Early or delayed umbilical cord clamping? Experiences and perceptions of nurse-midwives and obstetricians at a regional referral hospital in Tanzania

Abstract

Background Umbilical cord clamping is a crucial step during the third stage of labour that separates the newborn from the placenta. Despite the available evidence that delayed umbilical cord clamping is more beneficial to infants, as well as the existence of 2014 WHO recommendation that the umbilical cord should be clamped between 1 and 3 minutes, its implementation is still low in many countries including Tanzania. Objective This study describes the experiences and perceptions of nurse-midwives'and obstetricians'about the timing of umbilical cord clamping at a regional referral hospital in Tanzania. Methods A descriptive qualitative study design that adopted a purposeful sampling strategy to recruit 19 participants was used. Nine semi-structured interviews with six nurse-midwives'and three obstetricians', as well as one focus group discussion with ten nurse-midwives'were conducted. Thematic analysis guided the analysis of data. Results Three main themes generated from the data, each having 2 to 5 subthemes. 1. Experiences about the timing of umbilical cord clamping. 2. Perceptions about the umbilical cord clamping. 3. Factors influencing the practice of delayed umbilical cord clamping to improve newborn health outcomes.

Impact of stimulation among non-crying neonates with intact cord versus clamped cord on birth outcomes: observation study

“…A study in Tanzania showed that although the healthcare provider commonly practiced clamping the umbilical cord immediately after delivery, they were aware that delayed cord clamping has a potential benefit of oxygenation to the newborn in the event of the need for resuscitation. 25 Our study also shows that despite the education of healthcare providers on keeping the cord intact during resuscitation, two-thirds of the noncrying babies received resuscitation after cord clamping. There is a need to implement a delay in clamping as a quality improvement intervention to improve initial steps of resuscitation-especially stimulation and if necessary bag-and-mask ventilation.…”

Integrated review of the knowledge, attitudes, and practices of maternity health care professionals concerning umbilical cord clamping

“…Midwives' attitudes and perceptions of CCT were reported in six papers 11,33,40–42,45 . Expectant women's preferences were significant factors in the management of third‐stage labor and cord clamp timing 11,33,45 .…”

“…This search of international literature identified 18 eligible studies. Reference lists of selected articles were also examined for relevant publications, which met review inclusion criteria 11,14–16,32–45 . Empirical studies selected for this review used quantitative (n = 15) and qualitative designs (n = 3).…”

“…Cross‐sectional survey and audit studies varied in sample size (27‐1243 participants) with most studies recruiting from several maternity professional disciplines (see Table 2). Focus groups using multidisciplinary (n = 22) 11 and midwife‐only (n = 10) 42 samples were used to explore third‐stage labor management including cord clamping practices in two studies. Two qualitative studies reported on multidisciplinary cord clamping perceptions and practice 41,42 …”

“…Reference lists of selected articles were also examined for relevant publications, which met review inclusion criteria. 11,[14][15][16][32][33][34][35][36][37][38][39][40][41][42][43][44][45] Empirical studies selected for this review used quantitative (n = 15) and qualitative designs (n = 3). Cross-sectional survey design was frequently used (n = 13) [14][15][16][32][33][34][35][36]39,40,[43][44][45] ; and/or observational audit…”