Delayed Cord Clamping

Specialties Ob/Gyn

Published

Does anyone work in L&D? I'm doing my BSN Capstone Project on delayed cord clamping and am curious if anyone practices it in their facility. My project is aimed towards the benefits of implementing delayed cord clamping and would love any opinions, particularly negative feedback so I can present all sides. All of my evidence-based research has come up empty handed on any negative aspects of implementing. I have a handful of friends in L&D and have yet to come across any facilities who practice it.

Personally I am all for it. The benefits far outweigh the risks and I have yet to come across any evidence-based practice for immediate cord clamping or against delayed cord clamping. However there isn't much clinical opinion from those who actually practice it and their thoughts. Thanks!

Yes this is homework and no I'm not looking for anyone to do it for me :)

Specializes in Eventually Midwifery.

OP, you may want to post something in the CNM section, as they seem to be some of the few that actually do this.

Specializes in OB.

I'm a CNM and I practice it, as do my midwife colleagues (I work in a group of 15). The problem is that our hospital system requires every baby to have cord blood gases done, so often I get pushback from the nursing staff that by the time I give them a section of the cord, there's no blood left to use as a specimen. However if the baby is fine, which they are 90% of the time, the gases don't matter, so I just keep doing what I do. It's stupid that the gases are required on all babies, in my opinion, so I don't really let it get in the way of a practice that has been shown to be SO beneficial.

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

What on earth is the rationale for collected gases on ALL deliveries?

Specializes in Reproductive & Public Health.

Good lord, gases on all babies? In addition to cord blood for a type/coombs? Cord blood is easy to get, no matter how long you delay, but I imagine gases are more of a challenge since you have to be sure of your vessel. I've always practiced delayed cord clamping (even in the OR, we delay or strip), and all the midwives I've worked with (and a good percentage of the OBs) delay as well. When I did homebirth, we routinely delayed until just before/after the placenta was born (not for any evidence-based reason, just how we did it).

In my experience, delayed cord clamping is resisted mainly because it forces us to sit back and wait. We all have so many tasks we need to complete and there is pressure to get it all done. And I do still hear vague mentions of polycythemia and jaundice. Plus, some units don't really train/support nurses to manage the immediate postpartum as a couplet. It's definitely a unit systems/culture issue.

It's a big change, if you are used to the whisk-baby-to-the-bassinet model. It takes an organized, unit-wide effort, in my experience. But once delayed cord clamping (and uninterrupted skin to skin) is implemented, the staff response seems to be almost universally positive.

As an L&D nurse, I worked with one doctor who would always catch the baby, suction (don't get me started), clamp within 10 seconds, wipe off the screaming kid, and then proceed to hold him/her up and ask the family to take pictures. Argh. All while mom is in stirrups and hasn't hardly even laid eyes on her baby.

Specializes in Reproductive & Public Health.

I'm always particularly interested in NICU's perspective on this issue.

Specializes in Reproductive & Public Health.
I heard, anecdotally from my OB preceptor 10 years ago when I was a student, about a homebirth midwife who stripped the cord, and the baby ended up with kernicterus (sp?). That's all I have.

In that case, the woman must have been sensitized and the midwife did not pick up on it. It's quite possible she did not provide prenatal rhogam (the mother may have declined it, but I also know homebirth midwives whose counseling is very biased when it comes to prenatal rhogam), and then failed to monitor for the development of antibodies. Or, the mother was sensitized from a previous pregnancy and the midwife did not screen for it. Either way, we are talking gross negligence, in my (non-lawyer) opinion.

Stripping the cord is a baaaaad idea if a mother has developed anti-d antibodies, but it is,like, the LEAST bad thing about that situation overall. Gross incompetence, complete failure to meet the standard of care. Almost certainly an avoidable tragedy.

Specializes in OB.

Yes, gases on every baby. It's the policy at all NYC public hospitals. No real rationale that I've ever been able to suss out other than that we care for mostly poor immigrants whose babies are therefore at higher risk for morbidity/mortality, in some vague way. As I said, I don't let it get in the way of my clamping delay (obviously if a baby is in distress and gases are appropriate it's different) but I do often think about the waste of money it costs to run all of those tests.

Specializes in Nurse Scientist-Research.

In my experience, delayed cord clamping is resisted mainly because it forces us to sit back and wait.

I think this is the crux. That and tradition. Developed in a time when there wasn't really much the provider could do, cutting the cord gave them a "purpose" perhaps?

I don't go on deliveries, just know about some of the practices d/t involvement in the data collection project which is really focused on temp stability but delayed cord clamping was implanted after the start of the project so it became a topic of discussion. The benefits to the preterm infant are undeniable. And we very quickly drop that hematocrit with all our blood work. They need that extra blood.

My unit does delayed cord clamping routinely unless baby's status dictates otherwise. And we also do cord gases on every baby, but only need such a small amount from the placenta that I haven't seen it be an issue.

Our NICU team (who are in the room at delivery if we call them - we call if we suspect our baby will need extra support and thus have different code levels in case certain babies need extra support) are the ones calling out the time to the OB's in the OR or MD's in the delivery room so they know when to clamp.

Haven't seen any issues as of yet with temperature regulation. And we just did delayed on 30 week twins with a full NICU team present, so they must see benefits to the practice or I'm sure they wouldn't support it. Also saw delayed on a 26 weeker (baby was crying at delivery so perhaps that was why it was ok).

Within the last two months I've had the NICU doctor advise parents against delayed cord clamping due to increased risk of polycythemia for their term infant. They do a routine 30-60 sec delay for pretermers only. Midwives do this practice routinely on term babies, so I was surprised to hear this from the MD. While I have no idea if this was specific for this case, it seemed a stock answer and pretty much made my blood boil.

Specializes in Maternal - Child Health.
In that case, the woman must have been sensitized and the midwife did not pick up on it. It's quite possible she did not provide prenatal rhogam (the mother may have declined it, but I also know homebirth midwives whose counseling is very biased when it comes to prenatal rhogam), and then failed to monitor for the development of antibodies. Or, the mother was sensitized from a previous pregnancy and the midwife did not screen for it. Either way, we are talking gross negligence, in my (non-lawyer) opinion.

Stripping the cord is a baaaaad idea if a mother has developed anti-d antibodies, but it is,like, the LEAST bad thing about that situation overall. Gross incompetence, complete failure to meet the standard of care. Almost certainly an avoidable tragedy.

This may explain the case of kernicterus klone referred to, but please do not assume that it is the only possible cause.

Because it is (thankfully) so rare now, I won't disclose much, other than to say that the one and only case of kernicterus I have encountered was not due to an Rh, ABO, or other type of antibody mediated reaction. Nor were the serious cases of jaundice requiring multiple exchange transfusions.

I am curious to have other NICU nurses chime in, but in my experience, there have been other explanations unrelated to OB or CNM negligence for these life-threatening complications in newborns.

Specializes in Reproductive & Public Health.
This may explain the case of kernicterus klone referred to, but please do not assume that it is the only possible cause.

Because it is (thankfully) so rare now, I won't disclose much, other than to say that the one and only case of kernicterus I have encountered was not due to an Rh, ABO, or other type of antibody mediated reaction. Nor were the serious cases of jaundice requiring multiple exchange transfusions.

I am curious to have other NICU nurses chime in, but in my experience, there have been other explanations unrelated to OB or CNM negligence for these life-threatening complications in newborns.

You are right- thanks for the clarifying information.

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