2.

4 Knowledge of properly timed cord clamping

Term and preterm infants appear to benefit from proper time clamping of the umbilical
cord. As reported by the American College of Obstetricians and Gynecologists, properly timed
cord clamping accompanies significant neonatal benefits, including increased hemoglobin levels
and improved iron stores in their body for the first several months of life, a positive effect on
their development for term infants. Preterm infants' benefits include improved circulation,
improved blood volume, decreased need for blood transfusion, and reduced incidence of
necrotizing enterocolitis and intraventricular hemorrhage. Hence, a delay in umbilical cord
clamping for at least 30 to 60 seconds after birth in term and preterm infants is recommended
by the American College of Obstetricians and Gynecologists. It is also stated that the capacity to
render delayed umbilical cord clamping could differ between institutions and settings.

A cross-sectional study conducted in health centers in Jimma Zone, Ethiopia assessed

the knowledge and practice of Essential Newborn Care and Associated Factors among nurses
and midwives. Results show that 87 (32.0%) participants clamp the umbilical cord 2 to 3
minutes after the delivery of all crying babies while 126 (46.3%) of participants clamped the cord
less than 2 minutes or immediately after the delivery. In the study, after cord clamping, 250
(91.9%) participants always use sterile scissors when cutting the cord, but 22 (8.1%)
participants answered that they only use sterile scissors sometimes. The study also stated that
there is no notable association between age, religion, ethnicity, marital status, work experience,
and workload with the level of knowledge of Essential Newborn Care of the participants
(Neguisse, Hailu, & Megenta, 2018). 

In an institution-based cross-sectional study conducted in Wolaita Zone, Southern

Ethiopia, the study showed that half of the respondents, 109 (50.5%), answered that clamping
or tying the cord should be done 2 to 3 minutes after the delivery or when the umbilical artery
pulsation stopped. In comparison, 45 (20.8%) and 62 (28.7%) respondents answered that the
clamping or tying of the cord should be done promptly after delivery and within the first 1 to 2
minutes. The majority of respondents,182 (84.2%), responded that cutting the cord should be
done using sterile scissors, 14 (6.5%) responded that a new surgical blade must be used, and
20 (9.3%) responded that to cut the cord, use clean scissors (Arba & Zana, 2020).

A research by Caorong and Bangcola in 2016 reveal that 32 (97.0%) neonatal intensive
care unit (NICU) staff nurses have stated "always" in clamping the cord using a sterile plastic
clamp, 2 cm from the base, while 1 NICU staff nurse stated that he/she does cord clamping with
the use of sterile plastic clamp 2 cm from the base "often." This study also showed that 32
(97.0%)  NICU staff nurses have stated that they always use sterile plastic clamps 3 cm from
the plastic clamp, and 1 (3.0%) NICU staff answered often instead of always.  The 28 ( 84.8 %)
NICU staff nurses stated that they always cut the cord 2-3 minutes after the delivery or when the
pulsation of the cord stops. In comparison, 4 ( 12.1 %) NICU staff nurses answered that they
often cut the cord 2-3 minutes after the delivery or when the pulsation of the cord stops.
Furthermore, 1 NICU staff (3.0 %) said that he/she cut the cord  2-3 minutes after the delivery or
when the pulsation of the cord stops sometimes. 

According to a study conducted to assess the knowledge of nurse-midwives about the

effect of early timing of umbilical cord clamping on maternal and neonatal outcomes at delivery
rooms in maternity hospitals in Baghdad City, where the majority (69.1%) of the sample in the
study had less than ten years of service in the delivery room (76.6%). Among the 81
participants, 25 (30.9%) answered directly on the time of clamping the umbilical cord. 35 nurse-
midwives (43.2%) answered 1 to 3 minutes, 13 (16%) stated to clamp the umbilical cord after
more than 3 minutes, and only 8 (9.9%) answered to do it after the cord pulsation stops. The
study also stated that there is no significant relationship between the knowledge of the effect of
timing of umbilical cord clamping and the demographic characteristics and the general
information variables of the study population (Kamel & Ali, 2016).

Synthesize the literature by summarizing, paraphrasing, comparing, and contrasting similarities,

strengths, and weaknesses.

Synthesize:

Properly timed cord clamping has been essential to neonates because it appears to have significant
benefits that positively affect their development. Most studies about proper time cord clamping in
different countries showed that most nurses and midwives who work in the delivery room stated that
they tie the cord 2-3 minutes after the delivery or when umbilical pulsation stops. In contrast, one study
that we acquired showed that most participants still clamp the cord less than 2 minutes or immediately
after the delivery. All studies that we gathered about properly timed cord clamping stated that most
participants always use a sterile plastic clamp and clamp the cord 2cm from the base and 3cm from the
plastic clamp, while some participants often do this practice. Most nurses and midwives responded that
they always use sterile scissors when cutting the cord, while others answered that they often use it or
use other tools such as a new surgical blade and clean scissors.