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Cord-care practice in Scotland.

J Ireland1, A M Rennie, V Hundley

  • 1Dugald Baird Centre for Research on Women's Health, University of Aberdeen, Aberdeen Maternity Hospital, Cornhill Road, Aberdeen AB25 2ZL, UK.

Midwifery
|September 6, 2000
PubMed
Summary

Most NHS units in Scotland lack a written umbilical-cord stump care policy, with significant variation in practice and rationale. This inconsistency causes confusion for practitioners and patients, highlighting a need for evidence-based guidelines.

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Area of Science:

  • Maternal and Child Health
  • Nursing Practice
  • Healthcare Policy

Background:

  • Umbilical-cord stump care is a fundamental aspect of neonatal care.
  • Variations in clinical practice can impact patient outcomes and practitioner confidence.
  • Evidence-based guidelines are crucial for standardizing care.

Purpose of the Study:

  • To investigate the current policies, practices, and underlying rationale for umbilical-cord stump care within NHS Scotland.
  • To identify variations in cord care approaches across different healthcare settings.
  • To assess the basis of existing cord care policies, particularly the role of research.

Main Methods:

  • A two-stage postal questionnaire survey was administered to Heads of Midwifery/Senior Midwives and frontline maternity staff (midwives, enrolled nurses, nursery nurses).

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  • The study targeted NHS units in Scotland providing intrapartum care, categorizing them by delivery volume (small: <=1000; large: >1000 deliveries/year).
  • Data collected included the existence and rationale of cord-care policies and common practices.

    • Main Results:

    • Approximately half of the surveyed units reported having a written umbilical-cord stump care policy.
    • Large units were significantly more likely (four times) to have a written policy compared to small units.
    • The most common practice reported was minimal intervention (observing the cord and cleaning only if soiled), with research cited as the basis for policies in less than half of cases.

    Conclusions:

    • A minority of NHS units in Scotland have a formal written policy for umbilical-cord stump care, with smaller units being less likely to do so.
    • Considerable diversity exists in policies, practices, and their rationale, leading to practitioner anxiety and potential patient confusion.
    • There is a clear need for the midwifery profession to address the lack of evidence, conduct further research on cord healing and infection, and develop standardized, evidence-based care practices.