ABSTRACT
Over the past 40 years, there have been a number of review articles attempting to rationalise cord clamping practice. Early cord clamping was originally thought to be important in active management of the third stage of labour, but this was never evidence based. Without an evidence base to justify it, early cord clamping in clinical practice has remained very variable. There is good evidence that early cord clamping leads to hypovolaemia, anaemia and low iron stores in the neonate. We review all the evidence and discuss possible reasons why some obstetricians and midwives persevere with early clamping. We explain how a variable definition, defective education, deferred responsibility between obstetrician and paediatrician, variable guidelines and a lack of appreciation for the potential harm of the intervention, have all contributed. This study describes how the need for early cord clamping can be avoided in practically all clinical complications of birth.
Subject(s)
Delivery, Obstetric/methods , Umbilical Cord , Constriction , Female , Humans , Infant, Newborn , Labor Stage, Third , Midwifery/ethics , Midwifery/methods , Obstetrics/education , Obstetrics/ethics , Obstetrics/methods , Practice Guidelines as Topic , Pregnancy , Time FactorsABSTRACT
There is no consensus amongst medical and midwifery staff on the optimum time to cut the umbilical cord following childbirth. Studies have shown that delaying cord clamping for at least 30 seconds is associated with less need for blood transfusion and respiratory support. In 2004, Rabe et al. recommended delayed cord clamping for up to 120 seconds in preterm birth. The aim of our study was to ascertain whether or not obstetricians adopt this recommendation. Questionnaires were given to obstetricians from 43 different units in UK, other EU countries, USA, Canada, Australia etc. There was a 100% response rate. 53% adopted the recommendation only occasionally whereas 37% have never. Difficulty with implementation in clinical practice was the main reason for failure to adopt recommendation. Unawareness of the evidence of the benefits of delayed cord clamping was the reason in half of the non-compliant group. Obstetricians are reluctant to adopt the recommendation. Difficulty in clinical practice was the main reason. There is need for the Royal College of Obstetricians and Gynaecologists to produce guidelines for delayed cord clamping in obstetric practice.
