INTRODUCTION
Delayed cord clamping allows transfusion of placental blood to the newborn in the first minutes after birth.1 For term newborns, this practice increases hemoglobin and iron stores, preventing or delaying iron deficiency, and may improve young children’s development.1,2 It is recommended by the American College of Obstetricians and Gynecologists,3 but its prevalence in the United States is not well-reported. This study describes delayed cord clamping’s prevalence in U.S. hospitals overall and by facility characteristics.
METHODS
The Maternity Practices in Infant Nutrition and Care survey is a biennial census of U.S. hospitals providing maternity care; it is completed by staff most knowledgeable about hospital neonatal feeding practices.4 The 2018 Maternity Practices in Infant Nutrition and Care survey asked, “How many healthy newborns at your hospital have their umbilical cord clamped more than 1 minute after birth?” Response options were most (80% or more of healthy newborns), many (50–79%), some (20–49%), or few (0–19%). Facility characteristics assessed included type, teaching status, “baby-friendly” designation,5 birth volume, cesarean birth rate, and location. Descriptive analyses were performed to assess the practice’s prevalence by facility characteristics. Statistical tests were not performed because the Maternity Practices in Infant Nutrition and Care survey is a census and not subject to sampling error. This activity was reviewed by Battelle; it was determined to be research that did not involve human subjects and was conducted consistent with applicable federal law and Centers for Disease Control and Prevention policy (eg, 45 C.F.R. part 46; 21 C.F.R. part 56; 42 U.S.C. §241(d), 5 U.S.C. §552a, 44 U.S.C. §3501 et seq).
RESULTS
Of 2,913 eligible hospitals, 2,045 (70.2%) completed the Maternity Practices in Infant Nutrition and Care survey. Three hospitals missing delayed cord clamping data were excluded, resulting in an analytic sample of 2,042. Fifty percent of hospitals reported that “most” healthy newborns received delayed cord clamping (Table 1). Prevalence was 51.9% among nonprofit hospitals, 44.0% among government or military hospitals, and 43.4% among private hospitals. Similar percentages of teaching hospitals (49.5%) and nonteaching hospitals (51.0%) reported delayed cord clamping for most healthy newborns, and 52.7% of baby-friendly hospitals and 49.1% of non–baby-friendly hospitals reported it for most healthy newborns. Its prevalence for most healthy newborns by birth volume ranged from 46.4% among hospitals with 2,000–4,999 births to 53.2% among hospitals with fewer than 500 births. This practice for most healthy newborns ranged from 37.1% among hospitals with cesarean birth rates of 35% or higher to 61.0% among hospitals with cesarean birth rates less than 25%. Across states, the median percentage of hospitals reporting this practice for most healthy newborns was 52% (range 29–100%) (Fig. 1).
Table 1.
Delayed Cord Clamping for Healthy Newborns by Facility Characteristics, Maternity Practices in Infant Nutrition and Care 2018
| No. of Hospitals Responding to “How Many Healthy Newborns at Your Hospital Have Their Umbilical Cord Clamped More Than 1 Minute After Birth?” | |||||
|---|---|---|---|---|---|
| Facility Characteristic | Most (80% or More) | Many (50–79%) | Some (20–49%) | Few (0–19%) | Total |
| Overall | 1,020 (50.0) | 419 (20.5) | 292 (14.3) | 311 (15.2) | 2,042 |
| Type | |||||
| Government or military | 40 (44.0) | 19 (20.9) | 11 (12.1) | 21 (23.1) | 91 |
| Nonprofit | 813 (51.9) | 326 (20.8) | 220 (14.0) | 207 (13.2) | 1,566 |
| Private | 167 (43.4) | 74 (19.2) | 61 (15.8) | 83 (21.6) | 385 |
| Teaching hospital | |||||
| Yes | 698 (49.5) | 300 (21.3) | 195 (13.8) | 218 (15.5) | 1,411 |
| No | 322 (51.0) | 119 (18.9) | 97 (15.4) | 93 (14.7) | 631 |
| Baby-friendly designation* | |||||
| Yes | 265 (52.7) | 106 (21.1) | 63 (12.5) | 69 (13.7) | 503 |
| No | 755 (49.1) | 313 (20.3) | 229 (14.9) | 242 (15.7) | 1,539 |
| Annual birth volume | |||||
| Less than 500 | 381 (53.2) | 135 (18.9) | 89 (12.4) | 111 (15.5) | 716 |
| 500–999 | 220 (50.5) | 100 (22.9) | 59 (13.5) | 57 (13.1) | 436 |
| 1,000–1,999 | 212 (47.1) | 95 (21.1) | 65 (14.4) | 78 (17.3) | 450 |
| 2,000–4,999 | 181 (46.4) | 81 (20.8) | 73 (18.7) | 55 (14.1) | 390 |
| 5,000 or more | 26 (52.0) | 8 (16.0) | 6 (12.0) | 10 (20.0) | 50 |
| Cesarean birth rate (%)† | |||||
| Less than 25 | 244 (61.0) | 74 (18.5) | 46 (11.5) | 36 (9.0) | 400 |
| 25 to less than 30 | 321 (56.3) | 102 (17.9) | 74 (13.0) | 73 (12.8) | 570 |
| 30 to less than 35 | 263 (47.0) | 135 (24.2) | 75 (13.4) | 86 (15.4) | 559 |
| 35 or more | 188 (37.1) | 108 (21.3) | 96 (18.9) | 115 (22.7) | 507 |
Data are n (%) or n.
Hospitals reported whether they were designated “baby-friendly” as part of the Baby-Friendly Hospital Initiative.5
Proportion of cesarean births among live births. Six hospitals missing cesarean birth data were excluded from the cesarean birth rate analysis.
Fig. 1.
Percentage of hospitals reporting that most healthy newborns receive delayed cord clamping, Maternity Practices in Infant Nutrition and Care, 2018.
DISCUSSION
This national study describes the prevalence of hospitals routinely implementing delayed cord clamping, a recommended obstetric practice.2,3 There is opportunity to increase its practice in U.S. hospitals. Obstetric care protocols can be modified to routinely include it for newborns, regardless of birth mode. Continued training among clinicians is encouraged, particularly in areas with low prevalence of delayed cord clamping. Greater public awareness of its health benefits may prompt discussions between patient and clinician and result in improved care.
Limitations of this study include variation in who completes the Maternity Practices in Infant Nutrition and Care survey and how the practice is tracked at each hospital. Hospitals self-report their practices, which may result in inaccuracies. There may be variability in how hospitals define “healthy newborns” and their practices. Finally, nonresponding hospitals may have different characteristics and practices than respondents, potentially affecting generalizability.
Half of U.S. hospitals report delayed cord clamping for most healthy newborns, with variation in practice by hospital location and cesarean birth rate. Interventions targeting hospitals, clinicians, and patients might increase this practice, improving short-term and long-term infant health.
Footnotes
Presented at the American Society for Nutrition’s annual meeting, held virtually, June 7–10, 2021.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Each author has confirmed compliance with the journal’s requirements for authorship.
Financial Disclosure
The authors did not report any potential conflicts of interest.
REFERENCES
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