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Indian Pediatr 2013;50: 321-323 |
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Does Cord Clamp Affect the Proper Positioning
of Breastfeeding?
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Ashish Jain, Sudhir Dixit, Shweta Agarwal and Veena
Devgan
From Neonatology Division, Department of Pediatrics,
Hindu Rao Hospital Delhi.
Correspondence to: Dr Ashish Jain, Neonatologist,
Department of Pediatrics, Hindurao Hospital, Malka Gunj, Delhi, India.
Email: [email protected]
Received: December 27, 2011;
Initial review: December 28, 2011;
Accepted: May 29, 2012 .
Published online: July 05, 2012.
PII: S097475991101053-2
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To determine the appropriateness of breastfeeding position as
assessed by 4-point standard objective criteria in the presence of
commercial plastic cord clamp. 50 babies each with and without cord
clamp were selected randomly in post natal ward.
Mean gestational age in both the periods was comparable (39±1.13 and
39±1.34 weeks). On evaluation by the standard 4 points of proper
positioning, babies with cord clamp failed to keep their head and
body straight (66% vs 94%, P=0.001), keep their baby’s
body touching mothers abdomen (16% vs 94% P=0.000),
and body well supported (72% vs 96%, P=0.002).
However, both groups were appropriately able to turn baby’s body
towards mother and nose opposite the nipple (98% vs 88%, P=0.112).
On evaluation of mother’s satisfaction score, there was no
significant difference except in the mother’s concern about care of
cord clamp (P<0.001).
Key words: Attachment, Breastfeeding, Cord clamp,
Positioning.
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Breast milk and breastfeeding have undoubted
benefits at all levels [1,2]. The factors responsible for
effective breastfeeding have been extensively studied and reported by
various researchers [3-6]. The four components of positioning are very
vital in effective breastfeeding [7,8]. The modern cord clamps remain in
place for few days (average 3-4 days) in all the babies.
This foreign body in between the baby’s
abdomen and the mother’s abdomen may affect the
positioning while breastfeeding. We planned a study to see the effect of
this cord clamp on appropriateness of breastfeeding positioning.
Methods
The study was conducted in Neonatal unit of Hindu Rao
hospital Delhi, India over a period of 4 months from August to November
2009. Ethical clearance was taken from the ethical committee of the
hospital. 100 term normal appropriate for gestational age newborns were
enrolled after obtaining a written informed consent. Babies were
assessed at the age of 24±6 hours in the postnatal wards. Those with
congenital abnormalities, and babies who were sick and admitted in NICU
were excluded. Vaginal deliveries assisted through episiotomy were also
excluded. Mothers with significant discomfort after delivery were
excluded. All the mothers were counselled antenatally by staff nurse.
The plastic cord clamp used in the study was available in the hospital
supply (Polyclamp Poly Medicine Limited). Cord clamp was removed by
artery forceps with all aseptic precautions.
Between August to September 2009, 50 babies with cord
clamp selected randomly from the post natal ward were
observed by a pediatrician for positioning using standard 4 point
objective criteria during breast feeding. Observer was
not aware of the study. The maternal satisfaction score was also
evaluated using 6 point questionnaire based on Likert’s scale.
Similarly, another 50 babies with cord clamp removed were also selected
randomly during October to November 2009. Similar evaluation was
conducted as for the first group; but by another observer. Satisfaction
questionnaire was administered soon after assessment of breastfeeding
positioning in both the periods. Counseling was done before
administration of questionnaire.
At the end of assessment, the possibility of
effective positioning by 4 point standard objective criteria with and
without cord clamp was determined. Similarly, satisfaction score of
mother were also assessed. Data entry and analysis were done using SSPS
software. Continuous data with normal distribution was analysed by
student t test and non normally distributed data by Mann- Whitney U
test. Categorical data was analysed by chi-square or Fisher exact test.
P value of < 0.05 was considered significant
Results
Fifty babies each with and without cord clamp were
enrolled. The mean (SD) gestational age in both the groups were
comparable (with clamp: 39 (1.13) wk; without clamp: 39 (1.34) wk).
Table I depicts the results of comparison of the two groups
on positioning during breastfeeding. Satisfaction scores of mothers in
the two groups are compared in Table II.
TABLE I Comparison of Breastfeeding Positioning of Both Groups
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Components |
Group 1 (with cord clamp) |
Group 2 (without cord clamp) |
P value |
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Yes |
No |
Yes |
No |
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1. Baby’s head and body straight |
33 (66%) |
17 (34%) |
47 (94%) |
3 (6%) |
0.001 |
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2. Is baby’s body turned towards mother
and nose opposite the nipple? |
49 (98%) |
1 (2%) |
44 (88%) |
6 (12%) |
0.112 |
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3. Is baby’s body touching mother’s
abdomen? |
8 (16%) |
42 (84%) |
47 (94%) |
3 (6%) |
0.000 |
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4. Is baby’s whole body well supported? |
36 (72%) |
14 (28%) |
48 (96%) |
2 (4%) |
0.002 |
TABLE II Mother’s Satisfaction Score
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Question |
Group 1 (cord clamp)
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Group 2 (no clamp) |
P
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1.Fear that cord clamp interferes with
breast feeding |
2 (1-2) |
1(1-1) |
0.9 |
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2.Concern about care of cord clamp |
4(2-4) |
4 (4-4) |
0.00 |
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3.Fear that cord clamp interfere in
routine care of baby |
2 (1-3) |
2(1-4) |
0.31 |
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4.Does this cord clamp affect baby’s
skin? |
2 (1-3) |
2(1-4) |
0.08 |
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5.Does this cord clamp affect daily
clothing or unclothing of baby? |
2(1-2) |
2(1-4) |
0.06 |
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6.Does cord clamp affect KMC/prone
positioning? |
2(1-4) |
3(1-4) |
0.20 |
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*Responses on five point Likert scale; 1=strongly disagree,
2=disagree; 3= neutral, 4=agree; 5= strongly agree.
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Discussion
In the present study, it was seen that the presence
of the commercial cord clamp on the baby adversely affected three out of
four important points considered for a good positioning while
breastfeeding. Hence, the head and body was straighter, the baby’s body
was touching mother’s abdomen better and the baby’s whole body well
supported, when the cord clamp was absent (removed after 24 hrs).
Different authors have reported the role of
educational programs and workshops to improve the knowledge of midwives
in facilitating the positioning and attachment of breastfeeding in the
immediate post-natal period. There are no studies that have investigated
the effect of the commercial cord clamp on positioning while
breastfeeding.
The limitation of the study was limited observations
and non-uniformity of the education level among the mothers. The study
had a strength that the observations were done in two periods with
different policies, and the observers were different in both the
periods. The changed policy of the cord clamp was only known to the
investigator.
The presence of the cord clamp may be an important
determinant of poor positioning while breastfeeding, especially in the
early days of postnatal life. The policy of removal of the cord clamp
after 24 hours may have a positive effect in strengthening the
positioning and allay the common anxiety related to its care in the
mother.
Acknowledgement: Dr PP Singh, Medical
Superintendent, Hindurao Hospital, Delhi for the permission to share
this case.
Contributors: AJ: concept of design and
analysis of data. SD and SA: collected data and prepared the manuscript.
AJ and VD interpreted data. All authors contributed to revision of
article and final approval.
Funding: None; Competing interest:
None stated.
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What This Study Adds?
• Cord clamp adversely affects the proper breastfeeding
position in healthy term neonates.
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