Publication: Clinical audit to enhance safe practice of skilled birth attendants for the fetus with nuchal cord: evidence from a refugee and migrant cohort
Issued Date
2014
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Language
eng
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Mahidol University
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BioMed Central
Bibliographic Citation
BMC Pregnancy and Childbirth. Vol.14, (2014), 76
Suggested Citation
Megan Parr, Dabu, Colley Paw, Wai, Nan San, Say, Paw Si, Ma Ner, Tun, Nay Win, Aye Min, Gilder, Mary Ellen, Nosten, François H, Rose McGready Clinical audit to enhance safe practice of skilled birth attendants for the fetus with nuchal cord: evidence from a refugee and migrant cohort. BMC Pregnancy and Childbirth. Vol.14, (2014), 76. Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/3226
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Title
Clinical audit to enhance safe practice of skilled birth attendants for the fetus with nuchal cord: evidence from a refugee and migrant cohort
Abstract
Background: Current evidence for optimal management of fetal nuchal cord detected after the head has birthed
supports techniques that avoid ligation of the umbilical cord circulation. Routine audit found frequent unsafe
management of nuchal cord by skilled birth attendants (SBAs) in migrant and refugee birth centres on the
Thai-Burmese border.
Method: The audit cycle was used to enhance safe practice by SBA for the fetus with nuchal cord. In the three
birth centres the action phase of the audit cycle was initially carried out by the doctor responsible for the site. Six
months later a registered midwife, present six days per week for three months in one birth facility, encouraged
SBAs to facilitate birth with an intact umbilical circulation for nuchal cord. Rates of cord ligation before birth were
recorded over a 24 month period (1-July-2011 to 30-June-2013) and in-depth interviews and a knowledge survey of
the SBAs took place three months after the registered midwife departure.
Results: The proportion of births with nuchal cord ligation declined significantly over the four six monthly quarters
from 15.9% (178/1123) before the action phase of the audit cycle; to 11.1% (107/966) during the action phase of
the audit cycle with the doctors; to 2.4% (28/1182) with the registered midwife; to 0.9% (9/999) from three to nine
months after the departure of the registered midwife, (p < 0.001, linear trend). Significant improvements in safe
practice were observed at all three SMRU birth facilities. Knowledge of fetal nuchal cord amongst SBAs was
sub-optimal and associated with fear and worry despite improved practice. The support of a registered midwife
increased confidence of SBAs.
Conclusion: The audit cycle and registered midwife interprofessional learning for SBAs led to a significant
improvement in safe practice for the fetus with nuchal cord. The authors would encourage this type of learning in
organizations with birth facilities on the Thai-Burmese border and in other similar resource limited settings with
SBAs.