Towards designing an intervention to encourage uptake of delayed cord clamping – a qualitative data synthesis and clinical audit

BackgroundMany international bodies have recognised the health and cost benefits of delayed cord clamping for term newborns. A recent Quality Statement published by the UK’s National Institute of Health and Care and... [ view full abstract ]

Background

Many international bodies have recognised the health and cost benefits of delayed cord clamping for term newborns. A recent Quality Statement published by the UK’s National Institute of Health and Care and Excellence (NICE) encourages a 60 second delay before cord clamping. Immediate cord clamping has previously been normal practice for midwives and obstetricians in the UK. Current practice, and any barriers to change, are currently unknown.

Purpose/Objective:

• To identify the barriers and enablers for maternity healthcare professionals in delaying the clamping of the umbilical cord
• To conduct a clinical audit of current practice across three large teaching hospitals to identify what, if any, practice requires change

Method:

Qualitative synthesis- a search strategy of 95 terms was applied to seven databases. Data were synthesised via Framework Synthesis, using both a deductive (items from the Theoretical Domains Framework, (TDF)) and inductive approach (thematic analysis).

Audit– a prospective audit was conducted across three different clinical sites in London. Timings of cord clamping were audited alongside contextual factors such as lead professional, perceived fetal distress, and mode of delivery

Key Findings:

Eight studies fitting the inclusion criteria were synthesised. Three domains - ‘knowledge’, ‘beliefs about consequences’ and ‘social influence’ influenced behaviour, while ‘professional identity’ was facilitative and ‘environmental context’ was a barrier.

One-hundred-and-seven cases were audited. Of these 36% (n=39) met the NICE quality standard of delaying cord clamping. There were significant differences in adherence to the standard based on professional group (χ² (1,N=107)= 8.33, p<0.05). No other contextual factors provided significant differences.

Discussion:

The work presented here demonstrates that uptake of the guideline remains low, and that specific behavioural domains many encourage uptake. Due to the potential health and cost benefits of delayed cord clamping, a programme of research into the design and implementation of a theoretically-informed, complex-intervention to encourage health professional behaviour change is required.