A descriptive study of umbilical cord clamping practices by midwives, obstetricians and other medical staff in Zambia

Publication Type:
Thesis
Issue Date:
2022
Full metadata record
𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱 Delayed cord clamping, defined as clamping of the umbilical cord at 1 to 3 minutes after birth, has benefits, plays a vital role in improving haematological outcomes in infants and may reduce the lifetime risk of anaemia. The World Health Organization recommends delayed cord clamping. Implementation of this recommendation and diffusion of delayed cord clamping into clinical practice in Zambia is unknown. 𝗔𝗶𝗺 The purpose of this thesis was to explore umbilical cord clamping practices by midwives, obstetricians and other maternity care workers working in Zambia. 𝗠𝗲𝘁𝗵𝗼𝗱 An explanatory sequential mixed method study was conducted with three phases. Phase 1 used an online survey to explore the cord clamping practices by midwives, obstetricians and other maternity care workers across Zambia. Phase 2 collected and analysed guidelines that informed cord clamping practices from 100 birth units across Zambia. Phase 3 was a qualitative study with midwives and key informants from the Ministry of Health using semi-structured interviews. The qualitative data were analysed using the Theoretical Domain Framework. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀 In the survey, delayed cord clamping was reported to be practised in term healthy newborn babies by 40% of the 239 survey respondents. Half the respondents (51%) said they did not have guidelines to inform cord-clamping practice. In Phase 2, seven different guidelines were analysed. Of these, three provided information on delayed cord clamping while the other four emphasised immediate cord clamping. In Phase 3, the motivation to delayed cord-clamping practice by midwives was because of the identified benefits for babies. Key informants from the Ministry of Health identified the benefits that come with delayed cord clamping as the reason for its implementation. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻 Delayed cord clamping was identified as a challenge especially with few guidelines and a lack of dissemination. Immediate cord clamping was still prevalent. In order to bring about change, adopters need information to make an informed decision to embrace the new practice. There is a need for a national guideline on delayed cord clamping, which should be developed and disseminated through information sharing. Informal and formal information sharing about delayed cord clamping by prior adopters may result in practice change. 𝗜𝗺𝗽𝗹𝗶𝗰𝗮𝘁𝗶𝗼𝗻 𝗳𝗼𝗿 𝗽𝗿𝗮𝗰𝘁𝗶𝗰𝗲 The insights from this study will formulate strategies to increase the diffusion of delayed cord clamping in birth units across Zambia. A national guideline on delayed cord clamping, education and dissemination through education may result in change in birth units.
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