• practice change;
  • provider change;
  • medical decision making;
  • evidence-based care;
  • nurse–midwifery;
  • improving maternity care

Paper Presentation

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  2. Paper Presentation


To explore the experiences of maternity care professionals (midwives and physicians) who changed a practice to one with more scientific support. For the purpose of having the providers share a common phenomenon, the change from early to delayed cord clamping was chosen.


This qualitative study was conducted using a constructivist, grounded theory approach.


Participants were interviewed by phone. Practice settings ranged from home birth to freestanding and in-hospital birth centers to the hospital, which was the most common setting with eight of the 17 subjects providing care there.


The sample was made up of 17 providers (12 midwives and five physicians) from throughout the United States. Participants were in active clinical practice or had been within the past 3 years. They practiced early cord clamping for at least 6 months, changed to delayed cord clamping, and then practiced that for at least 6 months.


Participant interviews were recorded with permission and then transcribed. Coding and data management was conducted using ATLAS.ti Version6.1. The study was approved by the Institutional Review Board of George Washington University with multiple steps taken to protect the participants during analysis.


Five emergent themes acting as drivers of change included trusting colleagues, believing the evidence, honoring mothers and families, knowing with personal certainty, and protecting the integrity of the mother and the baby. Three domains of influence developed from the background of the stories of change: personal, professional, and institutional. From the findings, the Evolution to Provider Change Model was developed.

Conclusion/Implications for Nursing Practice

In maternity care, a number of current practices are not evidence based while many of those that are supported by evidence remain underutilized. Studies investigating efforts to incorporate evidence into practice reveal that at the organizational level, many initiatives are unsuccessful. Research into provider change at the level of the individual has been sparse in all medical fields.

This study provides new understanding about how individual maternity care professionals change practice. A new theoretical model is proposed that may be used in future nursing research on improving practice. Focusing on individual versus group change and on learning from those who have successfully changed practice toward more evidence-based care offers fertile ground for further study.