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Resuscitation and Delayed Cord Clamping; a reflection



I'd like to introduce Aster Purdey and her beautiful snuggly sling wrapped baby who I recently met at the RCM conference 2018. Aster is a second year midwifery student at the University of Cumbria, currently on maternity leave.  She is passionate about midwifery and feminism, with a specific interest in promoting physiological birth and home birth.


At the RCM our conversations led to resuscitation with an intact cord, we shared a fascination with physiology and how it makes sense to protect the newborn from the harms of immediate cord clamping at such a vulnerable time. Aster told me she'd written a reflection about it and I asked her if she'd share it with us... and she didn't disappoint. Thank you Aster xxx


 

This reflection is about delayed cord clamping (DCC) in infants who are born requiring resuscitation. Critical reflection is a useful technique to bridge the gap between theoretical knowledge and clinical practice (Horton-Deutsch and Sherwood, 2008), enabling students to broaden their understanding of a situation from different personal, empirical and ethical perspectives (Johns, 1995). 


The reflection is structured using Bower’s Reflective Model (2015) (See Appendix A). I chose this model because it is designed to encourage exploration of a topic from multiple perspectives (Bowers, 2015), which is fundamental to critical reflection (Hatton and Smith, 1995). I have adapted the model by removing the second and final questions as I did not feel it was relevant to this reflection.


What happened?


Images are for visual learning only and not related to the reflection

I was working on labour ward when a primiparous woman was transferred from maternity ward due to a concerning cardiotocography (CTG) trace. The decision was made by the obstetric registrar to perform a Grade 2 caesarean section and a paediatrician was requested to attend. At delivery there was thick meconium stained liquor present, and the neonate was born with reduced tone, centrally cyanosed and made no initial respiratory effort. The obstetrician clamped and cut the cord immediately at delivery and the baby was subsequently taken to the resuscitation area and given inflation breaths, followed by ventilation breaths and oxygen.  


Why is it important to analyse this event? 

DCC refers to the intentional delay between the birth of a baby and the clamping of the umbilical cord, the duration being for at least one minute or until the cord stops pulsating (Burleigh and Uwins, 2018; Katheria et al. 2018). Robust evidence indicates that DCC has multiple physiological benefits for healthy term and pre-term infants (Andersson, et al. 2011; Rabeet al. 2012; Mercer and Erikson-Owens, 2014; McDonald et al. 2013) (see Appendix B), whilst immediate cord clamping (ICC) is associated with the harmful effects of hypoxia, hypovolaemia, a sudden drop in cardiac output and anaemia (Bhatt et al. 2013, Rabe et al. 2012, McDonald et al. 2013). Considering these associated risks, it is important to develop knowledge concerning the physiological impact that ICC has on compromised infants (Wylie et al., 2015). This will better facilitate a process of informed choice for parents, which is equally important during obstetric emergencies as in other aspects of care (Treharne and Beattie, 2015).


Analysis of the event with supporting literature/research

The National Institute of