Clamping umbilical cords

Surfandnurse · Jun 26, 2016

Placing infant on blanket on mums abdomen face up to do initial resuscitation then shorten and cut cord, put on diaper and then place infant skin to skin.

That's what I've seen done and have been doing now that we don't take infant to warmer unless more resuscitation is needed. It is annoying to have the huge haemostat dangling so u tend to clamp and shorten quickly. We also have to send 6 inches of cord for drug screening quite frequently which has become an issue when doctors haemostat and cut the cord to short. U then have to put another clamp on in addition to your plastic clamp that stays on the neonate because u have to take this section of cord for analysis.

Elvish, BSN, DNP, RN, NP · Jun 26, 2016

Depending on the doc we have a couple ways of doing it.

1) Doc just puts the plastic clamp on closest to the abdomen then hemostat on other side, then when the cord is cut the plastic clamp is already on and in the right spot, and baby goes straight skin to skin if all is well. Saves us all a step.

2) Hemostats like in your scenario, they cut, then someone hands me the plastic clamp and I put it on. But I don't like to trim cords on mom's abdomen because like you, I think it's hard to get a good angle. So a lot of times I will just put the plastic clamp on, undo the hemostat on the other end, and let baby do skin to skin with the fairly long length of cord. Won't hurt anything. I wait to trim the cord til I get baby under the Panda to weigh. Better angle and I can usually enlist help from dad or grandma to hold appendages/extremities out of the way.

I agree having the hemostat on is not best practice. I don't like the thought of it poking baby and if by some odd chance it got undone it could be a bad scenario very quickly.

**LibraSunCNM, BSN, MSN, CNM** · Jun 26, 2016

Where I work as a midwife, the plastic umbilical cord clamp is on my delivery table as part of my setup, so we can always proceed like #1 in Elvish's examples. Makes it easier.

AspiringNurseMW · Jun 26, 2016

Student here trying to picture the logistics. Does delayed cord clamping play into this at all? Since EBP is in favor of DCC does that eliminate the issue when in use?

**LibraSunCNM, BSN, MSN, CNM** · Jun 26, 2016

Student here trying to picture the logistics. Does delayed cord clamping play into this at all? Since EBP is in favor of DCC does that eliminate the issue when in use?

No, you still need to clamp it before you cut it, whenever that may be.

Kooky Korky, BSN, RN · Jun 27, 2016

In days of yore, Dr. Frederick LeBoyer was a proponent of "Birth Without Violence". Some elements of this included being as quiet in the delivery room as possible, lowering the lights if not needed for any type of emergency, and not cutting the cord until baby had had a chance to receive the blood from the cord.

If there were any problems that needed immediate medical/nursing intervention, he reverted to standard delivery room prcedure. But if Mom and Baby were doing well, he advocated a calm, quiet, most gentle atmosphere and approach.

Most interesting reading.

Does anyone do the LeBoyer Method or anything like it?

Elvish, BSN, DNP, RN, NP · Jun 28, 2016

In days of yore, Dr. Frederick LeBoyer was a proponent of "Birth Without Violence". Some elements of this included being as quiet in the delivery room as possible, lowering the lights if not needed for any type of emergency, and not cutting the cord until baby had had a chance to receive the blood from the cord.
If there were any problems that needed immediate medical/nursing intervention, he reverted to standard delivery room prcedure. But if Mom and Baby were doing well, he advocated a calm, quiet, most gentle atmosphere and approach.
Most interesting reading.
Does anyone do the LeBoyer Method or anything like it?

We don't call it the Leboyer because full Leboyer involves warm bath, which we don't do immediately after delivery (if at all).

But lots of places have moved to kinder gentler births. Most of the births at our place involve low lights and quiet. We have a spotlight on mom's perineum so docs can see what they're doing (teaching hospital, baby docs :) ), and the radiant warmer lights in the corner (which can be dimmed), but no bright overhead business if we can help it. And unless that's what the patient wants, nobody really gets loud. Delayed clamping, we (unfortunately) don't do it routinely unless

**LibraSunCNM, BSN, MSN, CNM** · Jun 28, 2016

As long as mom and baby are ok, I routinely delay cord clamping, as well as try to keep the room quiet, lights dim, everything calm, etc. But I don't practice strict LeBoyer method, because as Elvish stated, it involves a warm bath at delivery, and we know from evidence that delaying the first bath is better for baby.

sharonx · Jun 28, 2016

Do you know if Umb drug screening is more expensive? I have been thinking of bring this one to Unit counsel. We only do meconium. sometimes it takes forever to collect it and sometimes we fear the moms will throw the diapers out.

sharonx · Jun 28, 2016

Great. These are all things that I have been thinking of or doing on my own. Most docs seem receptive to placing the plastic clamp on. Have some docs and even a mid wife believe it or not who are very resistant to doing this. I am going to clamp like you mention down by the hemostat and re-clamp on the warmer later in those cases :-)

sharonx · Jun 28, 2016

We are a very small unit and 3 mid wives. two of them put it on the table as you do and the other does nothing that would be more of an effort. Thanks, I think your method is definitely the safest.

Thanks!