Barriers to deferred cord clamping in preterm infants

Abstract

Objectives: To describe the range of practices employed by units conducting deferred cord clamping at very preterm birth. Design: Qualitative study using semistructured interviews with neonatal doctors, nurses, midwives, obstetricians and managers in a sample of UK maternity units. Participants: 33 neonatal doctors, neonatal nurses, midwives, obstetricians and managers. Setting: UK maternity units in 2012. Results: Four key themes emerged. The first concerns the variation in guideline content, the absence of a practice of stabilisation with cord intact, and issues with implementing and maintaining changes in practice. The second concerns the challenges in assessing eligibility. The third concerns the competing priorities of delivering the intervention and proceeding with other stabilisation manoeuvres and the associated anxiety experienced by professionals. The final theme relates to the issue of uncertainty as to optimal treatment choices. Conclusions: The evidence surrounding deferred cord clamping in very preterm infants is unclear. This study describes the reported practice of units deferring cord clamping in 2012 and will inform trial development.