Wanting the Best for Newborns: Umbilical Cord Clamping Practices of Midwives in Aotearoa/New Zealand
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Delayed clamping of the umbilical cord at birth has been demonstrated to enhance a new-born's physiological transition from intrauterine to extra-uterine life with significant benefits at birth extending into the first year of their life (Mercer, 2001). These benefits include increased blood volume for organ perfusion; increased red blood cell count providing iron; and increased haematopoietic stem cells to support on-going well-being (Hutton & Hassan, 2007). Timing of the decision to clamp the umbilical cord is frequently the domain of the midwife and two research studies have specifically identified midwives cord clamping practices relating these to neonatal transitional physiology (Airey, Farrar, & Duley, 2008; Mercer, Nelson, & Skovgaard, 2000). Cord clamping practices of midwives in New Zealand have not been specifically identified and it is not known what influences their practice. The aim of this research project was to identify and describe the umbilical cord clamping practices of midwives working in New Zealand including the rationale for their practice and any influences upon it. A quantitative and non-experimental survey method was used to collect the data. Midwives were asked to identify their rationale for the timing of cord clamping in specific birthing situations. An anonymous randomised sample of 400 midwives from the New Zealand College of Midwifes membership were invited to complete a postal questionnaire in 2008. A 64% return rate was achieved and the data was analysed using the Statistical Package for the Social Sciences (SPSS). Three significant findings were identified in the results. These were related to the perspectives of safety emerging from differing birth philosophies, incomplete understanding of intra-partum foetal hypoxia and neonatal transitional physiology, and the influence of the birth environment on cord clamping when newborn resuscitation was required. Practices varied due to a lack of consistent evidence to support practice and also an incomplete understanding of available evidence. Recommendations from this study include the need for further education for midwives about neonatal transitional physiology, accurate information for parents and modification of the birth environment to enable resuscitation of the newborn with an intact umbilical cord.
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