Preparing for Umbilical Cord Clamping
Before clamping an umbilical cord, emergency medical technicians (EMTs) follow preparatory steps to ensure the well-being of the newborn and birthing parent. First, EMTs rapidly assess the newborn, checking for a strong cry, good muscle tone, and effective breathing. Observing cord pulsation is also important, as it guides clamping timing.
Clamping timing varies with birth circumstances. Immediate clamping may be necessary in emergencies like maternal hemorrhage or a compromised newborn needing resuscitation. However, delayed clamping is often preferred when medically appropriate. Delayed clamping, waiting until cord pulsation ceases, allows beneficial blood transfer from the placenta to the newborn. Maintaining a sterile field is important to prevent infection.
Preparation involves gathering the necessary equipment: two sterile umbilical cord clamps or hemostats, sterile scissors, and appropriate personal protective equipment (PPE) for the EMTs. These items should be readily accessible and opened in a manner that preserves their sterility. Ensuring all equipment is prepared beforehand streamlines the process and allows for efficient management during a time-sensitive situation.
Precise Umbilical Cord Clamping Technique
After preparation, EMTs proceed with precise umbilical cord clamping. The first clamp is placed approximately 2 to 3 centimeters (about 1 to 1.2 inches) from the newborn’s abdomen. This specific distance helps to leave a sufficient length of cord for potential medical procedures or for the natural drying and detachment process. The clamp should be applied firmly to ensure complete occlusion of the blood vessels within the cord.
After the first clamp is securely in place, a second clamp is then applied. This second clamp is positioned about 2 to 3 centimeters (about 1 to 1.2 inches) distal to the first clamp. This creates a small segment of cord between the two clamps where the cutting will occur. The placement of the second clamp ensures that if there is any slippage or issue with the first clamp, there is a backup to prevent bleeding.
Before the cord is cut, it is important to visually inspect the segment of the cord between the two clamps. This inspection confirms that the cord contains the expected number of vessels: two arteries and one vein. The clamps are designed to securely compress the cord without causing undue damage to the delicate tissues. Proper application helps to prevent blood loss from either the newborn or the placenta once the cord is severed.
Post-Clamping Steps and Important Considerations
Following the application of both clamps, the umbilical cord is cut between them using sterile scissors. The cut should be made cleanly and decisively within the segment created by the two clamps, ensuring that neither the newborn nor the birthing parent is inadvertently injured. After the cord is cut, the EMT observes the cut end on the newborn’s side for any signs of bleeding.
Should any bleeding occur from the newborn’s cord stump, additional measures may be taken, such as applying another clamp closer to the newborn or re-evaluating the initial clamp’s placement. Maintaining the newborn’s warmth is important throughout and after the clamping procedure, often achieved by drying the newborn and placing them skin-to-skin with the birthing parent or wrapping them in warm blankets. This helps prevent hypothermia, which newborns are susceptible to.
Documentation of the procedure includes the time of birth, the time of cord clamping, and any notable observations or complications. While immediate complications related to clamping are rare, EMTs are trained to recognize potential issues such as persistent bleeding from the cord stump or signs of infection developing later. These observations guide further medical care and are communicated during the transfer of care to a hospital.