Kathrin Stoll, PhD and Eileen Hutton, PhD

ABSTRACT

Despite mounting evidence of the health benefits of delayed cord clamping of term and preterm neonates,
Canadian practice guidelines about the optimal timing of cord clamping have not been developed. At the time
the study was conducted, the Society of Obstetricians & Gynecologists of Canada (SOGC) recommended early
clamping as part of active management, while findings from several randomized controlled trials pointed at
reported benefits of delayed cord clamping. It is unclear how Canadian maternity care providers were interpreting
the evidence around umbilical cord clamping and what they do in clinical practice.
A link to an online survey was distributed to members of the Canadian Association of Midwives (CAM) and
the SOGC to assess maternity care providers’ umbilical cord clamping practices and attitudes. Respondents were
asked to answer questions pertaining to the timing of cord clamping, reasons for cord clamping practices and
perceived benefits and risks associated with delayed cord clamping (> 60 seconds) for 1) term and 2) preterm
infants (< 37 weeks).

A total of 353 respondents met eligibility criteria (i.e. they provided intrapartum care at the time of data
collection). The majority of obstetricians (77.9%) reported clamping the cord of term infants immediately (< 30
seconds), compared to 60.0% of family physicians and 9.8% of midwives; 6.5% of obstetricians, 9.1% of family
physicians and 65.7% of midwives reported delaying cord clamping by two minutes or more. Midwives were
more likely than physicians to make a conscious decision about the timing of cord clamping. Care providers
reported higher rates of immediate cord clamping with preterm infants, compared to term infants, with 85% of
physicians and 39% of midwives clamping the cord of preterm neonates within 30 seconds. The most common
reason for clamping the cord of a term neonate immediately was the infants’ need for resuscitation or other medical
interventions (79%). Personal routine was the most frequently cited reason for clamping the cord of a preterm
infant immediately (40%).

Findings from this survey highlight interprofessional variations in cord clamping practices. Clear practice
guidelines around the optimal timing of cord clamping should be developed that take into considerations the
health benefits of delaying cord clamping of term and preterm infants.

KEY WORDS
survey, attitudes, maternity care providers, cord clamping, clinical guidelines

This article has been peer-reviewed.

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