Evidence-Based Research and Delayed Cord Clamping: Implications for Cross-Cultural Education, Research, and Policy
Mary Ann Faucher, PhD, MPH, MS, BS, RN, CNM, FACNM
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- Eta Gamma
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Purpose: Conduct an educational capacity building research initiative for nurse midwives in India to improve iron status of newborns by delaying the clamping of the umbilical cord at birth. In India, iron deficiency affects nearly 80% of reproductive aged women and their offspring (Viveki 2012). Compared to immediate cord clamping, delayed cord clamping is a physiologic practice that also results in significantly enhanced serum levels of iron in newborns up to 6 months after birth (McDonald et al., 2013).
Methods: A two-part research design was implemented. Part 1 was quantitative utilizing a single group pre and post-test research design incorporating lecture and simulation. In Part 2, ten months after completion of Part 1, focus groups were conducted with the same group of nurse midwives about the benefits and barriers to implementation of delayed cord clamping.
Results: Significant improvement in knowledge, beliefs and the practice of delayed cord clamping were found comparing pre-test to post-test results both immediately after the intervention and at a 10-month follow-up visit. Simulation revealed important nuances of midwifery practice pertinent to the uptake of delayed cord clamping. Results from the focus groups illuminate perceived factors that affect midwife decision-making, areas of concern related to practice and perceived benefits of delayed cord clamping expressed by the nurse midwives.
Conclusions: One consequence of the medicalization of childbirth is immediate clamping of the umbilical cord at birth resulting in the newborn not receiving a significant amount of blood from the placenta that provides a substantial source of iron (McDonald et al., 2013). The upscaling of midwifery practice and education has been recommended as a strategy to improve maternal and infant outcomes around the world including in India, to address both the qualifications of midwives and the escalating rates of cesarean birth (Renfrew et al., 2014). Findings from this study have implications for cross cultural education with nurse midwives, research design, policy, , and keys to sustainability of evidence base-practice in this setting.
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nursing educational research;
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