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

Dorkasi Lushindiho Mwakawanga,Lilian Teddy Mselle,Alexandra Sawyer

doi:10.1371/journal.pone.0234854

Dorkasi Lushindiho Mwakawanga, Lilian Teddy Mselle + Show 1 more

Open Access

https://doi.org/10.1371/journal.pone.0234854

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Journal: PloS one	Publication Date: Jun 22, 2020
Citations: 6	License type: CC BY 4.0

Affiliation: Muhimbili University of Health and Allied Sciences

Abstract

BackgroundUmbilical 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.ObjectiveThis 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.MethodsA 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.ResultsThree 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.ConclusionAlthough the nurse-midwives`and obstetricians`commonly practiced clamping the umbilical cord immediately after delivery, they understood that delayed cord clamping has a potential benefit of oxygenation to the newborn in the event of the need for resuscitation. To move forward with the good practice in maternal and newborn care, proper pre-service and providers training on matters underlying childbirth is essential to address the gap of knowledge. Delayed cord clamping should be practiced widely to improve the health outcomes of the newborn.

Highlights

Umbilical cord clamping is done to separate the newborn from the placenta and is a crucial step during the third stage of labour
Despite the available evidence that delayed umbilical cord clamping is more beneficial to infants, as well as the existence of 2014 World Health Organisation (WHO) recommendation that the umbilical cord should be clamped between 1 and 3 minutes, its implementation is still low in many countries including Tanzania
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

Summary

Introduction

Umbilical cord clamping is done to separate the newborn from the placenta and is a crucial step during the third stage of labour. The most recent WHO Guideline on delayed cord clamping (2014) recommends that, even when positive pressure ventilation is required, the cord should not be clamped earlier than 60 seconds in both term and preterm babies [1]. This is a change from the WHO Basic Newborn Resuscitation Guideline of 2012 which emphasized that early cord clamping is recommended when the neonate is asphyxiated and needs to be moved immediately for resuscitation [3, 4], and is otherwise contraindicated. 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.

Methods

Discussion

Conclusion