Obstetricians' attitudes and beliefs regarding umbilical cord clamping.
OBJECTIVE
Although delayed umbilical cord clamping has been demonstrated to reduce the incidence of intraventricular hemorrhage and neonatal sepsis, and decrease the need for neonatal transfusions (without affecting cord pH, Apgar scores or the need for phototherapy), the extent to which this practice is being employed is unknown. We conducted a survey of US obstetricians to assess their attitudes and beliefs about cord clamping.


METHODS
Questionnaires were randomly mailed to members of the American College of Obstetricians and Gynecologists (ACOG), and the Collaborative Ambulatory Research Network (CARN). The data were analyzed using Chi-square and Student t tests.


RESULTS
The response rates for the CARN and other ACOG members were 47% and 21%, respectively. Most (88%) responders reported their hospital had no umbilical cord clamping policy. The most frequent response for optimal timing of umbilical cord clamping, regardless of gestational age, was "don't know". Potential for neonatal red blood cell transfusion was the only concern cited as a reason for being somewhat or very inclined to delay umbilical cord clamping (51%). Delayed neonatal resuscitation (76%) was listed as a reason to clamp the cord immediately, despite the paucity of literature to support immediate cord clamping in this cohort.


CONCLUSIONS
Despite substantial evidence supporting the practice of delayed cord clamping, few institutions have policies regarding this practice. Moreover, obstetricians' beliefs about the appropriate timing for umbilical cord clamping are not consistent with the evidence that demonstrates its beneficial impact on neonatal outcomes.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California , San Francisco, CA , USA .
Angie C
AC
Jelin
Miriam
M
Kuppermann
Kristine
K
Erickson
Ronald
R
Clyman
Jay
J
Schulkin
D001291:Attitude of Health Personnel; D002543:Cerebral Hemorrhage / Q000517:prevention & control; D003250:Constriction; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009774:Obstetrics; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011247:Pregnancy; D018805:Sepsis / Q000517:prevention & control; D013997:Time Factors; D014470:Umbilical Cord / Q000601:surgery*; D014481:United States / Q000453:epidemiology; D000078329:Workforce
Delayed clamping; opinion; preterm; survey; term