Midwives and the Fetal Nuchal Cord: A Survey of Practices and Perceptions

Abstract

A systematic search of studies of intrapartum management of the nuchal umbilical cord at term found no published controlled studies in this area. A postal survey containing both structured and open questions and a request for local protocols and guidelines was sent to all 637 midwives in 7 maternity units in England. There were 401 (63%) responses. There appeared to be no unit guidelines for this area of practice. Midwife approaches to nuchal cord during birth varied, and included clamping and cutting of loose nuchal cords and a hands-off approach to tight nuchal cords. Reasons for specific actions included doing what had been taught during midwifery training and learning from previous personal experiences. Theories of diffusion of innovation and of planned behaviour may provide a conceptual basis for understanding the adoption of specific practices. Future qualitative and controlled studies are needed to explore the nature and consequences of varying approaches to intrapartum nuchal cord management.

Adoption of the Cattell–Horn–Carroll Model of Cognitive Abilities by Australian Psychologists

“…Gotham (2006) states that the process of changing systems to use more effective practices involves three stages: development of practices that are efficacious in controlled studies and effective in practice, dissemination of information about EBPs that allows them to be adopted by clinicians, and the implementation of EBPs into practice settings while maintaining their effectiveness. An empirically useful model for understanding the factors that promote or inhibit both the dissemination and implementation of EBPs is the DoI model (Rogers, 1962), which has been used in a variety of fields including consumer marketing and media (Thakur, Summey, & John, 2013;Williams & Gulati, 2013), technology (Aubert, Schroeder, & Grimaudo, 2012;Schiavone, 2012), and medicine (Emani et al, 2012;Jackson, Melvin, & Downe, 2007;Kelley, Hannans, Kreps, & Johnson, 2012;Peeters, de Veer, van der Hoek, & Francke, 2012). DoI theory encompasses a number of elements.…”

Nabelschnurumschlingung: Alltäglich und unreflektiert?

“…In der Umfrage von Jackson et al gab die Mehrheit der befragten Hebammen (88 %) an, bei einer lockeren NSU die NS über den kindlichen Kopf zu streifen [21]. Nur 4% nabeln vorzeitig ab, wobei 9 % der Hebammen angaben, nicht ins Geburtsgeschehen einzugreifen.…”

“…Dabei wird das Kind ohne Manipulation der NS mit dem Kopf dicht am Damm durch eine Saltobewegung entwickelt [22]. In einer anderen Untersuchung hingegen gaben nur 3.5 % aller Befragten an, dieses Manöver bei straffer NSU anzuwenden [21].…”

Clinical audit to enhance safe practice of skilled birth attendants for the fetus with nuchal cord: evidence from a refugee and migrant cohort

“…Approaches to nuchal cord practice result from what has been taught and learned from personal experience and from diffusion within the workplace [22]. Midwifery guidelines for management of nuchal cord are variable [11,16,23].…”

“…Midwifery guidelines for management of nuchal cord are variable [11,16,23]. UK midwives reported everything from clamping and cutting of loose nuchal cords to hands-off approach for tight nuchal cords [22]. American College of nurse-midwives reported that just over half ( 57%) would clamp and cut the cord when it was very tight, 40% selected the somersault manoeuvre [24] and only 3.2% would clamp and cut the cord in most circumstances where a nuchal cord was present [25].…”