When babies are born, the umbilical cord has traditionally been clamped immediately. But NICE (National Institute for Health and Care Excellence) guidance issued in December 2015 recommends otherwise.
Dr James Harris, a senior midwife and a KIS postdoctoral research fellow says: ‘There is a lot of robust evidence to show that if you clamp the cord too early, the baby doesn’t get enough blood supply: some of the baby’s blood is still in the cord and placenta. Delaying clamping of the umbilical cord for at least one minute results in a balancing of the blood received by the baby, increases the amount of oxygen they receive at birth and leads to better outcomes for the baby.’
The NICE quality standard about intrapartum care [QS105] followed clinical guidelines published in 2014. Both the quality standard and the guideline say maternity professionals should wait for at least one minute after birth before clamping unless they are concerned about the integrity of the cord or the baby’s heartbeat. The guidelines say the cord should be clamped before five minutes (which enables maternity professionals to deliver a placenta with the help of the cord, though if a woman requests a completely natural delivery of the placenta, she should be supported in her choice).
CLAHRC South London has adopted a project by Dr James Harris investigating implementation of these guidelines. He is collecting data that will enable him to design and implement an intervention that encourages maternity professionals to routinely delay cord clamping.
He is also carrying out a review of the literature about the implementation of delayed cord clamping in other countries. In some parts of the USA and Europe, delayed cord clamping has been standard practice for a while, the research will find out the barriers and facilitators to implementation which have already been discovered, and any potential unintended consequences.
As part of the project, Dr Harris will survey heads of midwifery and obstetric clinical directors in maternity units across England to find out how NHS trusts decide which new NICE recommendations get implemented first. The research will include an audit of current practice on cord clamping in south London. As well as, interviews with professionals, women and their partners to develop an intervention to encourage maternity professionals to delay cord clamping.
The project is funded by a King’s Improvement Science postdoctoral fellowship and it will be completed in February 2019.