Variability and associated factors in the management of cord clamping and the milking practice among Spanish obstetric professionals

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. 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 early umbilical cord clamping (ECC), the cord is clamped within the first minute after birth, while in delayed cord clamping (DCC), the clamping is done between one and three minutes of birth, or when the cord stops beating 1-4. It should be pointed out that, since 2010, ILCOR recommend that the cord should not be clamped within one minute 5. Among the advantages for the newborn, it has been observed that DCC in term newborns resulted in increased levels of haemoglobin at birth and, consequently, better iron levels in the first few months of life, which can have a favourable impact on the child's development 6-9. In the case of preterm newborns, a reduction in rates of intraventricular haemorrhage and necrotising enterocolitis has been observed, as well as a reduced need for transfusion. If ECC is performed, there is an increase in the mortality rate with respect to DCC 10. However, an increased risk of jaundice has been described 11. With regard to mothers, 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. Due to the impact that clamping has on maternal-foetal health 3,6,8-11 international Clinical Practice Guides (CPGs) recommend this procedure DCC in all births, when possible 12-15. 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 ...

Behaviors and Attitudes of Obstetricians in Turkey Related to Cord Clamping, Cord Milking, and Skin-To-Skin Contact

“…In the literature, it is seen that delayed clamping is preferred in large hospitals with 1000-2000 deliveries per year compared to hospitals with 1000 or fewer deliveries. However, it is stated that this rate decreases in hospitals with an annual birth rate of 4000 or more [15]. In our study, the decrease in delayed clamping rates with the increase in the number of deliveries can be interpreted as a similar result and we think that this situation may be related to patient density.…”

“…When the literature is examined, it is seen that a small number of obstetricians often milk the cord. It is seen that 17% of all healthcare professionals who deliver in Spain and only six out of 50 centers included in the study in Norway apply milking protocols [15,19]. In our study, it was determined that 40.2% of the experts performed cord milking.…”

“…In our study, the factors that increase the rate of delayed clamping of the specialists were determined as the increasing age and professional experience, the low number of daily examined patients, and monthly births. On the contrary, in a study conducted in Spain, it was stated that increasing age and duration of expertise decrease the rate of delayed clamping [15]. This difference may be due to the variability in the socio-economic conditions of the countries, the prevalence in graduate education programs, and the change in the level of interest of physicians in childbirth practice.…”

“…Informed consent of the obstetricians was first obtained for the study. If they agreed to participate, a 15item questionnaire prepared by us based on previously published studies on the same subject was applied [15,16].…”

Umbilical cord clamping and management of the third stage of labor: A telephone-survey describing Swedish midwives’ clinical practice

“…They were practicing delayed CC, which is consistent with results from contemporary studies suggesting there has been an increase in the practice of delayed CC over the last 20 years. Nevertheless, the studies report a significant variation in the waiting time before clamping the cord 14 , 15 . Possibly the transition toward delayed CC practice in Sweden was facilitated by the national guidelines that recommend delayed CC 8 .…”