Abstract

Recent UK and international guidelines have advocated deferred clamping of the umbilical cord. The evidence of benefit for the neonate is robust, particularly for preterm infants at high risk of anaemia, interventricular haemorrhage and necrotising enterocolitis. Midwifery colleagues use the practise routinely but obstetricians, involved mostly in operative and surgical deliveries, have inconsistently adopted deferred cord clamping.

Triggered by inconsistent takeup at audit, an online survey was circulated to Consultants and trainees in obstetrics and gynaecology in the Wales Deanery (UK). Grounded theory was used to analyse the responses, including free text.

While 8% of respondents cited lack of knowledge of or disagreement with the practise, 87% of obstetricians and trainees admitted that as the surgical sequence involved in a delivery is automatic, they sometimes or often forgot to incorporate a delay before clamping. This automaticity is adaptive, arising from a need to reduce cognitive load during complex motor tasks.

Where visuospatial skills are sufficiently refined (task mastery), cognitive attentional skills are engaged only at key points. These are used as landmarks in expert sequences such as playing a musical instrument, using a gaming controller or surgery. During an abdominal delivery, clamping of the cord is unlikely to be a key landmark. This applies particularly for the experienced obstetrician in contrast to the novice.

The hypothesis that there would be an inverse relationship between the experience of the surgeon and the ease of incorporation of a new element to the operation was supported. Simple aide memoires facilitated incorporation of the new process, shown at reaudit.