents choose their birth hospital based on the food, the room, or the location. Those things matter. But what if there were another choice — one that could meaningfully affect your baby's long-term health?

In most Japanese hospitals, the cord is cut within seconds of birth. But simply waiting until the cord stops pulsating allows blood — still flowing from the placenta — to transfer to your baby.

That blood contains iron, red blood cells, immune factors, and stem cells: essential components that support your baby's growth and development.

This book explains delayed cord clamping (DCC) in plain language — no medical background required.

Here's how the book is structured:

• Chapters 1–2: What DCC is and why it matters
• Chapter 3: The jaundice risk — is it really so dangerous?
• Chapters 4–5: Global research and the Japan gap
• Chapters 6–7: What you can do

Please read to the end.

CHAPTER 1

The last blood your baby receives.

What is placental transfusion?

Your baby spends about 10 months in the womb receiving oxygen and nutrients through the placenta and umbilical cord.

What many parents don't know is that after birth, blood continues to flow from the placenta to your baby for several minutes. This is called placental transfusion.

What is lost when the cord is cut immediately?

When the cord is cut right away, much of that blood remains in the placenta. For full-term babies:

For preterm babies this is even more significant — up to 50% of blood volume can be lost. In an adult, this would be classified as moderate to severe hemorrhage.

What is received by waiting?

When cord clamping is delayed, blood naturally transfers from placenta to baby:

This blood contains:

• Hematopoietic and multipotent stem cells — support immunity, blood production, and tissue repair for life. Cannot be replaced after birth.
• Iron (40–50mg per kg of body weight)
• Immunoglobulins (immune-protective factors)

Your baby's body is ready to receive this blood

Before birth, progesterone circulates at very high levels in your baby's body. This hormone relaxes blood vessels, preparing them to receive the incoming placental blood. Progesterone drops rapidly within 12 hours of birth — which means the window to receive this blood is short, and your baby's body is primed for exactly that moment.

Iron deficiency in Japanese babies

Iron deficiency in infants is a recognized concern among Japanese pediatricians. After 6 months, breast milk alone provides insufficient iron — but if a baby's iron stores at birth are already low, they start at a disadvantage from day one.

How iron deficiency affects brain development

Iron plays a critical role in forming the neural circuits responsible for learning, memory, and emotional regulation. Iron deficiency in early life may lead to:

• Reduced cognitive function and learning capacity
• Delayed language development
• Difficulty with attention and focus
• Challenges with emotional regulation

In the next chapter, we'll look more closely at the stem cells in this blood — and why they're valued at millions of yen around the world.

CHAPTER 2

Why stem cells are so extraordinarily valuable.

What are stem cells?

Stem cells are the "origin cells" that can become many types of tissue and organs. They produce blood, regulate the immune system, and repair damaged tissue — the body's maintenance crew, active for life.

What are they worth in the world today?

Japanese regenerative medicine clinics

Clinics that culture stem cells from fat or bone marrow and administer them as injections charge ¥1–4 million per session. Wealthy patients fly in from overseas specifically for these treatments.

High-end clinics abroad

Treatments can cost ¥10–50 million in some international clinics. Professional athletes and Hollywood actors use them for anti-aging and sports recovery.

Cord blood banking services

Private cord blood banking — storing a baby's stem cells for potential future medical use — costs hundreds of thousands of yen upfront plus annual fees.

Public cord blood banks

Used in place of bone marrow transplants to treat leukemia and other blood diseases — real, life-saving applications.

I personally called approximately 20 obstetric hospitals to ask: "Do you practice delayed cord clamping?" The answer was nearly always the same:

The "risk" they referred to was jaundice. So how dangerous is jaundice, really? Let's look at the numbers in the next chapter.

CHAPTER 3

Jaundice vs. early clamping — which risk is actually bigger?

Why does jaundice happen?

When more blood transfers to the baby, the body has more red blood cells to break down. This process produces bilirubin — a yellow pigment that accumulates in the skin and eyes, causing the yellowish color we call jaundice.

Is serious jaundice (kernicterus) still a real risk?

The most feared form — kernicterus — occurs when bilirubin affects the brain. But in modern medicine:

• Phototherapy (a safe, painless light treatment) effectively manages elevated bilirubin
• Kernicterus in full-term infants has virtually disappeared over the past 30 years
• It is now so rare that it is no longer tracked in official statistics

How much does DCC actually increase jaundice?

Based on a large-scale clinical trial of full-term infants (n=3,911) summarized by ACOG:

Yes, jaundice frequency increases slightly. But it remains within the range manageable with phototherapy.

DCC is not the only cause of jaundice

Jaundice in newborns has many causes beyond cord clamping timing:

• Breastmilk jaundice — components in breast milk can slow bilirubin breakdown
• Blood type incompatibility — especially mother O / baby A or B, or Rh mismatch
• Prematurity — an immature liver processes bilirubin more slowly
• East Asian genetics — a known genetic tendency toward higher bilirubin levels

※ Author's note: I am blood type O and gave birth to a type-A daughter. I requested that cutting wait until pulsation stopped. She did develop jaundice — but with consistent feeding, it resolved within 2–3 weeks.

What does early clamping cost?

When the cord is cut immediately, your baby loses:

• ~30% of blood volume (up to 50% in preterm babies)
• ~50% of red blood cells
• Iron, immunoglobulins, and stem cells

One large meta-analysis (iCOMP, 6,000+ infants) found that delayed clamping of 120+ seconds was associated with a 69% reduction in mortality in preterm infants.

CHAPTER 4

What global research shows.

Study 1 — Sweden: developmental outcomes at age 4

A randomized controlled trial at a Swedish county hospital (2008–2010) enrolled 382 full-term infants and compared development at age 4.

Results: The delayed clamping group (180+ seconds) showed significant improvements in:

• Social development scores
• Fine motor skills
• Prosocial behavior (empathy and cooperation)

Study 2 — China: blood and oxygen levels in preterm infants

A study of 163 preterm infants (34–36 weeks) found that the delayed clamping group had:

• Significantly higher red blood cell and hemoglobin levels from birth through days 3–5
• Improved blood oxygenation
• Higher hemoglobin levels at 5–6 months of age
• Significantly lower rates of anemia

※ This study found no significant difference in jaundice rates between early and delayed clamping groups.

Study 3 — iCOMP meta-analysis (6,000+ infants)

Study 4 — ACOG Committee Opinion

For full-term infants: higher hemoglobin at birth, improved iron stores in the first months of life, and possible positive developmental effects.

For preterm infants: improved circulatory stability, reduced transfusion rates, lower incidence of necrotizing enterocolitis and intraventricular hemorrhage.

History also speaks

This importance was recognized over 200 years ago.

CHAPTER 5

Japan vs. the world.

The global picture

Why hasn't it spread in Japan?

1. The power of deeply ingrained habit

As birth moved from home to hospital in the 20th century, "cut immediately" became taught procedure. Once a practice is embedded in medical training, it is slow to change.

2. Limited domestic research

While extensive research has been conducted overseas, Japanese domestic research in this area has unfortunately been minimal. Evidence has not accumulated locally in the way it has abroad.

3. A culture of risk avoidance

Healthcare providers naturally want to minimize jaundice risk — that instinct is appropriate. But the comparison with the larger risks of early clamping (lost stem cells, blood volume, iron) may not have been fully considered.

Signs of change

• Most midwifery homes (助産院) in Japan have long practiced DCC as standard
• More parents are sharing stories online of successfully requesting and receiving DCC
• Some hospitals are beginning to accommodate requests written into birth plans
• Awareness of WHO guidelines is slowly growing among Japanese obstetricians and midwives

CHAPTERS 6 & 7

What you can do.

Can DCC be done with a cesarean section?

The answer is: yes, in many cases. Even after a cesarean delivery, the time between baby being lifted out and cord clamping can be extended. In many countries, DCC during C-section is already standard in numerous hospitals.

• Coordination between the surgeon, anesthesiologist, and midwife is required
• Some surgical situations may not allow it
• The key is to discuss it with your OB in advance and include it in your birth plan

Start by asking your hospital

Write it in your birth plan

Brief your partner

On the day of delivery, you will be focused on one thing. Make sure your partner knows your wishes and can speak on your behalf in the room if needed.

Medical judgment comes first in emergencies

If the baby or mother needs immediate intervention, the medical team's judgment takes absolute priority. DCC is a preference, not a demand — and every good medical team will understand that.

Midwifery homes as an option

For low-risk pregnancies, a midwifery home (助産院) is worth considering. Most practice DCC as a matter of course, and the conversation about it is simple.

Facilities in Japan known to offer DCC

※ Midwifery homes accept low-risk pregnancies. If you have a pre-existing condition or prior cesarean, you will need coordination with an obstetrician.

Closing

A few minutes at the moment of birth may carry more meaning than we once realized. Those minutes could be your baby's first gift.

As Erasmus Darwin wrote 200 years ago, and as the WHO now recommends — let your baby receive what is naturally theirs, if circumstances allow.

I hope this book helps make your birth experience — and your baby's start in life — a little better.

Wishing you a safe and joyful birth.

FAQ

Common questions.

Q. Can DCC be done with twins?

In some cases, yes. However, the need to deliver the second twin quickly may affect timing. Discuss with your OB well in advance.

Q. Can DCC be done for preterm babies?

Yes — and in fact, research shows the benefits are even greater for preterm infants. That said, preterm deliveries often require immediate medical interventions, so follow the medical team's guidance.

Q. How long should you wait?

WHO recommends at least 1–3 minutes. Ideally, waiting until cord pulsation fully stops (approximately 2–5 minutes) is considered optimal.

Q. Won't DCC cause polycythemia (too many red blood cells)?

Research shows that polycythemia from DCC is typically mild and rarely requires treatment.

Q. What if the cord is around the baby's neck?

In most cases, a nuchal cord can be unwound without cutting. In some situations medical judgment will take over — trust your team.

Q. What if the placenta detaches early?

In emergencies like placental abruption, the safety of mother and baby is the absolute priority. Do not insist on DCC in an emergency — follow medical guidance.

Q. Will the baby's first cry be delayed?

No. Babies can breathe and cry normally while still connected to the cord. DCC and a healthy first cry are not in conflict.