A Survey of Umbilical Cord Clamping Practices and Attitudes of Canadian Maternity Care Providers

Abstract

Despite mounting evidence of the health benefits of delayed cord clamping of term and preterm neonates, Canadian practice guidelines about the optimal timing of cord clamping have not been developed. At the time the study was conducted, the Society of Obstetricians & Gynecologists of Canada (SOGC) recommended early clamping as part of active management, while findings from several randomized controlled trials pointed at reported benefits of delayed cord clamping. It is unclear how Canadian maternity care providers were interpreting the evidence around umbilical cord clamping and what they do in clinical practice. A link to an online survey was distributed to members of the Canadian Association of Midwives (CAM) and the SOGC to assess maternity care providers’ umbilical cord clamping practices and attitudes. Respondents were asked to answer questions pertaining to the timing of cord clamping, reasons for cord clamping practices and perceived benefits and risks associated with delayed cord clamping (> 60 seconds) for 1) term and 2) preterm infants (< 37 weeks). A total of 353 respondents met eligibility criteria (i.e. they provided intrapartum care at the time of data collection). The majority of obstetricians (77.9%) reported clamping the cord of term infants immediately (< 30 seconds), compared to 60.0% of family physicians and 9.8% of midwives; 6.5% of obstetricians, 9.1% of family physicians and 65.7% of midwives reported delaying cord clamping by two minutes or more. Midwives were more likely than physicians to make a conscious decision about the timing of cord clamping. Care providers reported higher rates of immediate cord clamping with preterm infants, compared to term infants, with 85% of physicians and 39% of midwives clamping the cord of preterm neonates within 30 seconds. The most common reason for clamping the cord of a term neonate immediately was the infants’ need for resuscitation or other medical interventions (79%). Personal routine was the most frequently cited reason for clamping the cord of a preterm infant immediately (40%). Findings from this survey highlight interprofessional variations in cord clamping practices. Clear practice guidelines around the optimal timing of cord clamping should be developed that take into considerations the health benefits of delaying cord clamping of term and preterm infants.