Umbilical Cord Practices of Members of the American College of Nurse‐Midwives

Abstract

IntroductionThe purpose of this survey of American College of Nurse‐Midwives (ACNM) members was to describe umbilical cord practices of US midwives and to explore possible modifying factors. Contrasting this study with the 2000 survey of ACNM members on umbilical cord clamping by Mercer, Nelson, and Skovgaard, we hypothesized that there would be an increase in utilization of delayed cord clamping at birth by current midwives. The benefits of adequate placental transfusion at birth via delaying cord clamping (DCC) has been well described for both preterm and term neonates. Surveys and observations of provider practice across the globe show inconsistent uptake of the evidence‐based practices of DCC and cord milking. This study provides a 17‐year update to the Mercer et al study and gives the opportunity for current assessment of umbilical cord management by members of ACNM.MethodsThis was a cross‐sectional study of 1050 active members of ACNM who had attended women in labor and birth within 3 years of the survey. Participants were selected using non‐probability, purposive sampling with recruitment through serial e‐mails. Umbilical cord practices were assessed, and related factors were examined using Chi‐square tests and multivariate logistic regression models.ResultsThe overall response rate was 20%. Ninety‐two percent of the midwives performed DCC in this study as compared with 67% in the initial survey done in 2000. Over 50% of the midwives considered DCC in the presence of the following situations: shoulder dystocia, meconium‐stained fluid, and vaginal birth for a non‐reassuring fetal heart rate tracing. Twenty‐six percent said they would delay clamping if resuscitation was required. “I don't know” was the most common response when it came to cord management for breech births or when vacuum or forceps were used. Cord milking was used less frequently than DCC.DiscussionMidwifery use of DCC has expanded since 2000. The use of cord milking is variable with concerns about the validity of the practice. For many participants, uncertainty is present regarding cord clamping in complex clinical situations. The study provides important guidance for addressing knowledge deficits and continual improvement in practice.