Umbilical cord clamping: beliefs and practices of American nurse-midwives.

The optimal time for umbilical cord clamping after birth remains a critical unknown fact that has implications for the infant, the mother, and science. A national survey was conducted using a randomized sample (n = 303) of the active membership of the ACNM to determine cord clamping practices and beliefs of American nurse-midwives. The response rate was 56%. The respondents fell into three cord clamping categories: early (EC) or before 1 minute (26%); intermediate (IC) or 1 to 3 minutes (35%); and late (LC) or after pulsations cease (33%). The EC group believes that early clamping facilitates management of the newborn. The IC group believes that a moderate delay of clamping allows for a gradual transition to extrauterine circulation, although many think that the timing of cord clamping is not significant. The LC group have strongly held beliefs that late clamping supports physiologic birth processes. The majority of CNMs (87%) place the baby on the mother's abdomen immediately after birth and 96% avoid clamping a nuchal cord whenever possible. Although Varney's Midwifery was cited most frequently as a reference, 78% of the respondents listed no references reflecting, in part, the absence of evidence-based recommendations for cord clamping practices.