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

Authors

  • Hilary Jackson BSc, ADM, RM, RGN,

    Corresponding author
    1. Hilary Jackson, BSc (Hons), ADM, RM, RGN, holds the post of Midwife Matron in East Lancashire Hospitals NHS Trust in Burnley, England. She is a member of the North West Clinical Midwives Research Group.
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  • Cathie Melvin BA, MA, RM,

    1. Cathie Melvin, BA (Hons), MA, RM, is the Midwifery Research Coordinator for East Lancashire Hospitals NHS Trust, covering two hospital sites at Blackburn and Burnley in England. She is a member of the North West Clinical Midwives Research Group.
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  • Soo Downe BA, RM, MSc, PhD

    1. Soo Downe, BA (Hons), RM, MSc, PhD, is the Professor of Midwifery Studies at the University of Central Lancashire (UCLan) in England. She directs the Midwifery Studies Research Unit at UCLan, and she chairs the North West Clinical Midwives Research Group.
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Hilary Jackson, Midwife Matron, Women's Health Unit, Burnley General Hospital, Casterton Avenue, Burnley, Lancashire, BB10 2PQ, England. E-mail: hilary.jackson@elht.nhs.uk

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.

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