Umbilical Cord Clamping: Beliefs And Practices Of American Nurse-Midwives


  • Judith S. Mercer CNM, DNSc, FACNM,

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    • Judith S. Melson Mercer received a diploma in nursing from the Johns Hopkins Hospital School of Nursing, a BSN from the University of Maryland, and MS and certificate in midwifery from Columbia University, and a doctorate in Nursing from the Catholic University of America. Dr. Mercer served on faculty at Georgetown University for 16 years and directed the program for 10 years. Her practice experience ranges from home births to medical centers. Currently, she serves on the faculty at the University of Rhode Island College of Nursing, Nurse-Midwifery Program, Kingston, RI. She is a Fellow of the American College of Nurse-Midwives.

  • Carlene C. Nelson CNM, PhD,

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    • Carlene Nelson has been a nurse-midwife for more than 20 years in settings ranging from tertiary care centers to home births. She received a BSN from Johns Hopkins University, MS and PhD from the University of Maryland, and a midwifery certificate from Georgetown University. She has taught nurse-midwifery at Georgetown University and the University of Michigan. She presently resides in La Jolla, California.

  • Rebecca L. Skovgaard CNM, MS

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    • Rebecca L. Skovgaard received a masters in midwifery at Georgetown University and subsequently was on the faculty of the Georgetown University Nurse-Midwifery Program. She is currently an Associate in the Department of Obstetrics and Gynecology and an Assistant Professor in the School of Nursing, University of Rochester, Rochester, NY. She is a member of the editorial staff, Strong Perifax.

Judith S. Mercer, CNM, DNSc, FACNM University of Rhode Island College of Nursing, Nurse-Midwifery Program, 2 Heathman Road, Kingston, RI 02881.


The optimal time for umbilical cord clamping after birth remains a critical unknown fact that has implications for the infant, the mother, and science. A national survey was conducted using a randomized sample (n = 303) of the active membership of the ACNM to determine cord clamping practices and beliefs of American nurse-midwives. The response rate was 56%. The respondents fell into three cord clamping categories: early (EC) or before 1 minute (26%); intermediate (IC) or 1 to 3 minutes (35%); and late (LC) or after pulsations cease (33%). The EC group believes that early clamping facilitates management of the newborn. The IC group believes that a moderate delay of clamping allows for a gradual transition to extrauterine circulation, although many think that the timing of cord clamping is not significant. The LC group have strongly held beliefs that late clamping supports physiologic birth processes. The majority of CNMs (87%) place the baby on the mother's abdomen immediately after birth and 96% avoid clamping a nuchal cord whenever possible. Although Varney's Midwifery was cited most frequently as a reference, 78% of the respondents listed no references reflecting, in part, the absence of evidence-based recommendations for cord clamping practices.