Umbilical cord clamping time and maternal satisfaction

Midwifery. 2022 Sep 13;115:103487. doi: 10.1016/j.midw.2022.103487. Online ahead of print.


Objective: Clamping of the umbilical cord is part of the third stage of delivery. Delayed cord clamping (DCC) is recommended due to its contribution to prevention of anaemia. There is no evidence on the effect of DCC on maternal satisfaction. The aim of this study is to evaluate the effect of different sociodemographic and obstetric factors, including the timing of cord clamping, on maternal satisfaction with the birth experience in our healthcare system.

Design: Pragmatic non-drug intervention study with simple random assignment of participating mothers (Clinical Trials N°: NCT03624335).

Setting: A public, university-level hospital in Villarreal city, eastern Spain.

Participants: Childbearing woman, gestation week between 35 and 42 weeks, with regular medical pregnancy checks, single pregnancy and vaginal delivery (N = 198, 80% of the women recruited).

Interventions: umbilical cord clamping within 60 seconds of the birth (Early cord clamping, ECC) versus umbilical cord clamping after pulsation had been ceased (Delayed cord clamping, DCC).

Measurements: Birth satisfaction was measured using the Mackey Childbirth Satisfaction Rating Scale (MCSRS). Additionally, sociodemographic data, degree of knowledge about the moment of clamping and type of breastfeeding data were recorded. The Mann-Whitney and Kruskal-Wallis tests for comparison of the mean of two, three, or more groups, respectively, and Chi-square and Spearman for comparison of two qualitative and quantitative variables, respectively, were used. To determine the weight of each factor of MCSRS, an exploratory factor analysis was carried out using the maximum likelihood method for factor extraction and the varimax method for factor rotation. The adequacy of the factor analysis was checked by mean of Kaiser-Meyer-Olkin test and Bartlett sphericity test. The level of significance was set at a p-value of < 0.05.

Findings: The average degree of satisfaction was 4.55/5 (SD: 0.37). No statistically significant difference was observed between mothers' satisfaction according to mother level of study or mother's place of birth, while it changed significantly with age (p = 0.0398). Within the obstetric variables, satisfaction was significantly associated with spontaneous amniorrhexis, the duration of the second stage of delivery, and the Apgar value of the newborn at the first minute of life, and was independent of the number of previous pregnancies and deliveries, use of intrapartum oxytocin, epidural analgesia, episiotomy, the weight of the child at birth and type of breastfeeding. Furthermore, there was no relationship between the time of clamping and satisfaction (p = 0.5178).

Key conclusions: Maternal satisfaction with the birth experience varies with the age of the childbearing woman, and some intrapartum factors and the result is not influenced by the time of clamping of the umbilical cord. Therefore, this component of the physiological management of childbirth provides additional benefits for the health of the neonate, without negative consequences on the final perception of the maternal health care received.

Implications for practice: If there are no reasons that justify an early umbilical cord clamping, delaying it brings benefits to the neonate, without negatively affecting the maternal assessment of the experience of childbirth.

Keywords: Birth; Maternal satisfaction; Spain; Umbilical cord clamping.

Associated data