Evidence into Practice, Cord Clamping

In January of 2017, the American College of Obstetricians and Gynecologists (ACOG) released Committee Opinion #684 Delayed Umbilical Cord Clamping after Birth.

ACOG provides the following recommendations regarding the timing of umbilical cord clamping after birth:

  • In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes.
  • Delayed umbilical cord clamping is associated with significant neonatal benefits in preterm infants, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage.
  • Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30–60 seconds after birth.
  • There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing delayed umbilical cord clamping. Consequently, obstetrician–gynecologists and other obstetric care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor and treat neonatal jaundice.
  • Delayed umbilical cord clamping does not increase the risk of postpartum hemorrhage

In doing some research into cord clamping and where AWHONN stands I found a press release from 2015: Many Infants Show Health Benefits from Delayed Umbilical Cord Clamping.

The release stated “In many birth settings, it is standard practice to clamp and cut the umbilical cord immediately after birth. Early cord clamping is deeply embedded in maternity care as part of the routine of labor and birth. In fact, this practice was once believed to prevent potential harms such as jaundice from “too much blood.” However, no published, randomized controlled trial research since 1980 supports this concern. Additionally, no maternal health outcomes have been shown to be negatively affected by delayed clamping, including postpartum hemorrhage rates.”

Even with the ACOG Committee Opinion and AWHONN statement above: Is delayed cord clamping occurring in practice?

Moving research findings into sustainable improvements in patient outcomes remains an obstacle to improving the quality of care. In fact, up to two decades may pass before the findings of original research become part of routine clinical practice.

TWO DECADES!! As nurses we need to advocate for our patients and help move evidence into practice at the bedside. So I urge you to question hospital policies, have those tough conversations with physicians, participate in shared governance, speak to administration or leadership but we can’t allow two decades to pass before utilizing evidence based practice!

Posted in Uncategorized