Abstract
Clinical practice guides recommend delayed clamping of the umbilical cord. If this is not possible, some authors suggest milking as an alternative. The objective of this study was to determine the variability in professional practice in the management of umbilical cord clamping and milking and to identify factors or circumstances associated with the different methods. An observational cross-sectional study done on 1,045 obstetrics professionals in Spain in 2018. A self-designed questionnaire was administered online. The main variables studied were type of clamping and use of milking. Crude odds ratios (OR) and adjusted odds ratios (ORa) were estimated using binary logistic regression. 92.2% (964) performed delayed clamping. 69.3% (724) clamped the cord when it stopped beating. 83.8% (876) had heard of milking, and 55.9% (584) had never performed it. Professionals over 50 were less likely to perform delayed clamping, with an ORa of 0.24 (95% CI: 0.11–0.52), while midwives were more likely to perform delayed clamping than obstetricians, with an ORa of 14.05 (95% CI: 8.41–23.49). There is clinical variability in the management of umbilical cord clamping and the use of milking in normal births. Part of this variability can be attributed to professional and work environment factors.
Highlights
Umbilical cord clamping and cutting are done in the third stage of labour
In 2013, McDonald et al concluded that delayed cord clamping (DCC) was not related to an increased risk of postpartum haemorrhage (PPH) or a difference in postpartum haemoglobin levels compared with early clamping[2]
Due to the significant implications that cord clamping has for newborns, our objective was to determine the variability in clinical practice in the management of umbilical cord clamping and to identify the professional or work environment factors associated with the different ways of managing it
Summary
Umbilical cord clamping and cutting are done in the third stage of labour. Two types of clamping have been described, depending on how long after birth they are performed: early and delayed. In 2013, McDonald et al concluded that DCC was not related to an increased risk of postpartum haemorrhage (PPH) or a difference in postpartum haemoglobin levels compared with early clamping[2]. When DCC is not possible for any reason, such as immediate neonatal resuscitation or maternal haemodynamic instability, umbilical cord milking (UCM)has been proposed as an alternative option to DCC. This technique consists of milking the umbilical cord several times along 10 or 20 cm of the cord’s length, from the placenta toward the newborn[16,17]. Despite the fact that benefits for the newborn have been demonstrated, more studies are needed in order to recommend this practice[13,22,23]
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