Quality standard
Quality statement 6: Delayed cord clamping
Quality statement 6: Delayed cord clamping
Quality statement
Women do not have the cord clamped earlier than 1 minute after the birth unless there is concern about cord integrity or the baby's heartbeat.
Rationale
The benefits of delayed cord clamping include higher haemoglobin concentrations, a decreased risk of iron deficiency and greater vascular stability in babies. If they wish, women can ask healthcare professionals to wait longer to clamp the cord.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that midwives and obstetricians do not clamp the cord earlier than 1 minute after the birth unless there is a concern about cord integrity or the baby's heartbeat.
Data source: Local data collection.
Process
a) Proportion of cords clamped earlier than 1 minute after the birth where there is not a concern about cord integrity or the baby's heartbeat.
Numerator – The number in the denominator where the cord is clamped after 1 minute after the birth.
Denominator – The number of babies born where there is no concern about cord integrity or the baby's heartbeat.
Data source: Local data collection.
b) Proportion of cords clamped earlier than 1 minute where there is a concern about cord integrity or the baby's heartbeat.
Numerator – The number in the denominator where the cord is clamped earlier than 1 minute after the birth.
Denominator – the number of babies born where there is a concern about cord integrity or the baby's heartbeat.
Data source: Local data collection.
Outcome
Maternal satisfaction and experience of care.
Data source: National data is collected as part of the Care Quality Commission's Maternity Survey: section C ('Your labour and the birth of your baby').
What the quality statement means for different audiences
Service providers (for all 4 birth settings) have protocols in place to ensure that the cord is not clamped earlier than 1 minute after the birth unless there is concern about cord integrity or the baby's heartbeat.
Healthcare professionals (midwives and obstetricians) do not clamp the cord earlier than 1 minute after the birth unless there is concern about cord integrity or the baby's heartbeat.
Commissioners (clinical commissioning groups or integrated care systems) specify and check that service providers have protocols in place to ensure that the cord is not clamped earlier than 1 minute after the birth unless there is a concern about cord integrity or the baby's heartbeat.
Women who have just given birth do not have the cord clamped for at least 1 minute after the birth unless there are concerns about the baby. This is to allow more blood to reach the baby and may help to prevent anaemia.
Source guidance
Intrapartum care for healthy women and babies. NICE guideline CG190 (2014, updated 2017), recommendation 1.14.14 (key priority for implementation)
Definitions of terms used in this quality statement
Cord integrity
Concerns would arise over cord integrity if the cord was damaged in any way, if it had snapped during delivery or if there was bleeding to the cord. Definitions of cord integrity are not limited to those stated here. [Expert opinion]
Concern about the baby's heartbeat
Concern would arise if, after delivery, the baby has a heartbeat below 60 beats/minute that is not getting faster. [Adapted from NICE's guideline on intrapartum care for healthy women and babies, recommendation 1.14.14]