School of Nursing Poster Presentations

Title

Because it Belongs to the Baby: Practice and Cultural Beliefs on Umbilical Cord Management in Haiti

Document Type

Poster

Keywords

Haiti; umbilical cord cutting; anemia; maternal and child health

Publication Date

4-2017

Abstract

Studies show that waiting to clamp and cut the umbilical cord at birth is associated with multiple benefits for the infant. Early cord clamping (clamping as soon as the baby is born) has been shown to double the risk of infant anemia. Delayed cord clamping (DCC) provides as much as a 60% increase in iron rich red blood cells. For preterm newborns, DCC decreases the incidence of necrotizing enterocolitis, intracranial hemorrhage and the need for blood transfusion. Research conducted in low resource settings has demonstrated magnified benefits with delayed clamping when the mother herself is anemic.

Iron deficiency anemia in the first year of life is a significant health issue, because adequate iron stores are essential for growth and brain myelination. Infant anemia has been associated with long term neurocognitive deficits for as much as 25 years into adulthood, even when treated. DCC is an effective preventative strategy to support normal newborn development.

In Haiti, 63% of infants between 6 and 11 months are anemic. In addition, over 60% of women are anemic and maternal anemia is a significant risk factor for infant anemia. The maternity care system in Haiti is complex. Only 36% of births in Haiti occur in an institution. Skilled attendants are present at just 15% of rural births and 47% of urban births. A wide variety of care providers assist at births including traditional birth attendants (matrons), nurses (infirmière), direct entry midwives (auxiliaire sage femme), nurse-midwives (infirmière-sage femme), and a small number of physicians. Little is known about umbilical cord care and the perspectives of birth attendants in Haiti. Given the high incidence of maternal and infant anemia and the potential for long-term deficit effects, a better understanding is warranted.

Student and faculty researchers from the GW School of Nursing conducted a descriptive mixed methods study of Haitian maternity care providers regarding their umbilical cord practices and cultural beliefs. Semi-structured interviews were conducted with a convenience sample of fifty matrons, nurses, infirmières, auxiliaire sage femmes, infirmière-sage femmes, and physicians. The study was approved by the GW IRB.

Many care providers in Haiti knew about DCC. Although some believed that the baby would “bleed out” into the mother if the cord was not cut immediately, others adhered to traditional “ways of knowing” that had been passed down from previous generations. According to the latter providers, delayed clamping is important as it provides needed blood to the infant.

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Creative Commons License
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To be presented at GW Annual Research Days 2017.

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Because it Belongs to the Baby: Practice and Cultural Beliefs on Umbilical Cord Management in Haiti

Studies show that waiting to clamp and cut the umbilical cord at birth is associated with multiple benefits for the infant. Early cord clamping (clamping as soon as the baby is born) has been shown to double the risk of infant anemia. Delayed cord clamping (DCC) provides as much as a 60% increase in iron rich red blood cells. For preterm newborns, DCC decreases the incidence of necrotizing enterocolitis, intracranial hemorrhage and the need for blood transfusion. Research conducted in low resource settings has demonstrated magnified benefits with delayed clamping when the mother herself is anemic.

Iron deficiency anemia in the first year of life is a significant health issue, because adequate iron stores are essential for growth and brain myelination. Infant anemia has been associated with long term neurocognitive deficits for as much as 25 years into adulthood, even when treated. DCC is an effective preventative strategy to support normal newborn development.

In Haiti, 63% of infants between 6 and 11 months are anemic. In addition, over 60% of women are anemic and maternal anemia is a significant risk factor for infant anemia. The maternity care system in Haiti is complex. Only 36% of births in Haiti occur in an institution. Skilled attendants are present at just 15% of rural births and 47% of urban births. A wide variety of care providers assist at births including traditional birth attendants (matrons), nurses (infirmière), direct entry midwives (auxiliaire sage femme), nurse-midwives (infirmière-sage femme), and a small number of physicians. Little is known about umbilical cord care and the perspectives of birth attendants in Haiti. Given the high incidence of maternal and infant anemia and the potential for long-term deficit effects, a better understanding is warranted.

Student and faculty researchers from the GW School of Nursing conducted a descriptive mixed methods study of Haitian maternity care providers regarding their umbilical cord practices and cultural beliefs. Semi-structured interviews were conducted with a convenience sample of fifty matrons, nurses, infirmières, auxiliaire sage femmes, infirmière-sage femmes, and physicians. The study was approved by the GW IRB.

Many care providers in Haiti knew about DCC. Although some believed that the baby would “bleed out” into the mother if the cord was not cut immediately, others adhered to traditional “ways of knowing” that had been passed down from previous generations. According to the latter providers, delayed clamping is important as it provides needed blood to the infant.