Timing of umbilical cord clamping: experiences and perceptions of nurse-midwives`and obstetricians`at temeke regional referral hospital, Dar es salaam, Tanzania

Abstract

Background: Umbilical cord clamping is a crucial step during the third stage of labour that is done to separate the newborn from the placenta. The timing of umbilical cord clamping is still a controversial across the world. Despite the available evidence that delayed umbilical cord clamping is more beneficial to infants and the existence of the WHO recommendation since 2014, its implementation is still low in many countries. In Tanzania little is known about the experiences, perceptions and factors influencing the practice regarding the timing of umbilical cord clamping. Broad objective: This study aimed at exploring the experiences and perceptions of nurse-midwives` and obstetricians` regarding the timing of umbilical cord clamping at Temeke Regional Referral Hospital. Methods: An exploratory qualitative research design was employed, involving one focus group discussion with ten nurse-midwives. Nine (9) in-depth interviews with six nurse-midwives and three obstetricians were conducted. Participants were recruited purposely. Discussion and interviews guides were used to collect data. The recorded interviews were transcribed and thematic analytical framework guided analysis of data. Results: Three themes illustrating the experiences of nurse-midwives and obstetricians emerged from the analysis. These were clamping the umbilical cord within 60 seconds, clamping the umbilical cord after cessation of cord pulsation and depending of the baby`s condition. The perceived benefits of delayed cord clamping were oxygenation, increased blood volume and haemoglobin level, bonding and nutrients and perceived risks were blood overload and infection transmission. Having good knowledge, adequate skilled human and non human resources and availability of guidelines and SOPs were factors described to enhance application of evidence on umbilical cord clamping. Conclusion: Despite that most of participants had experience of immediate umbilical cord clamping, nurse-midwives and obstetricians perceived that a delay of umbilical cord clamping has a potential benefit of oxygenation to the newborn requiring resuscitation. We recommend continuous and sustainable on-job training, allocation of adequate skilled human and non human resources and regular supervision as strategies to enhance application of evidence.