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An Observational Study of Umbilical Cord Clamping Practices of Maternity Care Providers in a Tertiary Care Center

Authors

  • Eileen K. Hutton PhD, RN, RM,

    Assistant DeanProfessor, Professor, Corresponding author
    1. Midwifery Science at Vrije Universiteit Medical Centre, Amsterdam, The Netherlands
    • Midwifery Education Program at McMaster University, Hamilton, Ontario, Canada
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  • Kathrin Stoll PhD,

    Postdoctoral Fellow, Lecturer
    1. Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
    2. Midwifery Research and Education Unit, Department of bstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
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  • Natalie Taha BHk

    Student Undergraduate
    1. Medical Education Program, University of British Columbia, Vancouver, British Columbia, Canada
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  • The principal investigator (Eileen Hutton) was supported at the time of this study by a Canadian Institutes of Health Research New Investigators award, Ottawa, Ontario, and Michael Smith Foundation Research Scientist award, Vancouver, British Columbia, Canada.

Address correspondence to Eileen K. Hutton, PhD, RN, RM, Midwifery Education Program, McMaster University, 1280 Main St. W., MDCL 2210 Hamilton, ON, Canada L8S 4K1.

Abstract

Background

Severing the umbilical cord at birth is likely the oldest intervention, the timing of which remains fraught with controversy. Emerging evidence suggests benefit in delaying cord clamping for both term and preterm infants. The objective of this study was to investigate actual cord clamping time and circumstances at a large tertiary care center in Canada.

Methods

We used a stopwatch to time the interval from the time the infant was born as far as the umbilicus until the time that the umbilical cord was clamped before cutting. We reported on timing of the umbilical cord clamping overall and by practitioner group (obstetrician, midwife, and family practitioner).

Results

A total of 98 women and their practitioners consented to be observed at the British Columbia Women's Hospital and Health Center, Vancouver, Canada. More than one-half (56.2%) of all infants had their umbilical cord clamped within 15 seconds. The median (5th, 95th percentile) clamping time in seconds for the full sample was 12 (4, 402) with practitioner subgroups as follows: obstetricians (12 [3, 107]), family physicians (19 [6, 325]), and midwives (81 [6, undefined]). The median clamping time was likely to be longer when the birth occurred spontaneously, no umbilical cord blood was collected, and no birth or neonatal complications occurred.

Conclusions

In our sample taken in 2006 to 2007, most infants had umbilical cords clamped immediately after the birth, with more than one-half clamped within 15 seconds of birth. Since the time of our study, delayed umbilical cord clamping for the healthy term newborn has become a part of recommended management of third stage of labor and resuscitation guidelines. It would be informative to repeat a study like this one to determine compliance with the current standards of care. (BIRTH 40:1 March 2013)

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