Umbilical cord clamping: Beliefs and practices of American nurse-midwives

The optimal time for umbilical cord clamping after birth remains a critical unknown fact that has implications for the infant, the mother, and science . A national survey was conducted using a randomized sample (n = 303) of th e active membership of the ACNM to determine cord clamping practices and be liefs of American nurse-midwives. The response rate was 56%. The respondent s fell into three cord clamping categories: early (EC) or before 1 minute ( 26%); intermediate (IC) or 1 to 3 minutes (35%); and late (LC) or after pul sations cease (33%). The EC group believes that early clamping facilitates management of the newborn. The IC group believes that a moderate delay of c lamping allows for a gradual transition to extrauterine circulation, althou gh many think that the timing of cord clamping is not significant. The LC g roup have strongly held beliefs that late clamping supports physiologic bir th processes. The majority of CNMs (87%) place the baby on the mother's abd omen immediately after birth and 96% avoid clamping a nuchal cord whenever possible. Although Varney's Midwifery was cited most frequently as a refere nce, 78% of the respondents listed no references reflecting, in part, the a bsence of evidence-based recommendations for cord clamping practices. (C) 2 000 by the American College of Nurse-Midwives.