Delayed Cord Clamping in Term Neonates: Attitudes and Practices of Midwives in Irish Hospitals

Joan Devin,Patricia Larkin

doi:10.1891/2156-5287.8.1.4

Abstract

Background:At the time of birth, the baby is attached to its mother’s placenta via the umbilical cord. A delay in cord clamping is physiologically beneficial to the neonate as they receive an increase in blood volume (30%–40%), increased iron stores (20–30mg/kg), and an easier transition to extrauterine life. Active management of the third stage of labor, in order to prevent maternal postpartum hemorrhage, may contribute to early cord clamping practices in Ireland. Objective:To describe the current practices and attitudes of midwives in Irish hospitals toward delayed cord clamping in term neonates. Methods:A cross-sectional descriptive survey was distributed to three maternity hospitals and two Irish online midwifery groups. Results:One hundred and fifty-three valid responses were received. One hundred and eleven midwives (72.4%) defined delayed cord clamping as “clamping after the cord ceases to pulsate.” One hundred and forty (91.5%) respondents practiced delayed cord clamping. Moreover, 62.7 % (98/153) of participants routinely clamp the umbilical cord >1 minute when practicing active management of the third stage, with 49.1% (48/98) of those waiting until cord pulsations have ceased. Awareness of research, practice guidelines advising delayed cord clamping, and experience of practicing physiological third stage are associated with increased delayed cord clamping practices. Early cord clamping is influenced by a deteriorating neonatal or maternal condition and the cultural context within clinical sites. Delayed cord clamping times during active management of the third stage differ significantly between clinical sites and maternity care pathways.Conclusion:A variety of midwifery practices were identified with differing attitudes toward cord clamping practices. Diverse influences included the practice environment, awareness of research, and availability of adjunct resuscitation supports. Recommendations for future practice include a synchronized approach to delayed cord clamping in the third stage of labor, including the provision of a national guideline.

Highlights

At the time of birth, the baby is attached to its mother’s placenta via the umbilical cord
Midwives in Ireland frequently practice active management (Begley, Guilliland, Dixon, Reilly, & Keegan, 2012), which involves the administration of a uterotonic drug, clamping and cutting of the umbilical cord, and delivering the placenta by controlled cord traction
This study aimed to describe the current attitudes and practices of midwives in Irish hospitals, in relation to cord clamping

Summary

Introduction

At the time of birth, the baby is attached to its mother’s placenta via the umbilical cord. Active management of the third stage of labor, in order to prevent maternal postpartum hemorrhage, may contribute to early cord clamping practices in Ireland. Midwives in Ireland frequently practice active management (Begley, Guilliland, Dixon, Reilly, & Keegan, 2012), which involves the administration of a uterotonic drug, clamping and cutting of the umbilical cord, and delivering the placenta by controlled cord traction. It is usually completed within 12 minutes (Begley, Gyte, Devane, McGuire, & Weeks, 2015). Just 0.2% of births occur at home under midwiferyled care, usually with self-employed community midwives (Department of Health, 2016; Meaney, Waldron, Corcoran, Greene, & Sugrue, 2016)

Results

Discussion

Conclusion