Umbilical cord blood banking, donation and cord clamp timing: Exploring health professionals’ knowledge, attitudes and practice

Lisa Peberdy

doi:10.25907/00052

Background: Parents today have several options available to them for the management of their infant's umbilical cord blood during the third stage of labour. Parents can choose to have their infant's cord blood collected for private banking purposes for potential future use, collected for donation to a public cord blood bank or to allow full placental transfusion of cord blood to their baby. The timing of cord clamping after birth is controversial. Historically, at the time of birth usual practice had been early cord clamping (within one minute of birth), with umbilical cord blood discarded as a medical waste. Early cord clamping was recommended as part of a threestep process of active management of third stage labour to prevent postpartum haemorrhage (Hutchon, 2012). International guidelines now recommend deferring the timing of cord clamping after the birth of the infant for a minimum of one minute as a result of research surrounding the benefits to the infant associated with the timing of cord clamping at birth (World Health Organisation, 2014). The options of cord blood banking and cord blood donation require early cord clamping in order to collect a sufficient volume of blood for potential future therapeutic use (Armson, 2005; Downey & Bewley, 2012). Purpose: The purpose of this study was to first identify Australian health professionals' knowledge and attitudes towards placental transfusion, cord blood stem cell properties, cord clamp timing, cord blood banking and donation. The influence this had on their practice of informing parents of their third stage labour options of cord clamp timing and cord blood collection for private banking or public donation was investigated. Methods: The research design chosen for this study was an explanatory sequential mixed methods design using both quantitative and qualitative research methods to explore obstetricians and midwives' knowledge, attitudes and practices pertaining to third stage labour care options of cord clamp timing, cord blood banking and cord blood donation. Phase One of the study involved collection of quantitative data using a survey tool. Study participants included 129 midwives and obstetricians. Phase Two of the study involved semi-structured interviews with 14 midwives and obstetricians who participated in Phase One to gather qualitative data that explored and explained the quantitative survey data. Descriptive statistics were used to analyse the survey data and draw comparisons between the two professional groups. Thematic analysis was used for the qualitative data. Results: Participants were knowledgeable about the renewed international and national recommendations and guidelines promoting deferred cord clamping; however, the practice of actual deferred cord clamping was inconsistent and varied from two minutes post birth through to after cord pulsations had ceased. Participants were supportive of deferred cord clamping and promoting this aspect of third stage labour care to parents as best practice. Despite support for deferred cord clamping, participants reverted to early clamping in the case of compromised infants who required resuscitation. Participant knowledge of cord blood stem cell science and cord blood banking was low, with midwives reporting lower knowledge levels compared to obstetricians. As a result of low knowledge levels, attitudes towards this option were often conservative. Participants did not openly discuss the third stage labour option of cord blood banking and donation with parents as a result of limited knowledge of the option, instead referring them to do their own research. Despite lack of knowledge and perceived low value of cord blood banking, participants were keen for more evidence-based scientific information on this option. Participants had minimal exposure to cord blood donation, and correspondingly low knowledge levels. Despite minimal exposure and low knowledge levels, participants had more positive attitudes towards donation than private banking. Implications for Practice, Education and Research: Based on the findings presented in this thesis, several recommendations have been made for educators, researchers and clinicians to contribute significantly to the future development of maternity health professionals' education and practices pertaining to these third stage labour options, and the provision of parent-centred care and information sharing.

Umbilical cord blood banking, donation and cord clamp timing: Exploring health professionals’ knowledge, attitudes and practice

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